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S3 1538 > S3 M11 Mood & Affect > Flashcards

S3 M11 Mood & Affect Flashcards

(107 cards)

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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
Psychotherapy treatment PPD
Mental health professional Coping, problem solving, realistic goals. Fam can help
26
Antidepressant treatment for PPD
Little breast feeding side effect Work with Dr. to weight benefits to risks
27
Drug classes for PPD Most prescribed for psychosis
Antidepressants Antianxiety SSRIs Antipsychotics
28
SSRIs of choice
Sertraline Paroxetine
29
SSRIs
Inhibits reuptake so more serotonin is available
30
Serotonin Regulates
Neurotransmitter Mood, social behavior, appetite, sleep, memory, sex
31
SSRI side effects
Insomnia/drowsiness Blurred vision Dry mouth Joint pain Sex problems **SUICIDAL THOUGHTS**
32
Serotonin syndrome
To much serotonin Life threatening
33
S/S of serotonin syndrome
restlessness ^ in BP and HR Pupil dilation Loss of coordination Flu like (diarrhea, headache, shivering, sweating)
34
Severe serotonin syndrome S/S
High fever Seizures Irregular heartbeat Come
35
SSRIs interactions
**St. Johns wort - Serotonin syndrome**
36
SSRIs take how long to work within 2 weeks pt may become
4-6 weeks suicidal
37
DO NOT stop SSRIs suddenly Withdrawal S/S are
Flu like Nausea dizziness, uneasiness, fatigue
38
Suicide
Intentional act of killing one self
39
Risks for suicide
Psych disorders Certain chronic disorders Environmental factors Previous history Family history
40
Suicidal ideation
Many PTs with depression have suicidal ideation BUT do not have the energy to carry out the plan
41
Hints of suicide
DO NOT IGNORE
42
Determine suicide potential
Is there a plan? Are the means available? Are there preparations? Location? Time/date?
43
Nursing interventions for suicide
Safety No-suicide or no-self-harm contracts Assess support systems Be positive and nonjudgmental
44
If lethality is low observe \_ If lethality is high observe
Q10min One to one
45
Suicidal ideation meds
Antidepressants SSRIs MAOIs
46
MOA enzymes
Monoamine oxidase break down neurotransmitters (serotonin, norepinephrine, dopamine) MOAIs inhibit them
47
Foods to avoid with MAOIs
Tyramine (preservative) Aged cheese, fermented foods, beer, soy sauce
48
MAOIs and BP
orthostatic hypotension when initiating
49
MAOIs can lead to
Serotonin syndrome S/S confusion, restlessness, seating, muscle jerk movements
50
MAOIs side effects
Dry mouth Nervousness dizziness Sex problems ^BP Difficulty urinating Weight gain
51
All antidepressants take _ to work
2-4 weeks
52
Greatest risk of suicide with antidepressants occurs at
2 weeks PT now has energy to commit self harm
53
Major depressive disorder 101
2 or more weeks of sad mood or lack of interest in life AND
54
S/S of major depressive disorder
**Must have at least 4** Anhedonia Change in weight Change in sleep Drop in energy Drop in concentration Indecisiveness Suicidal ideation
55
How long does major depressive disorder last Most clear in
Few weeks to years 6 months
56
Cause of major depressive disorder
v in neurotransmitters risk ^ with fam history
57
Major depressive disorder meds
Tricyclic antidepressants MAOIs SSRIs Antipsychotics for psychotic features
58
Major depressive disorder therapy
Psychotherapy Electroconvulsive therapy
59
Tricyclic older antidepressants
Nortriptyline Amitriptyline Doxepin
60
Tricyclic antidepressants 101
Keep neurotransmitters available to brain Take 6 weeks to reach full effect Also used for panic disorder, obsessive-compulsive, eating disorders
61
TriCyclic Antidepressant Side-effects TCA'S
Thrombocytopenia Cardiac - arrhythmia, MI, stroke Anticholinergic - tachycardia, urinary retention Seizures
62
Tricyclic antidepressant side effects
Dry mouth Constipation Weight gain Blurred vision
63
Tricyclic antidepressant **contraindications**
Liver function Recent MI
64
Tricyclic antidepressants + MAOIs
SEROTONIN SYNDROME
65
Tricyclic antidepressants have anticholinergic side effects dont give to pt with
glaucoma benign prostatic hyperplasia urinary retention CVD kidney problems lung problems
66
Electroconvulsive therapy 101
Placing electrodes on clients head and delivering impulse Causes seizures Shock resets brain chemistry
67
When to resort to electroconvulsive therapy
