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Patient Centered Care 3 > Mood and Affect > Flashcards

Mood and Affect Flashcards

Apply Information About the Exemplars: Depression, Bipolar Disorders, and Suicide

1
Q

What is Major Depressive Disorder characterized as?

A

By a change in several aspects of an individual’s emotional state and functioning consistently over a period of 14 days or longer

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2
Q

What are the clinical manifestations of major depressive disorder?

A
  1. significant distress or impairment of functioning
  2. feelings of despair, hopelessness
  3. Sadness, crying
  4. Feelings of worthlessness, guilt
  5. Loss of self-esteem
  6. Loss of interest or pleasure in activities
  7. Substantial changes in weight or appetite over a short period of time
  8. Impairments in executive functioning
  9. Visible psychomotor agitation or retardation
  10. Aches and pains
  11. Excessive sleep loss or excessive sleeping
  12. recurrent thoughts of death or suicide
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3
Q

What is Anhedonia?

A

When individuals with MDD often no longer enjoy activities that previously brought pleasure, such as hobbies, sports, and sex

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4
Q

What does the acronym MAJOR DEPRESSION represent?

A
  1. Mood depressed; memory problems
  2. Anxious; Apathetic; Appetite changes
  3. Just no fun
  4. Occupational impairment
  5. Restless; Ruminative
  6. doubts self; Difficulty making decisions
  7. Empty feeling
  8. pessimistic; Persistent sadness; psychomotor retardation
  9. reports vague pains
  10. Energy gone
  11. suicidal thoughts and impulses
  12. Sleep disturbances
  13. irritability; Inability to concentrate
  14. Oppressive guilt
  15. nothing can help (hopelessness)
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5
Q

What is persistent depressive disorder?

A

Describes chronic depression for the majority of most days for at least 2 years (1 year for children and adolescents). No more than 2 months symptom free

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6
Q

What is Seasonal Affective Disorder?

A

MDD with a seasonal pattern.

Symptoms like sadness and low energy during the winter months when the days are shorter.

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7
Q

What are risk factors for Seasonal Affective Disorder?

A

Female gender, age, and personal or family history of depression or bipolar disorder, people who live farther away from the equator

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8
Q

What are some pharmacologic and nonpharmacologic therapy approaches to treating SAD?

A

Bupropion, SSRIs, light therapy.

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9
Q

What is adjustment disorder with depressed mood?

A

A change in mood and affect following a stressor, such as the end of a relationship, or multiple stressors; it may also be called situational depression. Symptoms last 3 months after the event but do not last more than 6 months

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10
Q

What are the clinical therapies for major depressive disorder?

A
  1. SSRIs
  2. TCAs
  3. Atypical antidepressants
  4. Electroconvulsive therapy
  5. CBT
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11
Q

What are the clinical therapies for Adjustment disorder with depressed mood?

A
  1. improved sleep
  2. Short-term sedative
  3. CBT alone may be sufficient to help the individual return to normal
  4. Alternative therapies such as massages therapy may provide relief
  5. Antidepressant therapy
  6. CBT
  7. Family therapy
  8. Antidepressant therapy
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12
Q

What are the clinical therapies for Persistent depressive disorder?

A
  1. Pharmacologic therapies are the same as for MDD
  2. Electroconvulsive therapy
  3. CBT
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13
Q

What are the signs of depression in children and adolescents?

A
  1. Toddlers can show regressive behaviors in toileting and other activities
  2. Preschoolers have fewer symbolic and other play activities and demonstrate self-destructive play themes. They may whine and show irritability, lack of interest, and lack of confidence.
  3. School-aged children may show a decrease in academic performance, increased or decreased physical activity, somatic complaints, and loss of friends. The older school-aged child may talk of running away or show signs of boredom and low self-esteem
  4. The adolescent can have a wide array of symptoms (decreased social contact, poor school performance, lack of involvement in typical activities, poor self-care, difficulty with parents and teachers, or a focus on violence)
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14
Q

What are the symptoms of depression in older adults?

A
  1. memory problems
  2. social withdrawal
  3. sleep disturbances
  4. loss of appetite
  5. irritability
  6. delusions or hallucinations
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15
Q

What are the steps to suicide assessment?

A
  1. Ask whether the patient has thoughts of self-harm
  2. how often these thoughts occur and whether the person would act on these thoughts
  3. Inquire whether or not the patient has a plan regarding carrying out suicide
  4. Assess lethality of the plan (degree of effort required, specificity of plan, accessibility of means to carry out the plan)
  5. history of prior suicide attempts or family history of suicide
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16
Q

What are some disorders that could trigger a depressive episode?

A
  1. autoimmune, oncologic, metabolic, and endocrine disorders

2. chronic illnesses: Asthma and diabetes

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17
Q

What are two general principles to keep in mind with implementing interventions for patients with depression?

