Exam 1 Flashcards
What is depression?
constantly in state of unhappiness
single episode or recurrent episodes
How is depression diagnosed?
- 5 specific clinical findings
- occurs everyday
- minimum of 2 weeks
What are the two types of depression?
major depressive disorder
persistent depressive disorder
What are the symptoms of major depressive disorder?
SIG E CAPS
Suicidal thoughts
Interest lost
Guilt
Energy decreased
Concentration diminished
Appetite changes
Psychomotor retardation (slow mvmt)
Sleep disturbance (insomnia/hypersomnia)
What are the symptoms of persistent depressive disorder?
PAILED
Pessimistic thinking
Able to function, but not optimal
Irritable
Low self-esteem
Eating excessively/not enough
Daytime fatigue
How will a nurse assess a patient who has depression?
physical exam
recognize symptoms
depression scale
Hx of depression
support systems
cultural factors
How is the memory of someone with depression?
bad memory retention
What is the suicide and homicide assessment?
ask:
- thoughts of harms?
- do you have a plan?
- can you carry it out?
homicide: thoughts to harm others?
What disorders can mimic depression?
vitamin D deficiency
hypothyroidism
What is the patient health questionnaire-9 (PHQ-9)?
screening tool to help refer pt somewhere else for further evaluation
What is the acute phase of depression?
tx is 6-12 weeks
goal: reduction of symptoms
What is the continuation phase of depression?
tx is 4-9 months
goal: prevent relapse w/ edu, meds, therapy, psychotherapy
What is the maintenance phase of depression?
can last years
goal: prevent future episodes
What is the outcome for someone with depression?
safety is priority
pt will:
- identify 3 coping mechanisms
- name 2 ppl of support
- gain 5 lbs
- sleep 6-8 hrs/night
What will a nurse do during the implementation stage for someone with depression?
- therapeutic silence
- support pt
- ensure adequate food, sleep, ADLs, elimination needs
- family education
- check pt often (suicide precaution)
- med education
- teach self-care strategies
What are interdisciplinary treatments for depression?
milieu therapy
psychotherapy (CBT- 1st line of tx)
mindfulness-based cognitive therapy (type of CBT)
group therapy (pts support each other)
What are alternative therapies for depression?
light therapy (seasonal depression)
St. John’s wort
What are examples of brain stimulation therapies?
electroconvulsive therapy
vagus nerve stimulation
transcranial magnetic stimulation
deep brain stimulation
What is electroconvulsive therapy used for? Why?
major depressive disorder
schizophrenia
acute mania
last option if all RXs don’t work
Is a patient sedated during electroconvulsive therapy?
yes
What is the side effect of electroconvulsive therapy? Who should not do it?
memory loss
dont: cardio problems or stroke
Which brain stimulation therapy is the most invasive?
vagus nerve stimulation
Which brain stimulation is safer than electroconvulsive therapy?
transcranial magnetic stimulation
What is deep brain stimulation used for?
parkinson’s
chronic pain
depression
OCD
What will a nurse do in the evaluation stage for a pt with depression?
absence of suicidal thoughts
improvement in appetite, bowel functioning, and sleep
ability to do ADLs
What is the difference between anxiety and fear?
anxiety:
- source of threat is unknown
- feeling of apprehension
fear:
- reaction to a specific danger
What are the three types of anxiety?
normal anxiety
acute anxiety
pathological anxiety
What is normal anxiety?
motivation to complete tasks
What is acute anxiety?
triggered by acute stressor
What is pathological anxiety?
intense response that is dramatic, anxiety is still present even after threat
What are the levels of anxiety?
mild
moderate
severe
panic
Describe mild anxiety
perceptual field: sharp
ability to learn: good
physical characteristics:
- restlessness
- mild irritability
- finger biting
Describe moderate anxiety
perceptual field: narrowed (selective attention)
ability to learn: altered, but possible
physical characteristics:
- pounding heart
- increased RR/HR
- somatic symptoms
Describe severe anxiety
perceptual field: can’t see or hear much
- overly focused on superficial details
ability to learn: unable
- therapeutic communication won’t work
physical characteristics:
- automatic behavior
- severe somatic symptoms
- hyperventilation
- sense of dread
Describe panic anxiety
psychotic form of anxiety
perceptual field: unable to process
ability to learn: unable
characteristics:
- erratic/impulsive
- hallucinations
- pass out
- dissociate
- freeze
As anxiety goes up,
cognition goes down
What are panic disorders?
panic attacks
anticipatory anxiety
What are the characteristics of panic attacks?
recurrent and unexpected
lasts 1-30 minutes
no trigger
sudden onset of fear
What are phobias?
persistent and irrational fear of a object, activity, or situation
What is social anxiety disorder?
provoked by exposure to a social situation or performance situation
What is agoraphobia?
fear of being in places or situation where:
- help might not be available
- escape might be difficult or embarrassing
What is generalized anxiety disorder?
excessive anxiety and worry about a number of events
What is obsessive compulsive disorder?
uncontrollable thoughts of ritualistic behaviors
What are defense mechanisms?
used to reduce anxiety
protect from painful awareness
adaptive vs maladaptive
What will the nurse do during the assessment process for anxiety?
check symptoms of anxiety
physical exam
assess for self-harm/suicide
psychosocial assessment
cultural beliefs
What are the expected outcomes for anxiety?
demonstrate coping skills
demonstrate ability to perform tasks
desensitize self to feared objects
decrease time spent in ritualistic behaviors
What will a nurse implement for someone with anxiety?
encourage them to be involved in care
therapeutic communication
supportive counseling
health education
milieu therapy
provide community resources
What are interdisciplinary treatments for anxiety?
psychotherapy
acceptance and commitment therapy
meditation
mindfulness
What is done during the evaluation process for anxiety?
decreased symptoms?
learn behaviors to manage anxiety?
can recognize symptoms?
self-care?
