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S3 1538 > S3 M11 Mood & Affect > Flashcards

S3 M11 Mood & Affect Flashcards

1
Q

Postpartum depression and baby

A

Effects connection between mom and baby
seen by week 6

a consistent behavior of not wanting to care for child

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2
Q

baby blues

A

hormone drop

80% of moms
after first 2-3 days
resolves by day 10

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3
Q

Postpartum depression can lead to

A

a permanent depressive disorder

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4
Q

Postpartum wellcheckups are important to prevent

A

Postpartum psychosis

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5
Q

Depression and being excited for tomorrow

A

indicator of suicide

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6
Q

MAOI food contradiction

A

Cheese
Wind/beer
Soy sauce
Pickles (tyramine)

Drastic ^ in BP

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7
Q

All antidepressants have the greatest risk of suicide at

A

2 weeks

ON TEST

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8
Q

DO NOT GIVE Tricyclic antidepressants with MOAIs =

A

Serotonin syndrome

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9
Q

Most common anticonvulsant meds instead of lithium

A

Depakote
Topamax

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10
Q

Extrapyramidal side effects

A

acute dystonia
pseudoparkinsonism?
Tardiva dyskinesia?
Akathisia?

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11
Q

Causes for post partum depression

A

Hormone imbalance - Estrogen/progesterone, thyroid/serotonin

Lifestyle - Sleep deprivation, feeling overwhelmed, loss of control

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12
Q

Risk factors for post partum depression

A

Poverty

Lack of support

Unplanned pregnancy

History of previous depression

Low self-esteem

Domestic violence

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13
Q

Difference between postpartum depression and baby blues

onset

KEY

A

Symptoms interfere with child care

occurs by 6 weeks and up to 6 months or a year

KEY is lasting longer than 2 weeks

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14
Q

Postpartum depression symptoms

A

No appetite

Sleep problems

Emotional lability

Sadness guilt inadequacy

Fatigue

Anxiety

Rejection of infant

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15
Q

PPD effects on mother

A

Can become a chronic depressive disorder.

Even if treated, ^ episodes of depression

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16
Q

PPD effects on father

A

Emotional strain

^ depression in father who are also at risk due to child birth

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17
Q

PPD effects on children

A

Emotional and behavioral problems

sleeping and eating difficulties

delayed language development

excessive crying

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18
Q

Postpartum psychosis occurs within _ after delivery

But can be as early as or as late as

A

2-3 weeks

48 hours or 6 months

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19
Q

Postpartum psychosis S/S

A

Pronounced sadness

Disorientation

Confusion

Paranoia

Hallucinations

Delusional thoughts of self-harm or harming the infant

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20
Q

Postpartum psychosis is an _

A

EMERGENCY

Needs immediate help and hospitalization

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21
Q

Postpartum depression prevention during pregnancy

A

Monitor for S/S of depression

Complete depression questioner during pregnancy and after delivery

Support groups, counseling, therapies

Antidepressant meds

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22
Q

Postpartum depression prevention after baby is born

A

Early screening for S/S

If PT has history, Dr. can recommend antidepressant treatment and psychotherapy immediately after delivery

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23
Q

Questions

History

Bonding

Emotional state

Comms

A

Past psychosis?

Is mom reluctant to care?

Mood, affect?

How does mom feel?

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24
Q

Questions

self care

support

exercise

diet

A

rest, bathe, journal, music?

fam?

5-10min

Eat healthy

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25
Q

Psychotherapy treatment PPD

A

Mental health professional

Coping, problem solving, realistic goals.

Fam can help

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26
Q

Antidepressant treatment for PPD

A

Little breast feeding side effect

Work with Dr. to weight benefits to risks

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27
Q

Drug classes for PPD

Most prescribed

for psychosis

A

Antidepressants

Antianxiety

SSRIs

Antipsychotics

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28
Q

SSRIs of choice

A

Sertraline

Paroxetine

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29
Q

SSRIs

A

Inhibits reuptake so more serotonin is available

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30
Q

Serotonin

Regulates

A

Neurotransmitter

Mood, social behavior, appetite, sleep, memory, sex

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31
Q

SSRI side effects

A

Insomnia/drowsiness

Blurred vision

Dry mouth

Joint pain

Sex problems

SUICIDAL THOUGHTS

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32
Q

Serotonin syndrome

A

To much serotonin

Life threatening

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33
Q

S/S of serotonin syndrome

A

restlessness

^ in BP and HR

Pupil dilation

Loss of coordination

Flu like (diarrhea, headache, shivering, sweating)

