Depressive Disorders

Question 1

Normal reaction to loss; loss of something, someone, pet; loss mean very diff things and loss can be very hard for someone else; process often to grief; not stages went through with grief and get over in 6 weeks; chunk heart goes with them and hole in heart; not mean cannot go on and productive life but have watch for potential for moving into depression; grief comes in waves; may be months/years - something reminds of loss (sorrow of loss) and feeling right there; potential in grieving process go to depression which will stop in tracks from doing what need to do - becomes a prob esp if gone on for sig amount of time; not resolved high potential to progress into depression; need watch for this
Often happens when experience loss; watch for not go on and one and develop into major depression

Answer 1

Grief:

Question 2

Abnormal reaction to loss; got stuck in grieving process where not functioning

Answer 2

Major Depression:

Question 3

Depression is the oldest and one of the most frequently diagnosed psychiatric illnesses - common cold of psychiatry - is on a spectrum; all can relate with someone who is depressed; oldest and most frequently diagnosed
How do you feel when with a depressed person?
What is the difference between transference vs countertransference?
Pathological depression occurs when adaptation is ineffective
***Mood vs Affect??
Depression is an alteration in mood that is expressed by feelings of sadness, despair, and pessimism

Answer 3

Intro

Question 4

Same emotions feel when with someone with major depression magnify that for them significantly is how they feel: hopelessness, frustration, anger
You feel depressed
Wears you out and brings you down; drain your energy
Helpless
Individual in major depression/depression feeling frustrated, hopeless, angry, irritated
Need have self awareness - some people tell suck it up - lead with that and someone not able to message to person is not care or understand; impacts relationships and objectivity
Culture influences it
Messages in head - should (should be able to get up and go) - if cannot - start to say not bad person and drives deeper into - self talk; meet where are in depression - goal: help get through it but also help what works best for them; find out and talk to them

Answer 4

How do you feel when with a depressed person?

Question 5

Transference - remind me of someone know; +/-; influences interaction; HCP reminds pat of someone; transference of emotion from person to HCP
Countertransference - pat reminds HCP of someone; react to person based on emotion
Factor when giving care - impact of care if +/- reaction

Answer 5

What is the difference between transference vs countertransference?

Question 6

Mood - inner feelings may have; depressed feeling, etc
Affect - how outwardly display mood; expressed
Do mental status exam - part head to toe and one first parts do; major parts is this
See if congruency; listen what telling you and look how expressing it and see how expressing that
If see incongruence respond in mood vs affect - use observation and stop talking - great therapeutic technique is making observations
Mental status - first thing do on any assessment

Answer 6

***Mood vs Affect??

Question 7

Gender Prevalence
Marital Status
Seasonality:

Answer 7

Epidemiology - depression

Question 8

Depression is more prevalent in women than in men…or do they seek treatment more often?? So stat thrown off
More prevalent in woman than men but are woman seeking treatment than men - not mean not depressed; children and adolescents get depressed

Answer 8

Gender Prevalence

Question 9

Single and divorced people are more likely to experience depression than married persons or persons with a close interpersonal relationship (differences occur in various age groups)
All about connection - interpersonal relationships - not mean married - but someone who has connection with - if have one support person helps

Answer 9

Marital Status

Question 10

seasonal Affective disorders are more prevalent in the spring and in the fall (seasons are changing) - very real - more in spring and fall - seasons where things are changing
Get lights to help

Answer 10

Seasonality:

Question 11

Many
Biological Theories
Physiological Influences - predisposing
Cognitive theory

Answer 11

Predisposing factors to depression

Question 12

Genetics
Biochemical influences

Answer 12

Biological Theories

Question 13

Hereditary factor may be involved. - some factors in fam

Answer 13

Genetics

Question 14

Deficiency of norepinephrine, serotonin, and dopamine has been implicated
Antidepressants hit on these big neurotransmitters - norepinephrine, serotonin, and dopamine (3 key neurotransmitters most meds hit on)
Most mental illnesses coming from; look at neurotransmitters

Answer 14

Biochemical influences

Question 15

Many things cause depression
Medication side effects - suicide ideation (increased risk suicide); cause depression
Neurological disorders - physiological conditions
Electrolyte disturbances - physiological conditions
Hormonal disorders - physiological conditions
Cardiac probs and surgery - increased risk for depression
Nutritional deficiencies - what feed body; very imp
Other physiological conditions
Variety causes depression; antidepressants: suicial ideation

