Depression Flashcards
What disorder is characterized by sad, despondent mood, or loss of interest in usual activities?
Depression
Common comorbidities to depression are:
- -anxiety
- -psychotic disorders (schizophrenia)
- -eating disorders
- -personality disorders
- -substance abuse
RF for depression are…
- -abuse
- -neglect
- -poverty
- -withdrawn (lonely)
- -hormones (female)
- -traumatic event (loss, divorce)
- -dysfunctional family relationship
- -hx. mental illness/substance abuse (alcoholics, bipolar)
- -Neurotransmitter deficiency
- -secondary to medical illness
What two neurotransmitter deficiencies play a role in depression?
- -serotonin
- -norepinephrine
What does serotonin do/control in the body?
- -mood
- -sexual behavior
- -sleep cycles
- -hunger
- -pain
What does Norepinephrine do/control in the body?
- -attention
- -behavior
What are some ways to help prevent depression?
- -early detection and tx.
- -exercise
- -proper diet
- -rest
- -meditation
- -painting/coloring books/word games
- -no drugs, alcohol
- -therapy (seek help if notice change in mood)
What depressive disorder is associated with single/recurrent episodes of unipolar depression with a significant change in the clients normal function?
Major Depressive Disorder (MDD)
To be diagnosed with MDD; How many clinical findings must the patient have and for how long?
- -at least 5 findings
- -occur almost everyday for a minimum of 2 weeks
What are the signs and symptoms of MDD?
- -sadness
- -hopelessness
- -somatic complaints (pain, stomachaches)
- -anhedonia
- -lack energy
- -loss of appetite (abnormal eating patterns)
- -anxiety attacks
- -sleep issues
- -stress
- -psychomotor retardation
- -feelings of guilt, worthlessness, and self blame
What is anhedonia?
no pleasure in normal activities
What is insomnia?
trouble falling/staying asleep
What is middle insomnia?
trouble falling asleep then waking up in the middle of the night
What is terminal insomnia?
Trouble falling asleep, then waking up very early
What is hypersomnia?
excessive sleep/drowsiness
When is the client at greatest risk for suicide in MDD?
the first few weeks
This disorder is a dysthmic disorder and tends to be chronic. The symptoms are less severe than MDD and usually occurs in childhood, adolescence, and early adulthood.
Persistent depressive disorder (PDD)
-To be diagnosed with PDD that patient must have symptoms for how long in adults? children?
- -2 years in adults
- -1 year children
A patient with PDD may have a period of relief lasting less than…
2 months
What depressive disorder is associated with the time of year?
Seasonal affective disorder (SAD) relates to the season
What common season is SAD seen in patients?
Winter (cold, gloomy, less daylight)
What is the first line of treatment with someone that has SAD?
Light therapy (natural light)
What does light therapy inhibit?
nocturnal secretion of melatonin
When a patient does light therapy they need to expose their face to…
how long?
- -10,000 lux light box
- -30 min/day
This drug is an atypical depressant that can be prescribed to prevent major depressive episodes.
Bupropion
Bupropion should not be given to clients at risk for…
seizures
What things would a nurse look for during a physical assessment of a patient with depression?
- -look sad?
- -poor grooming/hygiene?
- -slow movement/slumped posture
- -agitated? (pacing, tapping fingers, restless)
- -too tired to speak?
- -interacting?
What black box warning do antidepressants come with?
Risk for suicidal thoughts/actions (especially in young population)
What must the patient not do when taking antidepressants?
stop abruptly (must slowly dc)
Because the physician does not know how the pt. will react to the antidepressants, what dose will be therapeutic, or if they cause adverse effects the clients meds will be done by…
trial and error
What type of drug is the leading tx. for depression?
SSRI’s
What are some SSRI meds that may be given to a pt. with depression?
- -citalopram
- -fluoxetine
- -setraline
If a patient is taking an SSRI, they should not take what herbal supplement?
- **St. Johns wort
- -ginkgo
The nurse should educate the patient about SSRI’s. The pt. should follow a…
healthy diet and exercise (weight can occur with long term use)
The nurse should monitor for what syndrome when taking SSRI’s?