A
  1. It is impossible to make patients with depression feel better by being cheerful. In fact, an overly cheerful attitude tends to make them feel even worse because it trivializes or minimizes the impact of their feelings. Try to adopt a more emotionally neutral attitude while maintaining confidence that they will feel better.
  2. Recognize that working with patients with depression may eventually lower your own mood and make you feel “down” yourself. This is called emotional contagion. The nurse should be aware of personal feelings and, if necessary, ask to be assigned to a different type of patient for a time
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18
Q

How can a nurse improve self-esteem?

A
  1. Encourage patient participation in recreational activities. Simple conversation with a staff member or another pt helps interrupt the pattern of negative thoughts. Use care to identify activates that are not too complex for the patient’s current level of functioning. Experiences of success , not more failures, are needed.
  2. Give positive, matter-of-fact reinforcement, such as “I notice that you combed your hair,” rather than overly enthusiastic compliments or excessive praise such as “What a great hairstyle!” Appropriate recognition increases he likelihood that the patient will continue the positive behavior, wile insincerity can be perceived as ridicule or infantilizing.
  3. Be accepting of patients’ negative feelings, but set limits on the amount of time spent discussing accounts of past failures. Be alert for opportunities to interrupt negative conversational patterns with more neutral ones
  4. teach assertiveness techniques, such as the ability to say “no” to protect one’s rights while respecting the rights of others. Patients with low self-esteem often allow others to take advantage of them. Practice these techniques with the patient, providing feedback on how it feels to be the recipient of assertive communication or an assertive action.
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19
Q

How does a nurse instill hope in a patient that has depression?

A
  1. help pts id their personal strengths. It may be useful to write these down. Recognize that it often takes time for patients to realize that they have any strengths. Recognizing strengths helps a pt design an activity or engagement plan that the pt is more likely to enjoy and find successful
  2. Help pts weigh and choose alternatives. Taking responsibility even for small choices, such as when or where to eat, helps the patient regain self-esteem.
  3. Explore problem-solving models with the patient, including practicing problem-solving. “When you found out the toaster was broken, you threw it against the wall. You said all that you did was put a dent in the wall and make a mess for you to clean up. Wheat might you do differently next time that might be more helpful?”
  4. Help pts to identify resources such as family, community, or friends who can provide support and encouragement in overcoming problems they identify.
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20
Q

What are the risk factors for suicide?

A
  1. Social isolation, lack of support systems
  2. recent unemployment
  3. Recent loss of a significant relationship
  4. feelings of failure, hopelessness
  5. access to lethal means
  6. History of trauma or abuse
  7. Chronic physical illness, including chronic pain
  8. gender (men more likely to die, women more likely to attempt)
  9. Age
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21
Q

What are the interpersonal factors of suicide?

A
  1. history of abuse or rape
  2. loneliness
  3. loss and grief can be profound influencing factors
  4. Situations that take away a person’s control over life
  5. feelings of hopelessness
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22
Q

What are some social factors that can cause suicide?

A
  1. Financial strain, job loss
  2. Bullying
  3. Discrimination
  4. Individuals in justice, child welfare settings
  5. LGBTQ populations
  6. members of armed forces, veterans
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23
Q

What may people who are ambivalent about suicide do?

A

Use a mild overdose of pharmaceuticals

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24
Q

What may people determined to die use?

A

More lethal methods like using a gun, hanging themselves, or jumping from a tall building

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25
Q

What behavior may be a sign of suicidal ideation?

A
  1. may mention feeling helpless in face of stress
  2. May discuss life after death
  3. Verbal cues such as “It won’t matter for long” or “I can’t take this much longer”
  4. Giving away possessions
  5. Withdrawing from relationships
  6. Obtaining means to end life
  7. Some individuals demonstrate no overt behaviors
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26
Q

What is the mnemonic for short-term indications of suicidal intent and what does it stand for?

A
  1. I- Ideation
  2. S- Substance abuse
  3. P- Purposelessness
  4. A- anxiety
  5. T- Trapped
  6. H- Hopelessness
  7. W- Withdrawal
  8. A- Anger
  9. R- Recklessness
  10. M- Mood changes
27
Q

What cognitive characteristics may be evident in someone with the intent to commit suicide?

A
  1. unusually rigid thinking
  2. Dichotomous thinking
  3. Magnification
  4. overgeneralization
  5. Externalization of self-worth
  6. Predicting negative outcomes without considering possible positive ones
28
Q

What are some signs that someone who is planning suicide is experiencing social isolation?

A
  1. alienation from family, friends
  2. Difficulty adapting to demands of new social roles
  3. Loss of loved one
  4. Unemployment
  5. Loss of autonomy
  6. feeling like a burden to others
29
Q

What are the suicide rates in different ethnic groups?