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34
Q

Severe serotonin syndrome S/S

A

High fever

Seizures

Irregular heartbeat

Come

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35
Q

SSRIs interactions

A

St. Johns wort - Serotonin syndrome

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36
Q

SSRIs take how long to work

within 2 weeks pt may become

A

4-6 weeks

suicidal

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37
Q

DO NOT stop SSRIs suddenly

Withdrawal S/S are

A

Flu like

Nausea dizziness, uneasiness, fatigue

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38
Q

Suicide

A

Intentional act of killing one self

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39
Q

Risks for suicide

A

Psych disorders

Certain chronic disorders

Environmental factors

Previous history

Family history

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40
Q

Suicidal ideation

A

Many PTs with depression have suicidal ideation BUT do not have the energy to carry out the plan

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41
Q

Hints of suicide

A

DO NOT IGNORE

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42
Q

Determine suicide potential

A

Is there a plan?

Are the means available?

Are there preparations?

Location?

Time/date?

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43
Q

Nursing interventions for suicide

A

Safety

No-suicide or no-self-harm contracts

Assess support systems

Be positive and nonjudgmental

44
Q

If lethality is low observe _

If lethality is high observe

A

Q10min

One to one

45
Q

Suicidal ideation meds

A

Antidepressants

SSRIs

MAOIs

46
Q

MOA enzymes

A

Monoamine oxidase

break down neurotransmitters (serotonin, norepinephrine, dopamine)

MOAIs inhibit them

47
Q

Foods to avoid with MAOIs

A

Tyramine (preservative)

Aged cheese, fermented foods, beer, soy sauce

48
Q

MAOIs and BP

A

orthostatic hypotension when initiating

49
Q

MAOIs can lead to

A

Serotonin syndrome

S/S

confusion, restlessness, seating, muscle jerk movements

50
Q

MAOIs side effects

A

Dry mouth

Nervousness dizziness

Sex problems

^BP

Difficulty urinating

Weight gain

51
Q

All antidepressants take _ to work

A

2-4 weeks

52
Q

Greatest risk of suicide with antidepressants occurs at

A

2 weeks

PT now has energy to commit self harm

53
Q

Major depressive disorder 101

A

2 or more weeks of sad mood or lack of interest in life

AND

54
Q

S/S of major depressive disorder

A

Must have at least 4

Anhedonia

Change in weight

Change in sleep

Drop in energy

Drop in concentration

Indecisiveness

Suicidal ideation

55
Q

How long does major depressive disorder last

Most clear in

A

Few weeks to years

6 months

56
Q

Cause of major depressive disorder

A

v in neurotransmitters

risk ^ with fam history

57
Q

Major depressive disorder meds

A

Tricyclic antidepressants

MAOIs

SSRIs

Antipsychotics for psychotic features

58
Q

Major depressive disorder therapy

A

Psychotherapy

Electroconvulsive therapy

59
Q

Tricyclic older antidepressants

A

Nortriptyline

Amitriptyline

Doxepin

60
Q

Tricyclic antidepressants 101

A

Keep neurotransmitters available to brain

Take 6 weeks to reach full effect

Also used for panic disorder, obsessive-compulsive, eating disorders

61
Q

TriCyclic Antidepressant Side-effects

TCA’S

A

Thrombocytopenia

Cardiac - arrhythmia, MI, stroke

Anticholinergic - tachycardia, urinary retention

Seizures

62
Q

Tricyclic antidepressant side effects

A

Dry mouth

Constipation

Weight gain

Blurred vision

63
Q

Tricyclic antidepressant contraindications

A

Liver function

Recent MI

64
Q

Tricyclic antidepressants + MAOIs

A

SEROTONIN SYNDROME

65
Q

Tricyclic antidepressants have anticholinergic side effects

dont give to pt with

A

glaucoma

benign prostatic hyperplasia

urinary retention

CVD

kidney problems

lung problems

66
Q

Electroconvulsive therapy 101

A

Placing electrodes on clients head and delivering impulse

Causes seizures

Shock resets brain chemistry

67
Q

When to resort to electroconvulsive therapy

A

When antidepressants don’t work

Actively suicidal

68
Q

Electroconvulsive therapy regiment

A

6 to 15 times

3x a week

69
Q

To receive improvement in depression, electroconvulsive therapy should be done at least

Max benefits achieved at

A

6 times

12-15 times

70
Q

Nursing for major depressive disorder

A

Get history

Safety - ASK DIRECTLY “are you suicidal”