Answer 15

Physiological Influences - predisposing

Question 16

Very active
View depression as more cognitive than affective situation
Views primary disturbance in depression as cognitive rather than affective - hwo people thinking- distort things and - in expectations in enviornment, future, self; very - thinking
Change stinking thinking and - thoughts and help them reframe thinking
Three cognitive distortions that serve as the basis for depression: - negative voices and what telling self
Turn thinking around to + message giving self
Major depression - hoplessness/helplessness felt

Answer 16

Cognitive theory

Question 17

Negative expectations of the environment
Negative expectations of the self
Negative expectations of the future
hopelessness/helplessness

Answer 17

Three cognitive distortions that serve as the basis for depression: - negative voices and what telling self

Question 18

Major Depressive Disorder (According to DSM-5)
Persistent Depressive Disorder (aka Dysthymia)

Answer 18

Types of depressive disorders

Question 19

Depression that drags down
Characterized by depressed mood
Loss of interest or pleasure in usual activities - lost interest in things that usually enjoy/give pleasure
Symptoms have been present for at least 2-3 weeks - look at whole sum what going on; not just days
No history of manic behavior - if have manic get into bipolar disorder
Cannot be attributed to use of substances or another medical condition - other outside cause
Factors that have meet to get diagnosed
Stops people in tracks and often seek out treatment/encouraged to do so
Not functioning; day to day life not enjoyable
Completely drop in mood
Major Depression Symptoms

Answer 19

Major Depressive Disorder (According to DSM-5)

Question 20

Affective: feelings of total despair, feelings of worthlessness, flat affect - blunt affect - best story and same voice and no facial expression change; monotone
Everything slows down - curl down; getting out of bed is hard; ADLs is hard; feeling helplessness and hopelessness
Whole body slows down: Physically slows down - constipation; thinking and movements slows down; - thinking
Behavioral: psychomotor retardation, curled-up position, absence of communication
Cognitive: irrelevant delusional thinking with delusions of persecution and somatic delusions, confusion, suicidal thoughts; thinking slows down
Physiological: a general slow-down of the entire body

Answer 20

Major Depression Symptoms

Question 21

Chronically down in dumps
Sad or described as “down in the dumps”
No evidence of psychotic symptoms - below baseline of when feel good
Essential feature is a chronically depressed mood for:
Treated outpat

Answer 21

Persistent Depressive Disorder (aka Dysthymia)

Question 22

depressed mood Most of the day
depressed mood More days than not
For at least 2 years/longer

Answer 22

Essential feature is a chronically depressed mood for:

Question 23

Below - for at least year or two
Not diagnosed a lot but is there; esp in inpat

Answer 23

For at least 2 years/longer

Question 24

Never used to think kids be depressed
May present differently than adults; not know depressed/down; cannot tell feeling down; beyond what is normal developmental - not lot expressiveness
Manifest depression variety ways

Answer 24

Childhood Depression

Question 25

severe recurrent temper outbursts-aggression more than 12 months
DX-not made before age 6 or after 18
NOTE: This is only diagnosed between ages 6-18
Diagnosis New to DSM-5; seen at crit for kids; severe temper outbursts and aggression going on for 1+ yr/for a sig period time; only in window made; SEVERE; blow up instantly

Answer 25

Disruptive Mood Dysregulation

Question 26

Anger, aggressiveness
Running away
Skipping school
Delinquency
Social withdrawal
Sexual acting out
Substance abuse
Restlessness, apathy
may/Not present depression in same way as an adult
Present with behavior changes - not go out anymore
Change in behavior - pay attention and what is going on - something going on that precipitated that change in behavior

Answer 26

Symptoms include: - ADOLESCENCE

Question 27

A visible manifestation of behavioral change that lasts for several weeks - look for changes last for awhile and are diff and behavior is diff; tell parents to watch for this and adolescents

Answer 27

Best clue that differentiates depression from normal, stormy adolescent behavior:

Question 28

Perception of abandonment by parents or close peer relationships - feeling people left them/abadoned them and that is how felt

Answer 28

Most common precipitant to adolescent suicide:

Question 29

take it serious and not ignore it that just talking; one time don’t one time too late

Answer 29

Kids and preadolescents are suicidal -

Question 30

Supportive psychosocial intervention - one to one/grps
Antidepressant medication
Sim to what do with adults

Answer 30

Treatment with: - adolescents

Question 31

All antidepressants carry an FDA black-box warning for increased risk of suicidality in children and adolescents. - All antidepressants carry black-box warning - suicide ideations in children and adolescants

