Week 2 - Depression Flashcards by Sasha K.

Depressive Disorders

All share symptoms of: Sadness, emptiness, irritability, somatic (body) concerns, and impairment of thinking

All impact a person’s ability to __________

All share symptoms of: Sadness, emptiness, irritability, somatic (body) concerns, and impairment of thinking

All impact a person’s ability to function

How well did you know this?

Not at all

Perfectly

Depressive Disorders Classification

Major depressive disorder

Others>
Disruptive mood dysregulation disorder
Persistent depressive disorder (previously dysthymia)
Premenstrual dysphoric disorder
Substance/medication-induced depressive disorder
Depressive disorder due to another medical condition

Major depressive disorder

How well did you know this?

Not at all

Perfectly

Disruptive Mood __________ Disorder

-Diagnosed in children ages 6 to 18

Symptoms
-Constant and severe irritability and anger
-Temper tantrums out of proportion to the situation at least 3 times per week
-Exhibits symptoms in at least two settings: home, school, and with peers

Management
-Symptomatic medications; CBT & parent training & facial expression recognition training

Dysregulation

How well did you know this?

Not at all

Perfectly

Persistent Depressive Disorder

Formerly known as ________

Low-level depressive feelings through most of each day, for the majority of days
>At least ______ in adults
> At least 1 year in children and adolescents

Must have two or more of the following:
-Decreased appetite or overeating, insomnia or hypersomnia, low energy, poor self-esteem, difficulty thinking, and hopelessness

Persistent Depressive Disorder

Formerly known as dysthymia

Low-level depressive feelings through most of each day, for the majority of days
>At least 2 years in adults
> At least 1 year in children and adolescents

Must have two or more of the following:
-Decreased appetite or overeating, insomnia or hypersomnia, low energy, poor self-esteem, difficulty thinking, and hopelessness

How well did you know this?

Not at all

Perfectly

Premenstrual Dysphoric Disorders

Symptom cluster in last week prior to onset of a ________; include
>Mood swings, irritability, depression, anxiety, feeling overwhelmed, and difficulty concentrating

Symptoms decrease significantly or disappear with the onset of __________

Symptom cluster in last week prior to onset of a woman’s period; include
>Mood swings, irritability, depression, anxiety, feeling overwhelmed, and difficulty concentrating

Symptoms decrease significantly or disappear with the onset of menstruation

How well did you know this?

Not at all

Perfectly

Substance-induced depressive disorder

Person does not experience depressive symptoms in the absence of ______________________

drug or alcohol use or withdrawal

How well did you know this?

Not at all

Perfectly

Depressive disorder associated with another medical condition

CVA, Parkinson’s Huntington’s, Alzheimer’s, TBI, Cushing’s disease, hypothyroidism, arthritis, back pain, metabolic conditions, HIV, diabetes, infection, cancer, and autoimmune problems

How well did you know this?

Not at all

Perfectly

Major Depressive Disorder

____ (or more) of the following in 2-week period

Weight and appetite changes
Sleep disturbances
Fatigue
Worthlessness or guilt
Loss of ability to concentrate
Recurrent thoughts of death
Psychomotor agitation

PLUS—at least one symptom is also either
-Depressed mood or
-Loss of interest or pleasure (anhedonia)

Five (or more) of the following in 2-week period

Weight and appetite changes
Sleep disturbances
Fatigue
Worthlessness or guilt
Loss of ability to concentrate
Recurrent thoughts of death
Psychomotor agitation

PLUS—at least one symptom is also either
-Depressed mood or
-Loss of interest or pleasure (anhedonia)

How well did you know this?

Not at all

Perfectly

Major Depressive Disorder (Cont.)

-Persistent for minimum ______ - ______
-Chronic: Lasting more than ___ years
-Recurrent episodes common
-Symptoms cause distress or impaired function
-Episode not attributed to physiological effects
-Absence of a manic or hypomanic episode

-Persistent for minimum 2 weeks to 6 months
-Chronic: Lasting more than 2 years
-Recurrent episodes common
-Symptoms cause distress or impaired function
-Episode not attributed to physiological effects
-Absence of a manic or hypomanic episode

How well did you know this?