Promote ADLs

Self care - diet sleep hydration etc

DO ONE TASK AT A TIME

71
Q

Suicide and meds

A

Antidepressants will give pt the energy to follow through with suicide

pt may also hide meds to attempt suicide later

72
Q

Therapeutic comms for suicide

A

Verbalization of emotion

Education - on illness and meds

Follow up on appts

73
Q

PT needs to be taught to ID

A

Signs of relapse, get treatment immediately

74
Q

Suicide risk and antidepressants

A

PT will have more energy to follow through

PT may believe meds don’t work because they take time to kick in

GREATEST RISK IS IN 2 WEEKS AFTER STARTING

75
Q

Bipolar disorder 101

A

Mood disorder

Recurrent depression and mania

76
Q

Mania 101

A

Euphoric

Grandiose

Energetic

Sleepless

Poor judgment

Rapid thoughts, actions, and speech

77
Q

Depressed phase of bipolar

A

same as depression

2 or more weeks + 4 symptoms

78
Q

Manic episode onset

A

sudden and rapid

over a few days

can last days to months

79
Q

Psychotic manifestations with mania are more likely in

A

adolescents

80
Q

At what age do manic episodes first occur

A

Teens

20s

30s

81
Q

Bipolar types

A

Mixed

I

II

82
Q

Bipolar mixed

A

Alternates between major depressive and manic

has periods of normal behavior

83
Q

Bipolar I

A

Mostly manic

with at least 1 depressive episode

84
Q

Bipolar II

A

Mostly depressive

with at least 1 manic episode

85
Q

Diagnosis of a manic episode

A

1 week of

heightened activity grandiose/agitated mood and 3 or more S/S

86
Q

Manic S/S

A

Exaggerated self esteem

Pressured speech

Distractibility

Sleeplessness

Flight of ideas

87
Q

In manic phase, pt engages in

A

high risk activities involving poor judgment

spending sprees, sex with strangers, impulsive investments

88
Q

Bipolar meds

A

Antimanics - lithium

Anticonvulsants - stabilize moods, protect cycle

Antipsychotics - for psychosis

89
Q

Lithium - Mood stabilizer 101

A

Reduces and sometimes can stop cycling between moods

Lithium is NOT METABOLIZED, EXCRETED THROUGH URINE

90
Q

Normal lithium serum range

A
  1. 5-1.0 maintenance
  2. 8-1.4 treatment

above 1.5 TOXIC

91
Q

Lithium serum toxicity S/S

1.5-2.0

A

N&V

Diarrhea

Poor coordination

Drowsiness

Slurred speech

92
Q

Lithium serum toxicity S/S

2-3

A

Ataxia - lack of muscle control, spasms, hypertonia etc

Blurred vision

Tinnitis

Pruritus

Large urine output

Incontinence bladder and bowel

93
Q

Nurse interventions for lithium toxicity between 1.5-3.0

A

Stop med

Call Dr.

Prepare for gastric lavage

Start IVs to maintain electrolytes

94
Q

Lithium serum toxicity S/S 3.0 and above

A

Cardia arrhythmia

Hypotension

Peripheral vascular collapse

Seizures

Drop in LOC

95
Q

Nursing interventions for lithium above 3.0

A

All previous plus

Aminophylline, mannitol or urea to get rid of lithium

Hemodialysis to remove lithium

96
Q

What to monitor when lithium is above 3.0

A

Monitor resp, circulatory, thyroid, and immune systems

97
Q

Anticonvulsant meds used as mood stabilizers

A

Gabapentin

Carbamazepine

Divalproex

Topiramate

98
Q

Common side effects for anticonvulsants

A

drowsiness

sedation

weakness/fatigue

99
Q

Nursing - safety with anticonvulsants

A

Get up slow

monitor hypotension

100
Q

Antipsychotics 101

A

block dopamine

reduce delusions and hallucinations

101
Q

Antipsychotic meds

A

1st gen - thorazine

2nd gen - clozapine

3rd gen - aripiprazole

102
Q

Side effects of antipsychotics

A

Dystonia - muscle contract repetitively, twisting movements

Pseudo parkinsonism

Tardive dyskinesia - involuntary movements of body and face

Akathisia - inability to remain still

103
Q

Psychotherapy and bipolar disorder

A

Used during depressive or normal phase

combined with meds = reduces suicide and injury

helps client and family

104
Q

Nursing in depressive state of bipolar

A

Same as major depression

history

safety

suicide watch

promote ADLs

promote self care - sleep, diet, exercise

105
Q

Manic phase care for nursing

A

Use short sentences

Remind client to respect distance

High calorie finger foods

Promote rest/sleep

Decrease stimuli

Protect client dignity

106
Q

Bipolar - education for fam

A

Teach ways to manage disorder

Med management - blood work

Teach about salt and fluid intake

Teach S/S of toxicity

Teach S/S of relapse

107
Q

Salt and lithium

A

Maintain same level

Salt excess or depletion will affect lithium levels

S3 1538 (15 decks)

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