Major Depressive Disorder Flashcards
What is a nurse’s top priority when caring for a patient with major depressive disorder?
Individuals with depression have a high risk for suicide
Why is depression so difficult to diagnose and recognize in patients older than 65 years old?
Differentiate between early dementia and depression
What are some common contributors to someone being diagnosed with major depressive disorder?
Stressful life events, medical illness, woman’s postpartum periods, poor social network, substance abuse, being unmarried, trauma occurring early in life
What are the most common medications that are linked to depression?
Digoxin, Beta-blockers, PPI & H2 blockers
If a patient is taking a medication that affects their serotonin levels, what is most likely to be affected?
Mood, sexual behavior, sleep cycles, hunger, and pain perception
If a patient is taking medication that modifies their norepinephrine, what is most likely going to change about them?
attention and behavior
What are the parameters that allow a patient to be diagnosed with major depressive disorder?
A single episode or recurrent episodes of depression resulting in a significant change in a client’s normal functioning accompanied by at least 5 clinical findings. Must also occur almost every day for a minimum of 2 weeks and last most of the day
What are some common symptoms that are found in patients with major depressive disorder?
Anhedonia, Fatigue, sleep disturbances, changes in appetite (weight increase/decrease of more than 5% of total body weight over 1 month), feelings of hopelessness or worthlessness, persistent thoughts of death or suicide, inability to concentrate or make decisions, change in physical activity.
What are the expected findings of someone with MDD?
Somatic reports, slowed speech, delayed response, 5 A’s, anxiety, sluggishness, change in eating patterns/constipation, decreased libido, poor grooming, social isolation
What are some common clinical findings that are indicative of major depressive disorder?
Suicidality, interest loss, guilty feelings, energy changes, concentration difficulties, appetite changes, psychomotor changes, sleep disturbances
What are the parameters for a patient with Persistent Depressive Disorder (Dysthymia)
Chronically depressed mood that lasts >2 years, reports of at least 3 clinical findingsless severe symptoms than MDD
When does PDD typically occur and how does the duration differ between adults and children?
Early onset, such as in childhood or adolescence lasts 2 years for adults and 1 year in children
How many clinical findings of depression is required to diagnose PDD?
Contains at least 3 clinical findings of depression and can later lead to MDD
A patient is said to have premenstrual dysphoric D/O, what clinical findings indicates that this patient has this disorder?
Severe depression and irritability in the week or two before menstruation
What is the most commonly used screen tool when assessing patients with MDD?
Colombia Suicide Rating Scale
What are the questions that are asked in the Colombia Suicide Rating Scale?
- Have you wished you were dead or wished you could go to sleep and not wake up?
- Have you actually had any thoughts of killing yourself?
- Have you been thinking about how you might kill yourself?
- Have you had these thoughts and had some intention of acting on them?
- Have you started to work out or worked out the details of how to kill yourself? Do you intend to carry out this plan?
- Have you ever done anything, started to do anything, or prepared to do anything to end your life? (If YES, ask How long ago did you do any of these?)
What is the nurse’s priority in treating a patient with MDD
Risk for suicide - safety is always the highest priority
If a patient is at risk for committing suicide, what is the nurse’s priority?
Implement 1:1 observation for patients at risk for suicide
A nurse is assigning a patient that had a very high risk for suicide, what parameters should this nurse follow when assigning the patient to a room?
DO NOT assign a private room. Place the patient in the room close to the nurse’s station. With a room-mate. DO NOT allow patient any of their personal belongings and they should be monitored when using the restroom
What are some of the most commonly used SSRI’s?
Citalopram, Escitalopram, Fluoxetine, Flucoxamine, Paroxetine, Sertraline
What are the most common SE associated with SSRI’s?
nausea, weight gain, nervousness, HA, constipation, CNS stimulation, sexual dysfunction, diaphoresis
What are some manifestations of serotonin syndrome?
Labile BP, mental confusion, agitation, fever, hallucinations, incoordination
If a patient were to abruptly stop their antidepressants, what would happen to them?
Discontinuation syndrome: pins and needles, flu-like symptoms, zapper like s/s
What are the most commonly used SNRI’s?
Venlafaxine (Effexor), and Duloxetine (Cymbalta), Desvenlafaxine, Levomilnaciprain
What is the main nursing assessment for a patient taking SNRI’s?
Monitor blood pressure, especially at higher doses and with a history of hypertension… discontinuation syndrome
What are some commonly used TCA’s?
Amitriptyline, Amoxapine, Clomipramine, Despiramine, Doxepin, Imipramine, Maprotiline, Nortriptyline, Trimipramine
If a patient is taking TCA’s, what side effects should the nurse be wary of?
orthostatic hypotension and anticholinergic effects: urinary retention, constipation, dry mouth, blurred vision
What anticholinergic effect requires immediate medical intervention?
Urinary retention and severe constipation warrant immediate medical attention
What are the most commonly used MAOI’s?