Not at all

Perfectly

Depression Epidemiology

Leading cause of __________ in the United States
>Children and adolescents
>Older adults

Comorbidity
>Combination of anxiety and depression is perhaps one of the most common

Leading cause of disability in the United States
>Children and adolescents
>Older adults

Comorbidity
>Combination of anxiety and depression is perhaps one of the most common

How well did you know this?

Not at all

Perfectly

Jeff’s parents have described his lack of interest in things he used to enjoy, like games with his friends, and his classes, which he used to like. This may be best described by the term

Inappetance

Impetance

Indolence

Anhedonia

How well did you know this?

Not at all

Perfectly

Depression risk factors

Biological factors
>Genetic (first-degree family members)
>Biochemical
…>Stressful life events
-Hormonal
-Inflammatory
-Diathesis-stress model
>Interplay between genetic and biological
-Cognitive

How well did you know this?

Not at all

Perfectly

More risk factors of depression

-________ gender
-Adverse childhood experiences
-Stressful life events
-Neuroticism
-Other disorders, such as substance use, anxiety, and personality disorders
-Chronic or disabling medical conditions

-Female gender
-Adverse childhood experiences
-Stressful life events
-Neuroticism
-Other disorders, such as substance use, anxiety, and personality disorders
-Chronic or disabling medical conditions

How well did you know this?

Not at all

Perfectly

Depression - assessment

-Assessment of suicidality
-Self-assessment
-Behavior/Affect: Anergia
-Mood: Depressed mood and anhedonia
-Emotions: Anxiety; feelings of worthlessness, hopelessness, guilt, anger, helplessness
-Thoughts/Perceptions: delusions and/or hallucinations
-Comorbidity: chronic pain (sometimes)

How well did you know this?

Not at all

Perfectly

Depression - Self-Assessment

Patients with depression: Often reject the advice, encouragement, and understanding

A nurse’s best response:
-Recognize unrealistic expectations for yourself or the patient
-Identify feelings that originate with the patient
-Understand the roles biology and genetics play in major depressive disorder

Patients with depression: Often reject the advice, encouragement, and understanding

How well did you know this?

Not at all

Perfectly

Which question would be a priority when assessing for symptoms of major depression?

“Tell me about any special powers you believe you have.”

“You look really sad. Have you ever thought of harming yourself?”

“Your family says you never stop. How much sleep do you get?”

Do you ever find that you don’t remember where you’ve been or what you’ve done?”

“You look really sad. Have you ever thought of harming yourself?”

How well did you know this?

Not at all

Perfectly

Depression - Nursing diagnosis

-Risk for suicide—safety is always the highest priority
-Chronic low self-esteem
-Imbalanced nutrition
-Constipation
-Disturbed sleep pattern
-Ineffective coping
-Disabled family coping

How well did you know this?

Not at all

Perfectly

Depression - Outcomes identification

Recovery model
>Focus on patient’s strengths
>Treatment goals mutually developed
>Based on patient’s personal needs and values

How well did you know this?

Not at all

Perfectly

Depression

Implementation (Cont)
-Counseling and communication
-Health teaching and health promotion
-Promotion of self-care activities
-Teamwork and safety

Evaluation
-Tailored to each patient’s unique presentation
-Basic self-care, thought processes, self-esteem, and social interactions

Implementation (Cont)
-Counseling and communication
-Health teaching and health promotion
-Promotion of self-care activities
-Teamwork and safety

Evaluation
-Tailored to each patient’s unique presentation
-Basic self-care, thought processes, self-esteem, and social interactions

How well did you know this?

Not at all

Perfectly

Communication Techniques

-Use simple, concrete words
-Allow time for a response
-Listen for covert messages
-Ask about suicide plans
-Avoid platitudes

When a patient is silent:
-Avoid direct questions
-Make observations to reinforce reality

-Use simple, concrete words
-Allow time for a response
-Listen for covert messages
-Ask about suicide plans
-Avoid platitudes

When a patient is silent:
-Avoid direct questions
-Make observations to reinforce reality

How well did you know this?

Not at all

Perfectly

Evaluation

-Tailored to each patient’s unique presentation

-Basic self-care, thought processes, self-esteem, and social interactions

-Tailored to each patient’s unique presentation

-Basic self-care, thought processes, self-esteem, and social interactions

How well did you know this?

Not at all

Perfectly

Choosing an antidepressant

-Symptom profile of the patient
-Side-effect profile (e.g., sexual dysfunction, weight gain)
-Ease of administration
-History of past response
-Safety and medical considerations

How well did you know this?