Serotonin syndrome (too much nerve cell activity)
- SNRI’s can also be given with depression. Two examples are:
- Caution if clients has a history of…
- -Venlafaxine, duloxetine
- -HTN
An example of a tricyclic antidepressant is…
amitriptyline
To minimize anticholinergic effects when taking amitriptyline advise the patient they can…
- -chew sugarless gum
- -increase fiber
- -increase fluids
An example of a monoamine oxidase inhibitors is…
–Phenelzine
A patient taking phenelzine is at risk for hypertensive crisis and should avoid foods with…
Tyramine (avocados, figs, smoked meat, liver)
This type of therapy helps manage specific symptoms and promote coping skills.
Psychotherapy ( + thinking, helpful patterns of thinking/behavior)
This type of therapy is the most effective approach to depression. It focuses on skill training and problem solving to help reorient patterns of negative thinking/behaviors.
Cognitive behavioral therapy
This type of therapy was commonly used long ago but, it is not really used anymore. It passes electric current through brain to induce tonic clonic seizures.
Electroconvulsive therapy (ECT) “shock therapy”
some complimentary and alternative methods to help with depression are:
- -exercise (reduce anxiety)
- -Vitamin B12 (low B12 linked to depression)
- -Omega 3 fatty acids
- -Acupuncture (pain relief couple with SSRI for increased benefit)
- The nurses main focus is…
- Assess for risk of ___, implement appropriate precautions.
- If prior hx. of suicide DO NOT…
- -SAFETY
- -suicide
- -leave pt. alone
If a patient expresses suicidal ideations the nurse must…
report it (confidentiality does not apply)
A suicide risk assessment questions will include..
- -Thoughts of self harm?
- -How often?
- -Intent/plan?
The patient should meet functional needs such as…
- -nutrition
- -daily hygiene
- -adequate sleep
when assessing for legal/illegal drug use the nurse must use…
matter of fact questions
If a toddler is suspected of having depression they may show a sign of…
regression (toileting)
Preschoolers may show signs of depression by…
- -self destructive type play
- -whine
- -irritable
School aged children may show signs of depression by…
- -poor academic performance
- -somatic complaints (headache, tummy pain)
Older kids may show signs of depression by…
- -talk about running away
- -boredom
- -low self esteem
Adolescents may show depression by…
- -reduced social contact
- -poor academic performance
- -not participating in activities
- -poor self care
- -violent
Adolescents are at a higher risk for…
suicide
What nurse should the test perform on the child to rule out comorbidities contributing to a child’s depression?
–hearing and vision screening
Three nursing dx. for depression are:
- -Risk for self directed violence
- -Situational low self esteem/chronic low self esteem
- -ineffective health maintenance
- when a nurse is implementing care for a client with depression, the nurse must make sure the patient maintains….
- the nurse should instill…
- -self confidence
- -instill hope
The nurse must assess her own feelings/mood. What is the nurse at risk for when caring for a patient with depression?
–emotional contagion
It is good to recognize a patients accomplishments but the nurse should refrain from using…
–flattery or excessive praise
The nurse should be accepting of the clients negative feelings. What should she set a time limit on when talking to the pt.?
talking about past failures
The nurse should teach this technique to boost the patients confidence and improve communication skills.
Assertiveness Techniques
Discharge planning begins…
with first contact
What is an expected outcome of a patient with depression?
- -remain free from injury
- -able to describe hopelessness
- -Client is able to resume normal activity patterns (work, school)
Pharm and non-pharm treatment for MAD is:
- -SSRI’s
- -TCA’s
- -Atypical depressants
- -ECT (if not responding to other methods)
- -CBT
Pharm and non-pharm treatment for SAD is:
- -Bupropion
- -light therapy
- -CBT
Pharm and non-pharm treatment for Adjustment disorder with depressed mood is:
- -improve sleep
- -short term sedative
- -CBT
- -Family therapy
- -Massage therapy
- -antidepressants
Adjustment disorder develops within how many months of stressor?
3 months
Pharm and non-pharm treatment for PDD is:
- -SSRI’s
- -TCA’s
- -atypical antidepressants
- -ECT (if other methods don’t work)
- -CBT
What should the nurse consider when caring for an older adult with signs of depression?
- -ask about meds taking (can cause depression)
- -use geriatric depression scale
- -assess cognition
What are 3 nursing diagnosis for an older adult with depression?
- -risk for injury
- low self esteem
- -ineffective health maintenance
what is the nurses goal when caring for a patient with depression?
- -safety
- -improve self esteem
- -engage in social activities
- -comply with tx. regimen
