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Exam 4 > Depression > Flashcards

Depression Flashcards

1
Q

How is depression characterized?

A

By a sad despondent mood

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2
Q

What are the symptoms associated with depression?

A
  • Lack of energy
  • Abnormal eating
  • Sleep disturbances
  • Feelings of despair
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3
Q

Where are the majority of depressed clients found?

A

In mainstream settings

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4
Q

What are the risk factors for depression?

A
  • history of abuse, neglect, loss
  • Age greater than 65 yrs
  • Stressful life events
  • Poor social support
  • dysfunctional family relationships
  • family history or personal history of mental illness, substance abuse
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5
Q

Is there a definitive way to prevent depression?

A

No.

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6
Q

What things are helpful for the possible prevention of depression?

A

Exercise, proper diet and rest, avoiding drugs; illicit drugs

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7
Q

What is MDD?

A

Major depressive disorder

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8
Q

How is major depressive disorder defined?

A

a change in several aspects of individual’s emotional state and functioning for TWO WEEKS

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9
Q

What kind of feelings might a person struggling with MDD have?

A

Sadness, discouragement, hopelessness,

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10
Q

Does MDD consist of a single episode or more than one?

A

Either one, depress on person and situation

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11
Q

What is the DSM-5?

A

Diagnostic criteria to diagnose MDD. You have to have at least 5 on the list to be diagnosed.

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12
Q

What are the 9 things, or criteria, of the DSM-5 test?

A
  • depressed mood
  • sleep disturbance
  • anhedonia
  • weight increase or decrease
  • increase or decrease in motor activity
  • fatigue, decreased energy
  • feelings of guilt, worthlessness, self-blame
  • dismissed ability to concentrate
  • suicidal ideation
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13
Q

What is postpartum depression?

A

Depression that starts anytimes up to four weeks after birth of a child.

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14
Q

What is dysthymic disorder?

A

A milder form of depression, with early onset, (childhood or adolescence)

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15
Q

How long does dysthymic disorder typically last?

A

At least two years in adults, with no more than 2 months being symptom free.

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16
Q

How many clinical findings of depression does dysthymic disorder find?

A

At least 3

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17
Q

Do the symptoms of MDD or dysthymic disorder tend to be more severe?

A

MDD

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18
Q

Dysthymic disorder tends to be …

A

Chronic.

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19
Q

What is SAD?

A

Seasonal affective disorder.

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20
Q

How is seasonal affective disorder defined?

A

Depressive disorder that relates to seasons

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21
Q

What time of year do people usually experience SAD?

A

Winter months

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22
Q

What is the #1 treatment for SAD?

A

Light therapy

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23
Q

What is the medication indicated for SAD?

A

Bupropion extended release.

May help to prevent major depressive episodes

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24
Q

Who is the calllaboration team made up of for pts with depression?

A

RN, MD, pharmacist, psychologist, family

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25
Q

Who can diagnose a pt with depression?

A

A licensed mental health provider.

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26
Q

What are the diagnostic tests for depression?

A

There are none. There are only helpful screenings you can do.

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27
Q

What can influence medication therapy?

A

Existing medical illnessses

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28
Q

What is psychotherapy?

A

The treatment of a mental disorder with psychological rather than medical means.

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29
Q

What is psychotherapy usually given in addition to?

A

Medication.

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30
Q

For mild depression, how is psychotherapy used?

A

It is used alone, without medication.

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31
Q

How does psychotherapy help pts with depression?

A

Helps them manage specific symptoms, promotes coping skills, CBT, helpful positive ways of thinking

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32
Q

What is CBT?

A

Cognitive behavior therapy.

33
Q

What is the most effective psychotherapeutic approach for depression?

A

CBT

34
Q

What meds are given to depressed pts?

A

Antidepressants, SSRI’s, MAOI’s

35
Q

What is the best way to find the right antidepressant drug?

A

Trial and error

36
Q

A doctor will continue what until depressed pt is symptom free?

A

Maintenance and slow discontinuation of the medication.

37
Q

What is the black box warning on antidepressants?

A

Huge risk for suicide.

38
Q

What is the prototype drug of Tricyclic antidepressants?

A

Imipramine

39
Q

What is the prototype drug of monoamine oxidases?

A

Phenelzine

40
Q

What is the prototype or SSRI’s?

A

Fluoxetine

41
Q

What are the signs of anticholinergic?

A

Can’t see, cant pee, cant spit, cant shit.

42
Q

What are the indications for Imipramine?

A

Depression, enuresis, neuropathic pain

43
Q

What is the action of Imipramine?

A

Inhibit reuptake of norepinephrine and serotonin

44
Q

What are the contraindications of Imipramine?

A

CV disease, recent MI, liver dysfunction, angle closure glaucoma, urinary retention, history of seizures, pregnancy, and manic depression

45
Q

What are the adverse affects of Imipramine?