Not at all

Perfectly

Antidepressants

Selective serotonin reuptake inhibitors (SSRIs)
> __________ therapy
>Rare risk of serotonin syndrome

Serotonin norepinephrine reuptake inhibitors (SNRIs)
>SSRIs may be tolerated better

Tricyclic antidepressants
>Anticholinergic adverse reactions

Monoamine oxidase inhibitors
>Effective for unconventional depression

Selective serotonin reuptake inhibitors (SSRIs)
>First-line therapy
>Rare risk of serotonin syndrome

Serotonin norepinephrine reuptake inhibitors (SNRIs)
>SSRIs may be tolerated better

Tricyclic antidepressants
>Anticholinergic adverse reactions

Monoamine oxidase inhibitors
>Effective for unconventional depression

How well did you know this?

Not at all

Perfectly

Newer Antidepressants

-Serotonin antagonists and reuptake inhibitors (SARIs)

-Norepinephrine dopamine reuptake inhibitor (NDRI)

-Noradrenergic and specific serotonergic antidepressant (NaSSA)

Two Other New Drugs for MDD
>Esketamine: an N-methyl-D-aspartate (NMDA) receptor antagonist an N-methyl-D-aspartate (NMDA) receptor antagonist
>Brexanolone (Zulresso): first and only FDA-approved medication specifically for postpartum depression

-Serotonin antagonists and reuptake inhibitors (SARIs)

-Norepinephrine dopamine reuptake inhibitor (NDRI)

-Noradrenergic and specific serotonergic antidepressant (NaSSA)

How well did you know this?

Not at all

Perfectly

Jeff was just diagnosed with a major depressive disorder. Which medication is the health care provider most likely to start the patient on? SSRI SNRI Tricyclic antidepressant Monoamine oxidase inhibitor

SSRI

Plan patient and family education to discuss what _________ pt might experience on his new medication regimen.

side effects

Other treatments for depression Integrative Medicine > St. John’s wort Brain Stimulation Therapies >ECT >Repetitive ranscranial magnetic stimulation (rTMS) >Vagus nerve stimulation (VNS) >Deep brain stimulation (DBS) Light therapy Exercise

Integrative Medicine > St. John’s wort Brain Stimulation Therapies >ECT >Repetitive ranscranial magnetic stimulation (rTMS) >Vagus nerve stimulation (VNS) >Deep brain stimulation (DBS) Light therapy Exercise

St. John’s Wort Flower processed into tea or tablets Thought to increase serotonin, nerepinephrin, and dopamine in the brain Useful in mild to moderate depression

Flower processed into tea or tablets Thought to increase serotonin, nerepinephrin, and dopamine in the brain Useful in mild to moderate depression

Electroconvulsive Therapy The most __________ depression treatment Psychotic illnesses = second most common indication ECT the primary treatment in -Severe malnutrition, exhaustion, and dehydration due to lengthy depression -Safer than meds with certain medical conditions -Delusional depression -Failure of previous medication trials -Schizophrenia with catatonia

The most effective depression treatment Psychotic illnesses = second most common indication ECT the primary treatment in -Severe malnutrition, exhaustion, and dehydration due to lengthy depression -Safer than meds with certain medical conditions -Delusional depression -Failure of previous medication trials -Schizophrenia with catatonia

Repetitive Transcranial Magnetic Stimulation -Noninvasive -Uses MRI-strength magnetic pulses to ________ focal areas of the cerebral cortex -Presence of metal is main contraindication Adverse reactions -Headache and lightheadedness -No neurological deficits or memory problems -Seizures rarely -Most are mild and include scalp tingling and discomfort at the administration site.

-Noninvasive -Uses MRI-strength magnetic pulses to stimulate focal areas of the cerebral cortex -Presence of metal is main contraindication Adverse reactions -Headache and lightheadedness -No neurological deficits or memory problems -Seizures rarely -Most are mild and include scalp tingling and discomfort at the administration site.

