depressive disorders

medications for depression

-SSRIs- fluoxetine, citalopram, escitalopram, paroxetine, sertraline -atypical antidepressants- wellbutrin, venlafaxine, duloxetine, mirtazapine, reboxetine, trazodone -TCAs- amitriptyline, imipramine, doxepin, nortriptyline, amoxapine, trimipramine -MAOIs- phenelzine, isocarboxazid, tranylcypromine, selegiline- transdermal MAOI

depression

-a mood disorder that is a widespread issue, ranking high among causes of disability. serotonin deficiency or a norepinephrine deficiency are major risk factors. -family history, twice as common in females between the ages of 15 and 40 than in males, over age 65. -a client who has depression has a potential risk for suicide, especially if he has a family or personal history of suicide attempts, comorbid anxiety disorder or panic attacks, comorbid substance use disorder or psychosis, poor self-esteem, a lack of social support, or a chronic medical condition.

major depressive disorder

-a single episode or recurrent episodes of unipolar depression resulting in a significant change in a client's normal functioning accompanied by at least five of the following specific clinical findings, which must occur almost every day for a minimum of 2 weeks, and last most of the day (depressed mood, difficulty sleeping or excessive sleeping, indecisiveness, decreased ability to concentrate, suicidal ideation, increase or decrease in motor activity, inability to feel pleasure, increase or decrease in weight of more than 5% of total body weight over 1 month)

nursing care for a depressed patient

-assess suicide risk -establish trusting and respectful relationships -therapy/therapeutic communication/active listening -maintain a safe environment -medications -alternative or complementary therapies -light therapy -electroconvulsive therapy, transcranial magnetic stimulation -vagus nerve stimulation

forms of depression

-dysthymic disorder is a milder form of depression that usually has an early onset, such as in childhood or adolescence, and lasts at least 2 years in length for adults. dysthymic disorder contains at least three clinical findings of depression and may, later in life, become major depressive disorder. -premenstrual dysphoric disorder is a depressive disorder associated with the luteal phase of the menstrual cycle. primary manifestations include emotional lability and persistent or severe anger and irritability. other manifestations include a lack of energy, overeating, and difficulty concentrating.

c the client is at greatest risk for suicide during the acute phase of MDD.

a charge nurse is discussing the care of a client who has major depressive disorder with a newly licensed nurse. which of the following statements by the newly licensed nurse indicates an understanding of the teaching? a) "care during the continuation phase focuses on treating continued manifestations of MDD." b) "the treatment of MDD during the maintenance phase lasts for 6 to 12 weeks." c) "the client is at greatest risk for suicide during the first weeks of an MDD episode." d) "medication and psychotherapy are most effective during the acute phase of MDD."

4 a client with depression often is withdrawn while experiencing difficulty concentrating, loss of interest or pleasure, low energy, fatigue, and feelings of worthlessness and poor self-esteem. the plan of care needs to provide successful experiences in a stimulating yet structured environment.

a client is admitted to the mental health unit with a diagnosis of depression. the nurse should develop a plan of care for the client that includes which intervention? 1) encouraging quiet reading and writing for the first few days 2) identification of physical activities that will provide exercise 3) no socializing activities until the client asks to participate in milieu 4) a structured program of activities in which the client can participate

b, c, d, e depressive disorders are more common in a client who has a chronic medical condition. depressive disorders are more likely to occur in a client who is experiencing a high amount of stress or in a client who has a family history of depression. a history of an anxiety or personality disorder increases a client's risk for depressive disorder.

a nurse is caring for a client who has major depressive disorder. which of the following should the nurse identify as a risk factor for depression? (select all that apply.) a) male sex b) history of chronic bronchitis c) recent death in client's family d) family history of depression e) personal history of panic disorder

c manifestations of persistent depressive disorder last for at least 2 years in adults.

a nurse is interviewing a client who has a new diagnosis of persistent depressive disorder. which of the following findings should the nurse expect? a) wide fluctuations in mood b) report of a minimum of five clinical findings of depression c) presence of manifestations for at least 2 years d) inflated sense of self-esteem

assessment

subjective data: -anergia -anhedonia -anger -hopelessness -reports of sluggishness, or feeling unable to relax and sit still -change in bowel habits, sleep disturbances, and decreased interest in sexual activity -somatic reports, such as fatigue, gastrointestinal changes, pain objective data: -affect- the client most often looks sad with blunted affect. -the client exhibits poor grooming and lack of hygiene. -psychomotor retardation is more common, but psychomotor agitation can also occur. -the client becomes socially isolated, showing little or no effort to interact. -slowed speech, decreased verbalization, delayed response- the client may seem too tired to even speak.

nursing administration

suicide prevention is facilitated by prescribing a week's worth of medication for an acutely ill client, and following that, only prescribing 1 month's worth of medication at a time -instruct the client to take antidepressant medication as prescribed on a daily basis to establish therapeutic plasma levels. -assist with the client's medication regimen compliance by informing the client that therapeutic effects may not be experienced for 1 to 3 weeks. full therapeutic effects may take 2 to 3 months. -instruct the client to continue therapy after improvement in manifestations. sudden discontinuation of the medication can result in relapse. -advise the client that therapy usually continues for 6 months after resolution of manifestations, and it may continue for a year or longer.

c a clinical finding of PMDD is emotional lability. the client can experience rapid changes in mood.

a nurse is teaching a client who has a new diagnosis of premenstrual dysphoric disorder. which of the following statements by the client indicates understanding of the teaching? a) "i can expect my problems with PMDD to be worst when i'm menstruating." b) "i should avoid exercising when i am feeling depressed." c) "i am aware that my PMDD causes me to have rapid mood swings." d) "i should increase my caloric intake with a nutritional supplement when my PMDD is active."

a the greatest risk for a client who has MDD and comorbid anxiety is injury due to self-harm. the highest priority intervention is placing the client on one-to-one observation.

a nurse working on an acute mental health unit is admitting a client who has major depressive disorder and comorbid anxiety disorder. which of the following actions is the nurse's priority? a) placing the client on one-to-one observation b) assisting the client to perform ADLs c) encouraging the client to participate in counseling d) teaching the client about medication adverse effects