Depression & Labs value Flashcards Preview

EXAM #4 (ad. antepartum) > Depression & Labs value > Flashcards

Flashcards in Depression & Labs value Deck (23):
1

depression

aka major depressive disorder (MDD)
range from mild - severe
range from 12-30% highest among women of low SES
20% in pregnancy
pregnancy may trigger recurrent of depressive symptoms
no recognize by provider 50% of the cases
Emotional functional and financial consequences impact the whole family

2

associated risk factor for prenatal depression

prior hx depression
poverty
marital problems
lack of partner
family domestic violence
chronic life work stress
unplanned unwanted pregnancy

3

Potential problems due to untreated depression in pregnancy

poor nutrition : inadequate weight gain
substance use (smoking, alcohol, drugs)
Preeclampsia
preterm birth
postpartum depression

4

maternal elevated cortisol levels associated with childhood:

sleep problems
attention deficient disorder
language and cognitive impairment

5

s/x depression

prior depression
poor social support
feelings isolation despair, worthlessness
fatigue prior pregnancy
insomnia
multiple somatic complaints/ symptoms
suicide ideation
weight change (often loss) unrelated to pregnancy
observe eye contact
observe general effect

6

screening & quantification

Beck Depression Inventory (BDI)
Edinburgh Postnatal Depression Scale (EPDS) both validated use in pregnancy and postpartum women
OB and psychological consult appropriate if screening is positive
management depends on severity

7

management mild depression

Adequate sleep, strategies to reduce stress
Psychotherapy
Support
Exercise
light therapy
St john's wort

8

Psychotherapy

** always part of treatment regime for depression
** short or long term
** psychologist, psychiatrist, clinical nurse specialist

9

support

advise her to communicate her needs to others
Ask for help with housekeeping, preparing meals and other daily tasks
support group for pregnant mothers, or for women with depression

10

exercise

exercise reduce depression hormone cortisol provides a feeling of accopmplishment enhances self-esteem and increases serotonin (neurotransmitter key in development of depression)

11

light therapy

sitting in front of special light box for about 30 minutes every day
recent studies indicate efficacy in pregnancy

12

St john's wort (hypericum perforatum)

studies have been short-term and not well controlled
no uniformity of dose or amount and types of ingredients not regulated by FDA)
may negatively interact with antidepressants
no evidence of teratogenicity
no enough scientific evidence to recommend use during pregnancy or breastfeeding

13

management of severe depression pharmaceuticals

SSRI :
* fetus exposed through placenta
*SSRI increase the amount of neurotransmitter in brain synaptic clefts
* associated with significant increase in LBW <10%
* Associated with 6 fold increase in PPHN ( persistent pulmonary hypertension) in recent studies
studies mixed on associated with increase spontaneous loss
* use only when risk/benefits weighed

14

Paroxetine (paxil)

NOT USED
Some studies report an increase in congenital malformations with use (craniosynostosis, omphalocele, heart defects)

15

Reasons to take antidepressants

you have been taking medicine for severe depression, and you don't want to stop now that you are pregnant
studies show that certain antidepressants are not likely to cause birth defects
you have tried other treatment, and it hasn't helped
you are more worried about how your depression may affect your baby than about how the medicine may affect your baby
ASk are there other reasons you might want to take antidepressants

16

reason NOT to take antidepressant

depression is mild
you don't want to take medicine while you are pregnant and other treatment seems to help
there are no studies that show that antidepressant are totally safe for pregnant women
you are ready and willing to try to control your symptoms by keeping up a healthy lifestyle eating right, getting enough sleep
ask : are there other reason you might not want to take antidepressants?

17

Hemoglobin

12-16gm/dL
low : iron , B12, folate deficiency
high: smoker living in high altitudes

18

MVC

80-100 g/mL
low: microcytic --> iron deficiency thalassemia, lead poisoning
high: folate deficiency vitamin B12 deficiency

19

platelet

150-450
important for adequate hemostasis
low: bleeding, inflammatory disease
high: DIC

20

WBC

3.4-10
high: infection inflammation corticosteroid
low: aplastic anemia, B12 folate deficiency
sepsis

21

sodium

135-145meq/L
high : dehydration
low: CHF vomiting diarrhea excessive sweating

22

K +

3.5-5.0
intracellular cation whose plasma level is regulated by renal excretion. plasma concentration determine neuromuscular and muscular irritability
Elevated or depressed K concentration interfere with muscle contraction

23

AST/ALT

5 to 40 unit/L for AST
7 to 56 unit/L for ALT

High: muscle damage
low