Vagus Nerve Stimulation Originally used to treat epilepsy Decreases seizures and improves mood Electrical stimulation boosts the level of neurotransmitters Side effects -Voice alteration (nearly 60% of patients) -Neck pain, cough, paresthesia, and dyspnea, which tend to decrease with time

Originally used to treat epilepsy Decreases seizures and improves mood Electrical stimulation boosts the level of neurotransmitters Side effects -Voice alteration (nearly 60% of patients) -Neck pain, cough, paresthesia, and dyspnea, which tend to decrease with time

Deep Brain Stimulation Surgically implanted electrodes (in the brain) Stimulates those regions identified as underactive in depression More invasive than VNS > Electrodes placed directly into the brain

Surgically implanted electrodes (in the brain) Stimulates those regions identified as underactive in depression More invasive than VNS > Electrodes placed directly into the brain

Light Therapy First-line treatment for _________________ Efficacy due to influence of light on melatonin Effective as medication for SAD Negative effects: headache and jitteriness

First-line treatment for seasonal affective disorder (SAD) Efficacy due to influence of light on melatonin Effective as medication for SAD Negative effects: headache and jitteriness

Exercise Biological, social, and psychological effects Increases _________ availability Dampens HPA axis (thought to be overly active in depression)

Biological, social, and psychological effects Increases serotonin availability Dampens HPA axis (thought to be overly active in depression)

Advanced Practice Interventions Psychological therapies -Cognitive-behavioral therapy (CBT) -Interpersonal therapy (IPT) -Time-limited focused psychotherapy -Behavior therapy Group therapy

Psychological therapies -Cognitive-behavioral therapy (CBT) -Interpersonal therapy (IPT) -Time-limited focused psychotherapy -Behavior therapy Group therapy

A patient with major depression walks and moves slowly. Which term should the nurse use to document this finding? Psychomotor retardation Psychomotor agitation Vegetative sign Anhedonia

Psychomotor retardation

Which assessment finding in a patient with major depression represents a vegetative sign? Restlessness Hypersomnia Feelings of guilt Frequent crying

Hypersomnia

Subsyndromal depression primarily occurs in which population? Adults Older adults Children Teenagers

Older adults

Dysthymia cannot be diagnosed unless it has existed for which length of time? At least 1 year At least 2 years At least 6 months At least 3 months

At least 2 years

It is likely that a patient diagnosed with seasonal affective disorder will begin to experience fewer symptoms beginning in which season? Fall Winter Spring Summer

Spring

Which neurotransmitter is considered a main regulator of mood? Select all that apply. One, some, or all responses may be correct. Acetylcholine Dopamine Glutamate Norepinephrine Serotonin

Norepinephrine Serotonin

Which food is safe for a patient taking monoamine oxidase inhibitors (MAOIs)? Avocados Pineapple Chocolate Cheddar cheese

Pineapple

Amitriptyline is a tricyclic antidepressant (TCA); these drugs are known to be _____ in smaller doses than other antidepressants.

lethal

A patient with depression is prescribed tricyclic antidepressants (TCAs). Which appropriate advice would the nurse give to the patient's family? This medication is contraindicated with cataracts. Do not give full dose to the patient at bedtime. Advise the patient to be cautious while driving. Double the dose if the patient forgets to take the bedtime dose.

Advise the patient to be cautious while driving. TCAs cause side effects such as blurred vision, drowsiness, or dizziness. So the patient must be advised to be cautious while crossing the road, driving, or working with machines. TCAs are contraindicated in patients with glaucoma. The patient must take a full dose at bedtime, so that the side effects are less during the day. If the patient forgets to take the dose, the next dose should be taken at the scheduled time. A double dose should be avoided.

A patient who has been assessed by the nurse as moderately depressed is given a prescription for daily doses of a selective serotonin reuptake inhibitor. The patient mentions, "I will take the medication along with the St. John's wort that I take daily." The nurse would take which action? Explain the high possibility of an adverse reaction. Suggest that the patient also use a sun lamp daily. Caution the patient to drink several glasses of water daily. Agree that taking the drugs at the same time will help the patient to remember them daily.

Explain the high possibility of an adverse reaction. Serious adverse reactions are a possibility if St. John's wort is taken with other antidepressants. There is no rationale for using a sun lamp or taking extra water. St. John’s wort should not be taken with other antidepressants.