A
  1. American Indians, Alaska native have the highest rates
  2. Next highest: non-Hispanic Whites
  3. African Americans have the second-lowest rate
  4. Hispanics have the lowest rate
30
Q

What pharmacologic therapy is used for suicidal patients?

A
  1. Antidepressants: SSRIs

2. Mood stabilizers and antipsychotics

31
Q

What some nonpharmacologic therapy options for suicidal patients?

A
  1. group therapy
  2. Individualized therapy
  3. Family therapy
  4. CBT
  5. Writing therapy
32
Q

What increases the risk of suicidal ideation in children?

A
  1. loss of a parent
  2. Physically or sexually abused
  3. Experience humiliation in school
  4. Have lost a loved one
33
Q

What increases the risk of suicidal ideation in adolescents and YA’s?

A
  1. Lack of meaningful relationships
  2. sexual problems
  3. Acute problems with parents or significant others
  4. Exposure to dramatic suicides of celebrities
  5. Element of “Contagion” among teens
  6. Bullying, harassment via social media

College Students

  1. Anxiety about academics
  2. New social situations and responsibilities
  3. Anxiety about their place in the world
34
Q

In what setting can those with suicidal ideations be treated based on their risk level?

A
  1. Low-risk= outpatient setting
  2. High-risk= immediate hospitalization
  3. Moderate-risk= outpatient setting or with partial hospitalization
35
Q

How can a nurse promote safety with a suicidal patient?

A
  1. Ensure that patients actively experiencing suicidal ideation have no access to items or modes that could be used to harm themselves
  2. Ensure that high-risk patient is never left alone
  3. in healthcare settings, instruct guests on what objects they cannot have while visiting the patient
  4. In homes, outpatient settings, community setting, alert appropriate people per protocol if the patient expresses considering suicide
  5. Monitor for signs of self-injurious behaviors
36
Q

How would a nurse increase patient knowledge to a suicidal patient?

A
  1. Provide pt and family teaching about symptoms of depression
  2. Provide education to patients who have comorbid disorders
  3. Provide med education
  4. Education of family members, concerned individuals should include telephone numbers of hotlines and local resources
37
Q

What are the risk factors for Bipolar Disorder?

A
  1. Family history of bipolar disorders
  2. Drug abuse
  3. Periods of very high stress
  4. Major life-altering event
  5. Women and men at equal risk
38
Q

What are the signs and symptoms of mania?

A
  1. abnormal, persistently elevated, expansive, or irritable mood
  2. Present most of the time, nearly every day or a week or more, accompanied by specific symptoms per DSM-5
  3. Flight of ideas
  4. Pressured speech patterns
  5. Increasing goal-directed activities
  6. Severe= Delusions/hallucinations
39
Q

What are some signs of hypomania?

A
  1. does not impair the functioning or require hospitalization
  2. Patients feel “on top of the world”; do not recognize changes in selves
40
Q

When does the onset of mania typically occur?

A

In the early 20s but can begin at any age

41
Q

What are some more manifestations of mania and hypomania in Bipolar Disorder?

A
  1. often follows severe disappointment or other psychic stressors
  2. Mood is euphoric or “high”
  3. behavior is excessive and out of bounds
  4. Overly enthusiastic involvement in projects
  5. Becoming irritable if obstacles get in the way
  6. Moods alternate between euphoria and irritability
  7. Increased sexual behaviors are common
  8. Grandiosity can reach delusional proportions
  9. Patients rarely believe they are ill
42
Q

What pharmacologic therapy is typically used for someone with Bipolar Disorder?

A
  1. Antipsychotic mood stabilizers
  2. Antidepressants
  3. Antiseizure meds
43
Q

What is the most common med to treat mania in patients with Bipolar Disorder?

A

Lithium carbonate

44
Q

When is Lithium carbonate not recommended?

A
  1. During pregnancy, breastfeeding
  2. Patients with impaired renal, congestive heart failure, organic brain disease
  3. Patients on sodium-restricted diets
45
Q

What is the therapeutic blood level of Lithium carbonate?

A

0.8-1.2 mEq/L

46
Q

What are the symptoms of Lithium Toxicity?

A
  1. Course hand tremor
  2. Slurred speech
  3. seizures
  4. delirium
  5. muscle weakness
  6. uncontrollable movements
  7. tinnitus
  8. blurred vision
  9. diluted urine
    10, sense of giddiness
47
Q

What teaching should be included with Lithium Carbonate?

A
  1. Keep fluid and salt intake stable
  2. Increase sodium if they are sweating a lot
  3. limit coffee, tea, and cola
  4. take with meals to reduce nausea
  5. side-effects include: thirst, nausea, dry mouth, mild hand tremors, weight gain, bloated feeling, and insomnia
48
Q

What antiseizure meds are often used with antipsychotics to manage mania?