When antidepressants don't work Actively suicidal
68
Electroconvulsive therapy regiment
6 to 15 times 3x a week
69
To receive improvement in depression, electroconvulsive therapy should be done at least Max benefits achieved at
6 times 12-15 times
70
Nursing for major depressive disorder
Get history Safety - ASK DIRECTLY "are you suicidal" Promote ADLs Self care - diet sleep hydration etc DO ONE TASK AT A TIME
71
Suicide and meds
Antidepressants will give pt the energy to follow through with suicide pt may also hide meds to attempt suicide later
72
Therapeutic comms for suicide
Verbalization of emotion Education - on illness and meds Follow up on appts
73
PT needs to be taught to ID
Signs of relapse, **get treatment immediately**
74
Suicide risk and antidepressants
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
Bipolar disorder 101
Mood disorder Recurrent depression and mania
76
Mania 101
Euphoric Grandiose Energetic Sleepless Poor judgment Rapid thoughts, actions, and speech
77
Depressed phase of bipolar
same as depression 2 or more weeks + 4 symptoms
78
Manic episode onset
sudden and rapid over a few days can last days to months
79
Psychotic manifestations with mania are more likely in
adolescents
80
At what age do manic episodes first occur
Teens 20s 30s
81
Bipolar types
Mixed I II
82
Bipolar mixed
Alternates between major depressive and manic has periods of normal behavior
83
Bipolar I
Mostly manic with at least 1 depressive episode
84
Bipolar II
Mostly depressive with at least 1 manic episode
85
Diagnosis of a manic episode
1 week of heightened activity grandiose/agitated mood and 3 or more S/S
86
Manic S/S
Exaggerated self esteem Pressured speech Distractibility Sleeplessness Flight of ideas
87
In manic phase, pt engages in
high risk activities involving poor judgment spending sprees, sex with strangers, impulsive investments
88
Bipolar meds
Antimanics - lithium Anticonvulsants - stabilize moods, protect cycle Antipsychotics - for psychosis
89
Lithium - Mood stabilizer 101
Reduces and sometimes can stop cycling between moods Lithium is NOT METABOLIZED, EXCRETED THROUGH URINE
90
Normal lithium serum range
0. 5-1.0 maintenance 0. 8-1.4 treatment above 1.5 TOXIC
91
Lithium serum toxicity S/S 1.5-2.0
N&V Diarrhea Poor coordination Drowsiness Slurred speech
92
Lithium serum toxicity S/S 2-3
Ataxia - lack of muscle control, spasms, hypertonia etc Blurred vision Tinnitis Pruritus Large urine output Incontinence bladder and bowel
93
Nurse interventions for lithium toxicity between 1.5-3.0
Stop med Call Dr. Prepare for gastric lavage Start IVs to maintain electrolytes
94
Lithium serum toxicity S/S 3.0 and above
Cardia arrhythmia Hypotension Peripheral vascular collapse Seizures Drop in LOC
95
Nursing interventions for lithium above 3.0
All previous plus **Aminophylline, mannitol or urea** to get rid of lithium Hemodialysis to remove lithium
96
What to monitor when lithium is above 3.0
Monitor resp, circulatory, thyroid, and immune systems
97
Anticonvulsant meds used as mood stabilizers
Gabapentin Carbamazepine Divalproex Topiramate
98
Common side effects for anticonvulsants
drowsiness sedation weakness/fatigue
99
Nursing - safety with anticonvulsants
Get up slow monitor hypotension
100
Antipsychotics 101
block dopamine reduce delusions and hallucinations
101
Antipsychotic meds
1st gen - thorazine 2nd gen - clozapine 3rd gen - aripiprazole
102
Side effects of antipsychotics
Dystonia - muscle contract repetitively, twisting movements Pseudo parkinsonism Tardive dyskinesia - involuntary movements of body and face Akathisia - inability to remain still
103
Psychotherapy and bipolar disorder
Used during depressive or normal phase combined with meds = reduces suicide and injury helps client and family
104
Nursing in depressive state of bipolar
Same as major depression history safety suicide watch promote ADLs promote self care - sleep, diet, exercise
105
Manic phase care for nursing
Use short sentences Remind client to respect distance High calorie finger foods Promote rest/sleep Decrease stimuli Protect client dignity
106
Bipolar - education for fam
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
Salt and lithium
Maintain same level Salt excess or depletion will affect lithium levels

S3 1538 (15 decks)

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