The nurse cares for a patient diagnosed with major depressive disorder. Assessment findings include psychosis and repeated threats to self-harm, including access to a cache of narcotic pain relievers. Which treatment modality is likely for this patient? Light therapy St. John's wort Electroconvulsive therapy (ECT) Cognitive-behavioral therapy (CBT)

Electroconvulsive therapy (ECT)

A nurse counsels a patient diagnosed with depression to begin a mild exercise regime. Which physiological basis supports the nurse's recommendation? Exercise reduces inflammation. Exercise stimulates serotonin production. Exercise will stabilize the client's sleep pattern. Exercise eliminates toxins from the client's body.

Exercise stimulates serotonin production.

Which individual demonstrates the greatest risk for experiencing major depression? A male teenager who failed to make the football team A female young adult who recently gave birth to her first child An older adult woman who retired after 25 years of factory work A middle-aged man who is a self-employed small business owner

A female young adult who recently gave birth to her first child Among women, rates peak between adolescence and early adulthood. It is particularly important to screen for depression among women of reproductive age, especially those who have children or plan to become pregnant. Although the male teenager and the retired woman do have characteristics that put them at risk for depression (e.g., disappointment, being a teenager, retirement, being female), they are less at risk than the female young adult who recently gave birth. The middle-aged man’s risk for major depression is relatively small.

Which risk factor would likely result in a diagnosis of major depressive disorder? Neuroticism Parents’ divorce Optimal physical health A cousin with depression

Neuroticism Neuroticism is a negative personality trait often seen in patients with major depressive disorder. A divorce of the parents may have an effect on a child, but it is less of a risk factor than neuroticism. Physical health would be a factor if the patient was in poor health. Family history generally only extends to first-degree family members.

A client was diagnosed with seasonal affective disorder (SAD). During which month would this client’s symptoms be most acute? June April January September

January The days are short in January, so the client would have the least exposure to sunlight. SAD is associated with disturbances in circadian rhythm. Days are longer in spring, summer, and fall.

A client diagnosed with depressive disorder begins selective serotonin reuptake inhibitor (SSRI) antidepressant therapy. What information should the nurse provide to the client and family? Need to restrict sodium intake to 1 gram daily. Importance of maintaining a tyramine-free diet. Importance of reporting increased suicidal thoughts. Need to minimize exposure to bright sunlight.

Importance of reporting increased suicidal thoughts.

An adult diagnosed with major depressive disorder was treated with medication and cognitive-behavioral therapy. The client now recognizes how passivity contributed to the depression. Which intervention should the nurse suggest? Social skills training Relaxation training classes Desensitization techniques Use of complementary therapy

Social skills training

A client diagnosed with major depressive disorder repeatedly tells staff, “I have cancer. It’s my punishment for being a bad person.” Diagnostic tests reveal no cancer. What is the priority nursing diagnosis? Spiritual distress Stress overload Risk for suicide Powerlessness

Risk for suicide

A nurse provided medication education for a client diagnosed with major depressive disorder who began a new prescription for phenelzine. Which behavior indicates effective learning? The client can identify foods with high selenium content that should be avoided. wears support stockings and elevates the legs when sitting. monitors sodium intake and weight daily. confers with a pharmacist when selecting over-the-counter medications.

confers with a pharmacist when selecting over-the-counter medications.

A client diagnosed with major depressive disorder began taking escitalopram 5 days ago. The client now says, “This medicine isn’t working.” What is the nurse’s best intervention? explain the time lag before antidepressants relieve symptoms. discuss with the health care provider the need to increase the dose. reassure the client that the medication will be effective soon. critically assess the client for symptoms of improvement.

explain the time lag before antidepressants relieve symptoms.

Which documentation for a client diagnosed with major depressive disorder indicates the treatment plan was effective? Slept 5 hours with brief interruptions. Personal hygiene adequate with assistance. Weight loss of 1 pound. Slept 6 hours uninterrupted. Sang with activity group. Anticipates seeing grandchild. Slept 7 hours uninterrupted. Preoccupied with perceived inadequacies. States, “I feel tired all the time.” Slept 10 hours uninterrupted. Attended craft group; stated “project was a failure, just like me.”

Slept 6 hours uninterrupted. Sang with activity group. Anticipates seeing grandchild.