A
  1. Valproic acid
  2. Lamotrigine
  3. Carbamazepine
49
Q

What are some antipsychotic mood stabilizers used for Bipolar Disorder?

A
  1. Aripiprazole
  2. Risperidone
  3. Olanzapine
  4. Quetiapine
50
Q

What are some side-effects of antipsychotic meds?

A

extrapyramidal effects: Parkinson-like symptoms, dystonia (muscle spasms), akathisia (jumping out of my skin feeling)

51
Q

What should the nurse do if extrapyramidal effects occur?

A
  1. report

2. give anticholinergic meds (benztropine, diphenhydramine, trihexyphenidyl)

52
Q

What are some behavior changes that could indicate that a child has Bipolar Disorder?

A
  1. Alterations in sleep patterns
  2. Talking a lot, racing thoughts
  3. May have long, violent temper tantrums
  4. Older children may take on multiple tasks, develop grandiosity
53
Q

What treatment is included for children who have Bipolar disorders?

A

Give the fewest medications possible at the lowest effective doses. Meds may be used to reduce the severity of symptoms and psychotherapy to learn how to adapt to stressors and build relationships

54
Q

How should an adolescent be treated for Bipolar Disorder?

A

The same guidelines for treatment for children should be used for adolescents. Mood swings should not be mistaken for typical bipolar disorder symptoms because they are teenagers.

55
Q

What should happen with the medications pregnant women with bipolar disorder are taking?

A

They should be tapered off, decreased in dosage, or charged if appropriate.

56
Q

What should be monitored if a pregnant woman with Bipolar Disorder continues taking Lithium Carbonate?

A
  1. Serum Lithium level should be monitored frequently
  2. Fetus should be assessed for potential heart defects
  3. Dose should be decreased at onset of labor
57
Q

What treatment for Bipolar Disorder should older adults get?

A
  1. Treated the same as younger adults with lower dosages of meds
  2. Monitor closely for toxicity
  3. Do not give lithium if they have kidney disease or thyroid disease
58
Q

What goals should a patient with Bipolar Disorder have?

A
  1. Remain free of injury
  2. Remain oriented
  3. Use appropriate behaviors in a variety of social settings
  4. Maintain self-care
  5. No longer experience sleep disturbances
59
Q

How would a nurse promote patient safety for a patient with Bipolar Disorder?

A
  1. Provide the patient with community support by supplying names, phone numbers for resources such as crisis hotline
  2. Assist patient in scheduling appointments with a mental health professional
  3. Monitor Activities
  4. Set and enforce limits on unsafe or socially inappropriate behaviors
  5. Provide a safe environment by reducing environmental stimuli
  6. Monitor for safety hazards
60
Q

How would a nurse promote reality-based thinking for a patient with Bipolar Disorder?

A
  1. Present reality by spending time with the patient, orienting to time and day location, other information as needed
  2. Establish consistency by following a schedule, assigning the same caregivers to work with the same patient when possible
  3. Refrain from arguing or trying to reason with patients experiencing delusions, other altered thought processes
  4. When patients communicate perceptions of altered reality, reflect their statements back to them for validation
61
Q

How would a nurse promote improved self-care for a patient with Bipolar Disorder?

A
  1. Ensure adequate nourishment and fluids
  2. assist pt w/ personal hygiene and toileting
  3. For a pt who gets minimal or no sleep Decrease stimulation in milieu to promote rest; encourage patient to perform tasks that require sitting down
  4. Incontinence is occasionally seen in severely regressed patients
  5. Constipation more common
62
Q

How would a nurse set limits for a patient with Bipolar Disorder?

A
  1. All staff must agree on established limits and enforce them consistently
  2. Patients must know what behaviors are expected, what consequences will result if they exceed limits
  3. Expect manipulative responses to limits but don’t be disarmed by them
  4. Consistent application of consequences essential to promote adaptive behaviors
63
Q

How would a nurse enhance rest and sleep for a patient with Bipolar Disorder?

A
  1. Design nursing activities to facilitate regular sleep-wake cycles
  2. Monitor pts closely for signs of fatigue
  3. Promote nighttime sleeping by limiting daytime naps
  4. Sleep may promote the rapid resolution of first episodes of mania- Before bedtime, decrease light/noise and encourage quiet activities and pre-sleep routines; warm bath and snack may help pt relax; Administer meds that do not suppress REM sleep; Encourage pt to stay in a darkened room; Assign a monotonous task to encourage drowsiness
  5. When pts can sleep, avoid waking them for nonessential care or activities- Allow for sleep cycles for at least 90 minutes

Patient Centered Care 3 (19 decks)

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