Answer 31

NOTES

Question 32

Senescence
Treatment
High rate of suicide in older pop - loss job, phys func, people; set up for depression and suicide ideation or die by suicide; increase identifying depression and suice in older adults and dying by suicide esp for older males
Potentially med
Talking about loss - lots of them

Answer 32

Older adult

Question 33

Bereavement overload
High percentage of suicides among elderly
watch - Symptoms of depression often confused with symptoms of neurocognitive disorder (Alzheimers - mean depression huge underlying factor - presented differently between middle age adults)

Answer 33

Senescence

Question 34

Antidepressant medication
Electroconvulsive therapy - also for younger adults
Psychosocial therapies

Answer 34

Treatment

Question 35

Risk for suicide related to:
Suicide is issue in society
SEX: More males - More males die by suicide - females make attempts and are catching up
Age (18-30—Over 65) - 18-30 critical age - high; over 80 really high rate; increase with suicide with COVID
Depression
***Previous Attempt - made previous attempt risk factor goes up; higher risk for future suicide
Ethanol Abuse - alcohol abuse/other substance abuse - using risk for attempt/die by suicide increases
Loss of Rational Thinking - part is this; not thinking rationally
Social Supports Lacking - key indicator; start to withdraw/feel abandoned
**Review SAD PERSONS (Text on page 368) - great for risk factors
**Organized Plan/Availability of plan/means - thinking killing/harming self - Organized plan - specific plan and means - very duable and if have plan; organized and plan and carry out risk factor goes up; risk factor goes up
No Spouse - No connection with someone
Chronic Illness
All increase risk for suicide

Answer 35

Suicidal risk

Question 36

Depressed mood - Issue for someone depressed; have to assess for if are depressed; ask if planning to harm self - need comfy when asking that question
Feelings of worthlessness
Anger turned inward on the self - feel angry
Misinterpretations of reality
**high percent of those who talk about suicide attempt within 6 months - Belief Talking about just trying to get attention but cannot assume - take suicidal ideations seriously to find out seriousness and what risk level
Those who have one or more chronic illness - lots probs; med noncompliance - about this: tired taking meds or feeling better; lot issues need deal with; constantly with issues wears on you and not know if want live with it anymore
Anyone risk for suicidal ideation; major depression increased risk because negativity and negative self talk; must assess for that

Answer 36

Risk for suicide related to:

Question 37

Committed suicide vs died by suicide - committed crime; died by sounds sadder; terminology changed in how discuss it
Verbal clues thinking about suicide: telling you, act diff, highly emotional statements, something happened take care would you take care of dog/kids - easier to recognize; want kill self; better off if wasn’t around; not worth anything
Nonverbal: isolating, self-care down, change in self-care/behavior, giving away possessions, risk activities/behaviors - not care/worried what happens
Consider whole pic
Watch when the depression lifts: more energy - risk for suicide: so tired cannot leave head to get off bed; get through treatment: on antipsychotic (take 2-4 weeks for affect) and treatment - then mood feel better and more energy - then attempt or die by it; think doing better; critical that ask if feel that way and ask that question
Suicides often occur 2-3 mo. After the beginning of improvement
In depression and more energy and been suicidal ask that question - potentially make attempt

Answer 37

Clues

Question 38

Close Observation/check when least expected - know routine and when paying less attention
Let them know they are safe - do everything can to keep them safe
Remove dangerous objects - if actively suicdal
Be alert to clues - not ignore; discuss it with them; follow-up and ask questions
Develop Safety Plan - helps; promise start feeling going act on thoughts and plan come and talk to someone and verbal - either commit or not and tells how closely watch them; effective; newer treatments; verbal contract - feel suicidal call someone and let someone know - lot be honest; if cannot high risk
Find out reason behind behavior so not become angry with them; become detective on with them
One-to-one: never leave the pat; within arms length and able touch them at atll times - try make it as least invasive; eyeball them at all times; remove dangerous objects; room search

Answer 38

Nursing care

Question 39

An individual experienced the death of a parent two years ago. This individual has not been able to work since the death, cannot look at any of the parent’s belongings, and cries daily for hours at a time. Which nursing diagnosis most accurately describes this individual’s problem?
A. Post trauma syndrome R/T parent’s death
B. Anxiety (severe) R/T parent’s death
C. Coping, ineffective, R/T parent’s death
D. Grieving, complicated, R/T parent’s death