What is the focus of priority nursing interventions for the period immediately after electroconvulsive therapy (ECT) treatment? Assisting the client to identify and test negative thoughts Supporting physiological stability Nutrition and hydration Reducing disorientation and confusion

Supporting physiological stability

When counseling clients diagnosed with major depressive disorder, what therapy would an advanced practice nurse address the client’s negative thought patterns? cognitive-behavioral desensitization alternative and complementary psychoanalytic

cognitive-behavioral

A nurse taught a client about a tyramine-restricted diet. Which menu selection would the indicate the client understood the information? Noodles with cheddar cheese sauce, smoked sausage, lettuce salad, yeast rolls Avocado salad, ham, creamed potatoes, asparagus, chocolate cake Mashed potatoes, ground beef patty, corn, green beans, apple pie Macaroni and cheese, hot dogs, banana bread, caffeinated coffee

Mashed potatoes, ground beef patty, corn, green beans, apple pie The correct answer describes a meal that contains little tyramine. Vegetables and fruits contain little or no tyramine. Fresh ground beef and apple pie are safe. The other meals contain various amounts of tyramine-rich foods or foods that contain vasopressors: avocados, ripe bananas (banana bread), sausages/hot dogs, smoked meat (ham), cheddar cheese, yeast, caffeine drinks, and chocolate.

Major depressive disorder resulted after a client’s employment was terminated. The client now says to the nurse, “I’m not worth the time you spend with me. I am the most useless person in the world.” Which nursing diagnosis applies? Situational low self-esteem Defensive coping Powerlessness Disturbed personal identity

Situational low self-esteem

A nurse worked with a client diagnosed with major depressive disorder, severe withdrawal, and psychomotor retardation. After 3 weeks, the client did not improve. The nurse is most at risk for what feelings? over-involvement. guilt and despair. interest and pleasure. ineffectiveness and frustration.

ineffectiveness and frustration.

A client diagnosed with major depressive disorder is receiving imipramine 200 mg at bedtime. Which assessment finding would prompt the nurse to collaborate with the health care provider regarding potentially hazardous side effects of this drug? Dry mouth Nasal congestion Urinary retention Blurred vision

Urinary retention

A client diagnosed with major depressive disorder says, “No one cares about me anymore. I’m not worth anything.” Today the client is wearing a new shirt and has neat, clean hair. Which remark by the nurse supports building a positive self-esteem for this client? “You look nice this morning.” “You’re wearing a new shirt.” “You must be feeling better today.” “I like the shirt you are wearing.”

“You’re wearing a new shirt.” Clients with depression usually see the negative side of things. The meaning of compliments may be altered to “I didn’t look nice yesterday” or “They didn’t like my other shirt.” Neutral comments such as making an observation avoid negative interpretations. Saying, “You look nice” or “I like your shirt” gives approval (nontherapeutic techniques). Saying “You must be feeling better today” is an assumption, which is nontherapeutic.

A client diagnosed with major depressive disorder began taking a tricyclic antidepressant 1 week ago. Today the client says, “I don’t think I can keep taking these pills. They make me so dizzy, especially when I stand up.” The nurse will implement which intervention? teach the client strategies to manage postural hypotension. limit the client’s activities to those that can be performed in a sitting position. withhold the drug, force oral fluids, and notify the health care provider. update the client’s mental status examination.

teach the client strategies to manage postural hypotension.

Transcranial Magnetic Stimulation (TCM) is scheduled for a client diagnosed with major depressive disorder. Which comment by the client indicates teaching about the procedure was effective? “I will be unable to care for my children for about 2 months.” “They will put me to sleep during the procedure, so I won’t know what is happening.” “I might be a little dizzy or have a mild headache after each procedure.” “I will avoid eating foods that contain tyramine.”

“I might be a little dizzy or have a mild headache after each procedure.”

A client diagnosed with major depressive disorder received six electroconvulsive therapy (ECT) sessions and aggressive doses of antidepressant medication. The client owns a small business and was counseled not to make major decisions for a month. What is the correct rationale for this counseling? Antidepressant medications alter catecholamine levels, which impairs decision-making abilities. Antidepressant medications may cause confusion related to limitation of tyramine in the diet. The client needs time to readjust to a pressured work schedule. Temporary memory impairments and confusion may occur with ECT.

Temporary memory impairments and confusion may occur with ECT.

A nurse instructs a client taking a medication that inhibits the action of monoamine oxidase (MAO) to avoid certain foods and drugs because of the risk of what? hypotensive shock. hypertensive crisis. cardiogenic shock. cardiac dysrhythmia.

hypertensive crisis.