A

Orthostatic hypotension, arrhythmias, sedation, bone marrow depression, anticholinergic effects

46
Q

What are the drug to drug interactions for Imipramine?

A

MAOI’s, SSRI’s, St, Johns Wart, CNS depressants, antihypertensives, sympathomimetics, oral anticoagulants

47
Q

What should you avoid while on Imipramine?

A

Alcohol and other CNS depressants.

48
Q

Why should you change positions slowly while on Imipramine?

A

Because of the risk of orthostatic hypotension

49
Q

Why do you need to be careful with driving while on Imipramine?

A

Because the sedation effects are unknown at first

50
Q

Does Imipramine have a long half life?

A

Yes

51
Q

Why should you avoid sunlight while on Imipramine?

A

It can make you sensitive to sunlight

52
Q

How long until you see therapeutic effects of Imipramine?

A

2-6 weeks.

53
Q

What is the action of Fluoxetine?

A

Inhibits CNS neuronal reuptake of serotonin with little effect on norepinephrine.

54
Q

What are the indications for Fluoxetine?

A

Depression, OCD, panic attacks, bulimia, PMDD, PTSD, Social phobias, anxiety

55
Q

What are the contraindications/cautions of Fluoxetine?

A

Pregnancy, lactation, impaired renal or hepatic function, cardiac disease, diabetes, severely depressed or suicidal patients

56
Q

What are the adverse effects of Fluoxetine?

A

Headache, drowsiness, dizziness, insomnia anxiety, tremors, chest pain, agitation, sexual dysfunction, palpitations, increased appetite, hyponatremia

57
Q

What are the drug to drug interactions of fluoxetine?

A

MAOI’s, TCA’s, St. John’s Wart.

58
Q

What is important to monitor for while a pt is on fluoxetine?

A

Changes in behavior, effectiveness of therapy

59
Q

What education is important concerning fluoxetine?

A
  • Notify MD before taking other drugs
  • keep all follow up appointments
  • report side effects
  • dont stop drug abruptly
  • take most SSRI’s in the AM w/ food
  • exercise and caloric restriction to avoid weight gain
60
Q

With SSRI’s what are the two considerations to be aware of?

A

Serotonin syndrome and discontinuation syndrome

61
Q

What is serotonin syndrome?

A

Overstimulation with serotonin caused by giving with other drugs that increase serotonin, ie. MOAI’s, St. John’s Wart.

62
Q

What is discontinuation syndrome?

A

Flu-like syndrome from abrupt withdrawal of drug

63
Q

What is the action of Phenelzine?

A

Irreversibly inhibit MAO’s, allowing norepinephrine, serotonin, and dopamine to accumulate in the synaptic cleft

64
Q

What is the indication for giving phenelzine?

A

Depression-for those who are unresponsive to or unable to take other antidepressive agents

65
Q

What are the adverse effects of Phenelzine?

A

Dizziness, nervousness, mania, hyperreflexia, tremors, confusion, insomnia, agitation, liver toxicity, N/V, constipation, anorexia, weight gain, dry mouth, orthostatic hypotension, hypertension

66
Q

How long until therapeutic effect for phenelzine?

A

4-8 weeks

67
Q

What are the contraindications for phenelzine?

A

Pheochromocytoma, CV disease, hypertension, glaucoma, increased intercranial pressure, and renal or hepatic impairment

68
Q

What are the drug to drug interactions for phenelzine?

A

Other antidepressants, sympathomimetics, insulin or oral antidiabetics agents, CNS depressants, opioid analgesics, general anesthetics

69
Q

What are the food interactions for phenelzine?

A

Don’t eat anything aged-can cause BP to sky rocket

70
Q

What are other therapies for depression?

A
  • Electroconvulsive therapy.
  • transcranial magnetic stimulation
  • alternative or complementary therapies include St. John’s wart
71
Q

What are some goals for nursing care?

A

Focus on safety
Therapeutic communication
Meet functional needs

72
Q

What should you assess for in patients with depression?

A

Symptoms of depression, any history of manic episodes, comorbidities

73
Q

Why should you assess for comorbidities in patients with depression?

A

Ensure there is not an underlying physical cause.

74
Q

What kind of drugs can complicate depression?

A

Legal or illegal, depends on the drug

75
Q

When you are assessing children that may have depression what should you include?

A
  • rule out a physical illness
  • get full story fro parents, caregivers
  • have a child psychiatrist or psychologist involved
76
Q

When you are assessing older patients for depression what should you include?

A
  • it may be hard to tell what’s going on due to poly pharmacy
  • use geriatric depression scale(pts with cognitive impairments)
  • use cornell depression scale (pts with sever cognitive impairments)
77
Q

What kind of attitude is important to adopt while maintaining confidence that client will feel better?

A

An emotionally neutral attitude.

78
Q

It is important for the nurse to pay attention to his or her…

A

Personal feelings, mood.

Exam 4 (13 decks)

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