Answer 39

Answer: D
2 years after death - gotten complicated: gone on for 2 years where not functioning
The excessive reactions the individual continues to exhibit such as daily crying, the inability to return to work, and the inability to look at parent’s belongings after a two-year period, are indicative of dysfunctional or complicated grieving. This individual’s grieving response has arrested in the anger stage, is being turned inward on the self, and is manifested by symptoms of depression

Question 40

Nursing interventions are aimed at:
Come up with negatives a lot; put up blocks and not want act like bragging but give permission that tell what like about self - helps self esteem
Develop trust and rapport: ask what like; ask about them; do what say going to do - best way develop trust; let know and explain it; common ground
Assistance in confronting anger that has been turned inward on the self - identify if have anger and what doing with it
Ensuring that needs related to nutrition, elimination, activity, rest, and personal hygiene are met; Ensure safety - eating and sleeping, personal hygiene - help with nutrition, sleep, hygiene and all are met
** Consider Secondary Gains - can have factor in people’s healing and getting better, progressing; in hospital bill collector cannot find you/go after you; not worry about laundry/go to grocery store; not progressing way hope to; may be reason and block coming on; may need to refrain how approaching; can be issue for all of us esp when ill and starts when kids: stay home, all attention, eat anything; something benefited by illness; happen any age; adults - not worry about dishes, meals, not have worry about bill collectors getting to you - factor in someone healing; talk about fears that will lose something with secondary gains - imp consider when someone not progressing

Answer 40

planning/implementation: working with someone who is depressed with suicidal ideation

Question 41

Maintaining client safety - safety is key; lead with this
Assisting client through grief process * if grieving.. - get out of process and function; helping through grieving process if are
Promoting increase in self-esteem - get them to identify their good qualities; verbalize their positives - Helping that person to do; so simple but effective; identify 3 things like about self - hard to do this - help focus on + have; when struggling with that start it for them
Encouraging client self-control and control over life situation ** help identify realistic goals
Helping client to reach out for spiritual support of choice

Answer 41

Nursing interventions are aimed at:

Question 42

Will know they are working through the grief when can see realistic elements of the lost person or object - getting to other side when look at whatever lost and be realistic about it; if can chuckle and see how really were (goods and bads) - starting get through other side
Keep someone safe; in grieving process -help them so can get out on other side and func; getting through cloud and bubble is able look at thing and person lost and humour about it start get through it

Answer 42

Assisting client through grief process * if grieving.. - get out of process and function; helping through grieving process if are

Question 43

Has experienced no physical harm to self is goal - safety
Discusses the loss with staff and family members - talking to someone; feelings/emotions
No longer idealizes or obsesses about the lost entity
Sets realistic goals for self
Attempts new activities without fear of failure
Is able to identify aspects of self-control over life situation
Expresses personal satisfaction and feel support from at least one person/spiritual practices - starting have personal satisfaction and identify people who are support
Interacts willingly and appropriately with others
Is able to maintain reality orientation
Is able to concentrate, reason, and solve problems on own
No harm to self is goal
Discuss losses
Help be realistic in what set
Able concentrate; do what need to do in life
Get out of bed is huge win - takes so much energy and so diff - doing those things hopefully come out of cloud and bubble - can func

Answer 43

Criteria for measuring outcomes: - The Client:

Question 44

Be aware of fam/primary support people around client and edu they need - need know about s/s of disorder, risk factors of suicide, watch for
Management of the Illness
Medication management
Assertive techniques
Stress-management techniques - teach client but also need teach fam/support people
**Journaling (really effective), teach stoppage of negative thoughts (simple technique and works)
Ways to increase self-esteem - identify 3 things like about self; help identify ways to do this
Electroconvulsive therapy - not front-line measure of treatment; for some indivs only thing works for them; can be very helpful but not first thing go to as treatment; not for all; option; works for some; tried everything else and in depths of depression ECT may help; pulls out deep depression where suicidal and not functioning
Imp Deal with fam/support indivs so reinforce how imp take the meds
Teach assertive and therapeutic techniques - no why questions; more I statements than you

Answer 44

client/fam edu

Question 45

Suicide and crisis lifeline number: 988 - chat line, text line, hotline - very successful
Suicide second leading cause death people 10-34; COVID increased rates
Many support groups
legal/financial assistance - give resources