Phenelzine, Tranyclopromine, Isocarboxazid, Selegiline
What unique effect do MAOI’s have that SSRI’s and SNRI’s don’t?
Increase dopamine, epinephrine, and serotonin
If a patient is taking an MAOI, what are the side effects that a nurse should keep an eye out for?
SE: dizziness, ORTHOSTATIC HYPOTENSION, constipation, dry moutn, and HYPERTENSIVE CRISIS
If a patient is prescribed a MAOI, what are some contraindications that would cause the nurse to withhold this medication?
MAOI’s interact with many meds: OTC cold meds and other SSRI’s (for 2 to 5 weeks before starting an MAOI) HYPERTENSIVE CRISIS
What foods should be avoided if a patient is taking a MAOI? What can eating this type of food lead to?
TYRAMINE RICH FOODS: avocados, figs, fermented/smoked meats, liver, cured fish, aged cheese, beer/wine, protein dietary supplements, bananas, chocolate. Can cause hypertensive crisis
What are some of the most commonly used atypical antidepressants?
Buproprion (Wellbutrin), Mirtazapine (remeron), Nefazodone (Serzone), and Trazadone (Desyrel)
A patient is being treated with Bupropion for their depression. What are some contraindications for bupropion?
Be careful in people with history of seizure disorder, head trauma, and eating disorders (bupropion is a weight reducing drug)
If a patient is taking an SSRI, they are unable to take St. John’s Wort because of what contraindication?
Fatale Serotonin Syndrome can occur if St. John’s wort is taken with SSRI’s
When would a patient be qualified to undergo ECT therapy?
Use for patients who have depressive disorder and are unresponsive to other treatments
What medications would be administered to a patient undergoing ECT therapy?
Atropine or Robinul (anticholinergic), propofol (anesthetic agent), and Succinylcholine Anectine (Neuromuscular blocking agent)
What are the prerequisites that a nurse must confirm are completed before a patient can undergo ECT therapy?
Consent forms completed, keep patient NPO for at least 4 hours (at midnight), anticonvulsants discontinued prior, ask patient to void and remove contact lenses, jewlery, hairpins, and dentures prior to treatment, assess EEG and EKG continously
What is the post-operative care that a nurse would perform on a patient that has just undergone ECT therapy?
Lateral recumbant position, orient to time, place, and situration, offer food, and offer medication for headache
What are the Kubler-Ross Five stages of Grief?
- Denial - rejection of reality 2. Anger - short temper, blaming others 3. Bargaining - negotiation that occurs as the individual seeks control over the situation 4. Depression - sadness, fatigue, anhedonia 5. Acceptance - acknowledgement of loss (or impending loss)
What are Worden’s Four tasks of mourning?
TEAR: Task 1 to accept the reality of the loss - accepting, task II - experience the pain of the loss and express it without judgement - coping, Task III - adjust to the new reality without the loss - changing environment, Task IV - re-establisha and re-invest in emotional ties - moving forward
A nurse is teaching a newly licensed nurse about the use of electroconvulsive therapy (ECT) for the treatment of MDD. Which of the following statements by the newly licensed nurse indicates understanding?
“ECT is effective for clients who are non-responsive to pharmacological interventions.”
A client diagnosed with MDD is being considered for ECT. Which client teaching should the nurse prioritize?
Discuss with the client and family expected short-term memory loss
Which symptoms would the nurse expect to assess in a client experiencing serotonin syndrome?
Confusion, restless, tachycardia, labile BP, and diaphoresis
The patient is taking an MAOI. Which will the nurse teach the patient to avoid?
cheese
A client has been taking bupropion for more than 1 year. The client has been in a car accident with loss of consciousness and is brought to the ED. For which reason would the nurse question the continued use of this medication?
The client is at risk for seizures from a potential closed head injury
A nurse is prpoviding teaching to a client who has new prescription for amitriptyline. Which of the following statements by the client indicates an understanding of the teaching?
I may experience inability to urinate and constipation when taking this medication
A nurse is assessing a client who has major depressive disorder. The nurse should identify which of the following client statements as an overt comment about suicide? SATA
My family will be better off if I’m dead, I wish my life was over, If I kill myself then my problems will go away
A nurse is caring for a client who states, “I plan to commit suicide.” Which of the following assessments should the nurse identify as the priority?
Lethality of the method and availability of means
A nurse is caring for a client who has end-stage lung cancer. Which of the following client statements should the nurse identify as an indication that the client is experiencing the bargaining stage of Kubler-Ross stages of grief?
I would give anything to live to see my grandchild born
A school nurse is providing care to a student who is angry and states, “My parents don’t know I’m gay so I can’t visit my girlfriend in the hospital while she receives cancer treatment.” Which of the following forms of grief id the client experiencing?
Disenfranchised Grief
Aside from the Colombia Rating Scale, what are some commonly used screening tools for those with MDD?
Hamilton, Geriatric, and Zung Self-rating depression scale. Patient Health Questionaire-9 and SAD PERSONS Scale