Answer 45

Support services

Question 46

Has self-harm to the client been avoided? - not harmed self
Have suicidal ideations subsided? - Not completely gone but subsiding and not as often/severe
Does the client know where to seek assistance outside the hospital when suicidal thoughts occur? - ask/seek out help when have feelings want to harm self
Has the client discussed the recent loss with the staff and family members? - how feeling about recent loss
Does client set realistic goals for self?
Go Back and see if achieved these
Need have realistic goal
Is the client able to verbalize positive aspects about self, past? accomplishments, and future prospects? - sounds simple but not easy but need brag about self sometimes
Can the client identify areas of life situation over which he or she has control? - find out if have control over life

Answer 46

Nursing process: eval

Question 47

Individual Psychotherapy - one to one
Group Therapy - very helpful
Family Therapy - very helpful
Cognitive Therapy - turning stinking around
Electroconvulsive Therapy (ECT) - more outpat
Transcranial magnetic Stimulation (TMS) - TMS is a recent treatment option; fairly new treatment; less invasive than ECT; outpat basis; not sedated; put magnetic coil that positioned lightly on head; finding fairly good results for people; sim to ECT and sometimes do series treatment; some success

Answer 47

Treatment modalities

Question 48

Antianxieties
Antidepressants
Watch for hoarding - 1000 - 3000 mg. can be lethal; not get dependent but if suicidal watch for hoarding; make sure not cheeking
7-14 days for impact
anticholinergic effects - all psych effects; dry mouth, eyes dry, constipation, urinary retention; everything slows down
Serotonin syndrome
MAOI
Adverse effects: Remember effects take 7-14 days
Tricyclics: Sedation, increased appetite anticholinergic effects, HA, postural hypotension

Answer 48

Psychopharm: Antidepressants

Question 49

Benzo - addictive; fairly fast acting; PRN situation; can be ongoing; synergistic with alcohol
Nonbenzo - not addictive; not act as fast; given over long period time

Answer 49

Antianxieties

Question 50

Sev classifications
Not addictive but can be in smaller doses be lethal; 1000-3000 mg is lethal - watch for hoarding and taking all at once
Not act as fast
2-4 weeks to feel effects; imp tell pat
3 diff classifications
Change in med let know; try find out what being told to pat
Tricyclics (TCAs):
Serotonin Selected Reuptake Inhibitor(SSRI):
MAO inhibitors: (MAOI)
Serotonin Norepinephrine Reuptake Inhibitor (SNRI):
**Antidepressants came into being in the 1950’s
**Be consistent in giving meds—pts./fams pick up on inconsistencies —especially if have sxs. of paranoia - something diff amount med/changes color - need be consistent and find out what others told indiv/fams because will stop taking it

Answer 50

Antidepressants

Question 51

Original antidepressants; sedation - very tired, increased appetite = increased weight, anticholinergic effects, HA, postural hypotension - dizzy if up too fast, dry mouth and increased weight stop taking it; Vs tricyclics - is drowsiness - give med at night

Answer 51

Tricyclics (TCAs):

Question 52

target specific neurotransmitters: common antidepressants that target serotonin; used more often; less side effects than TCAs

Answer 52

Serotonin Selected Reuptake Inhibitor(SSRI):

Question 53

rare that given because contraindicated with lot other things; Counter-indicated with many drugs and foods; not first line drug; only given if tried other drugs/treatments and not working; effective for depression

Answer 53

MAO inhibitors: (MAOI) -

Question 54

target serotonin and norepinephrine uptake

Answer 54

Serotonin Norepinephrine Reuptake Inhibitor (SNRI):

Question 55

can happen; SSRIs that do impact serotonin; get build up of serotonin and have AE; not mean getting ill if on SSRI - may have syndrome and may need get off or decrease dose because build up serotonin and buildup of AE; not happen often; if take newer SSRI
High Fever (common), eye twitching (common), muscle contractions (common)
Most commonly AE occur with SSRIs and SNRIs:
Most commonly occur with MAOIs:

Answer 55

Serotonin syndrome

Question 56

Insomnia, agitation, headache, weight loss, sexual dysfunction (decreased libido)
Insomnia - keep up - pretty common - give med in morning

Answer 56

Most commonly AE occur with SSRIs and SNRIs:

Question 57

Antidepressant - MAOIs
Hypertensive crisis
Potentially fatal reactions with all other antidepressants, carbamazepine, buspirone, sympathomimetics, tryptophan, dextromethorphan, CNS depressants, and amphetamines (avoid use within 2 weeks of each other)

Answer 57

Most commonly occur with MAOIs:

Question 58

Watch meds take; foods take; big classification food: tyromine food free diet (processed foods): pepporini, baloney, yogurt, red wine, cheeses; interacts with other antidepressants, prescribed drugs, OTC - MAOIs which works with norepi and meds gives shot norepi causes BP high really fast - HTN crisis - watch what eat and check HCP; rush norepi and BP sky high - crisis quickly; not prescribed unless classification really helps person - rare; not given often because so restrictive and AE

Answer 58

MAOI

Question 59

A 45-year-old woman with recurrent depression with no medication (left). Same patient treated with medication (right). The entire brain, particularly the left prefrontal cortex, is more active after recovery. Depression with meds and no meds; med does have impact on brain

Answer 59

Positron-emission tomography (PET) scan:

Question 60

When teaching about the tricyclic group of antidepressant medications, which information should the nurse include?
A. Strong or aged cheese should not be eaten while taking this group of medications.
B. The full therapeutic potential of tricyclics may not be reached for four weeks.
C. Long-term use may result in physical dependence.
D. Tricyclics should not be given with antianxiety agents.

Answer 60

Answer: B
Original
Give antianxiety 20-30 feel some relief; teach with antidepressant take 2-4 weeks; if not realize this no change and no longer take it
A client needs to be advised that it may take several weeks for tricyclic medications to reach their full therapeutic effect and for relief of symptoms to be noted

Question 61

Therapeutic effect may not be seen for as long as 4 weeks - understand take awhile for antidepressants to take effect
Do not discontinue use of the drug abruptly - up slowly and down slowly; almost psychotic-like symptoms if off abruptly
Avoid smoking and drinking alcohol - not always possibility
Be aware of risks of taking antidepressants during pregnancy
Teach fam same thing - Imp point to not discontinue drug abruptly - can have psychotic effects if on for awhile and go off abruptly - gradually up and down with dosage

Answer 61

client/fam edu related to antidepressants

Question 62

A client has been diagnosed with major depression. The psychiatrist prescribes paroxetine (Paxil). Which of the following medication information should the nurse include in discharge teaching?
A. Do not eat chocolate while taking this medication.
B. The medication may cause priapism (prolonged erection).
C. The medication should not be discontinued abruptly.
D. The medication may cause photosensitivity.

Answer 62

Answer: C
Chocolate/processed food: more related to MAOIs; red wine esp
Antidepressants such as paroxetine must be tapered and not stopped abruptly. All classifications of antidepressants have varying potentials to cause discontinuation syndromes. Abrupt withdrawal from SSRIs, such as paroxetine, may result in dizziness, lethargy, headache, and nausea

Question 63

Not take lightly; not first line of treatment but is helpful
So clinical now; muscle relaxants involved; can tell by monitors of seizures
Originally used for people with Schizophrenia. - found helped with severe depression and bipolar
Now most commonly used in severe depression
Induction of grand mal seizure by application of electrical current to the brain
Usually 6-12 txs. 3X/week - Do early in morning and up moving around by breakfast
Treat as Surgical Procedure
Treatment is short
Very impactful; effective for some; not first go to
Outpat
Side Effects: Confusion, memory loss (usually lose fogginess and memory comes back - may have some permanent loss), H.A., Nausea
Also for people epilepsy and seizures and clear after seizure
Not first line of treatment; sometimes life saver; depression - just want to be out of world; done everything in meds and ECT works - not first line treamtent; grand mal seizure induced but everything clinical and cannot tell unless on monitor
Sometimes experience more confusion but goes away
Memory loss - risk for this that may have permanent loss - most people not just initial treatment
HA and nausea - part because anesthesia

Answer 63

ECT

Question 64

Need Consent - Put under
Address the fear of patient and family - Hear electric shock so worried/frightened; give people ability to talk about it and provide edu; talk to pat, fam, caregiver about what to expect
NPO/ empty bladder/remove jewelry - Remove partial plates and dentures
Vital Signs
Post TX.

Answer 64

Treat as Surgical Procedure

Question 65

Monitor Vitals Signs
Usually respond 10-15 minutes
May need some orientation - have some confusion; grogginess away in 10-15 min and up and around

Answer 65

Post TX.

Question 66

Not want discount
Need ask
Find out how cope in past - may work now
HCP should not be working harder than pat on why should live
Put back on them and stop talking

Answer 66

Think fit to live and worthless and better off if dead