N121-M.H Exam 3

Ch. 22- (CLICKER QUESTION) Codependence

Shortly before kicking Antony out, his girlfriend had stayed home from a planned night out with her friends to pour all the alcohol in their apartment down the drain. What type of behavior is evident?

Ch.25-Identify comorbid psychiatric disorders that accompany suicidality

-46% of those who die by suicide have a diagnosed mental illness •Depressive disorder •Substance use •Psychosis -Risk for suicide •Anxiety disorders •Personality disorders •Eating disorders •Trauma-related disorders

Ch.14-Identify symptoms of disruptive mood dysregulation disorder, persistent depressive disorder (dysthymia) & premenstrual dysphoric disorder

*Disruptive Mood Dysregulation 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 *Persistent Depressive Disorder (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 *Premenstrual Dysphoric Disorder- -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

Ch.22-Define addiction, intoxication, tolerance, and withdrawal

-Addiction: is a chronic medical condition with roots in the environment, neurotransmission, genetics, and life experiences -Intoxication: the process of using a substance to excess -Tolerance: takes a higher dose to achieve the initial level of response -Withdrawal: symptoms that occur when a person stops using a substance

Ch.22-Describe alcohol intoxication, withdrawal, and treatment

-Alcohol Intoxication: legal definition if intoxication in most states: blood concentration of 80 or 100 mg. ethanol per deciliter of blood (0.08-0.10) -Alcohol Withdrawal: Shakes/Jitters (tremulousness) 6-8 hours after last use. *Alcohol withdrawal seizures 12-14 hours after cessation. *Alcohol withdrawal delirium is a medical emergency and occurs in the first 1-3 days or 24-72 hours -Cognitive Disturbances: Wernicke-Korsakoff -Alcohol Treatment: Pharmacotherapy, psychotherapy, motivation, support (Table 22.6, Pg. 425)

Ch.25-Discuss basic-level interventions to address suicidality in the hospital or in community settings

-Assessment--CUES: •Verbal and nonverbal clues •Overt statements •Covert statements/nonverbal cues •Lethality of suicide plan •History of attempts •Family history •Sudden switch from sad to happy mood •Social supports

Ch.22-Identify types of problematic drinking

-Binge Disorder: refers to drinking too much alcohol too quickly -Heavy Drinking: drinking too much too often

Ch.25-Discuss risk factors for the development of suicidal ideation and for suicide

-Biological Factors: •Familial tendency- •Higher among monozygotic (identical) twins •Importance of both genetic and epigenetic (external gene altering) factors. •Low serotonin levels -Cognitive Factors: •Freud—aggression turned inward •Menninger's three parts to suicide hostility- •Wish to kill •Wish to be killed •Wish to die •Aaron Beck—central emotional factor is hopelessness -Environmental Factors: •Family Conflict •Low Parental Monitoring •Clusters of Suicides: Contagion or Copycat Suicides •Teens at highest risk due to immature prefrontal cortex -Cultural Factors: •Religious Beliefs •Family Values •Sexual Orientation •Gender Identity •Bullying Behavior •Attitude Toward Death •Climbing Rates of Suicide in U.S. (1999-2017) •Increased for all races/ethnicities except non-Hispanic Asian or Pacific Islander groups -Social Factors: *Relationship problems *Recent or Imminent Crisis *Substance Abuse *Health Problems *Legal Problems *Loss of Housing -10 Major Risk Factors to assess suicidal potential: 1. Sex (Male) 2. Age 25-44 or 65+ Years 3. Depression 4. Previous Attempt 5. Ethanol Use 6. Rational Thinking Loss 7. Social Supports lacking or recent loss 8. Organized Plan 9. No Spouse 10. Sickness

Ch.14-Discuss brain therapies for major depressive disorder such as electroconvulsive therapy (ECT) and vagus nerve stimulation

-ECT: •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 (rTMS): •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 (VNS): •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 (DBS): •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 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 serotonin availability •Dampens HPA axis (thought to be overly active in depression)

Ch.14-Role play six principles of communication that are useful in working with patients with depression

-Help the patient question underlying assumptions and beliefs and consider alternate explanations to problems. -Work with the patient to identify cognitive distortions that encourage negative self appraisal. *For Example: Overgeneralizations,Self blame, Mind reading -Discounting of positive attributes. Encourage activities that can raise self-esteem. -Identify need for problem solving skills, coping skills, and assertiveness skills -Encourage exercise, such as running and/or weight lifiting -Encourage formation of supportive relationships such as support groups, therapy and peer support -Provide information referrals, when needed, for religious or spiritual information (readings, programs, tapes, community resources)

Ch.14-Name unrealistic expectations a nurse may have while working with a patient with depression and compare them in your own thoughts

-Patients with depression often reject advise, encouragement, and understanding of the nurse and others, and they often do not appear to respond to nursing interventions. -Nurse may experience feelings of frustration, hopelessness, and annoyance. These can be altered in the following ways: *Recognizing any unrealistic expectations for yourself or the patient-Identifying feelings that the patient may be experiencing -Understanding the roles biology and genetics play in precipitation and maintenance of a depressed mood.

Ch.14-Identify the major classifications of antidepressants and general advantages and disadvantages of each

-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

Ch. 14- (CLICKER QUESTION) Psychomotor retardation

A patient with major depression walks and moves slowly. Which term should the nurse use to document this finding?

Ch.22-Identify potential co-occurring substance use disorders and other psychiatric disorders

Co-Occurring Disorders may include any combination of two or more substance use disorders

Ch. 14- (CLICKER QUESTION) SSRI

Jeff was just diagnosed with a major depressive disorder. Which medication is the health care provider most likely to start the patient on?

Ch. 14- (CLICKER QUESTION) Anhedonia

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

Ch.14-Formulate five nursing diagnoses for a patient with major depressive disorder and include outcome criteria

Risk For Self-Directed Violence Risk For SuicideRisk For Self-Mutilation *S/S: Previous suicidal attempts, putting affairs in order, giving away prized possessions, suicidal ideation, feelings of worthlessness, hopelessness, and helplessness **Outcomes: Expresses feelings, verbalizes suicidal ideas, refrains from suicide attempts, plans for the future. *HopelessnessPowerlessness S/S: Feelings of hopelessness, helplessness, and powerlessness **Outcomes:Express hope for a positive future, believes that personal actions impact outcomes, demonstrates optimism and describes plans for the future>Self-Care Deficit>Self Neglect>Disturbed Sleep Pattern>Imbalanced Nutrition: less than body req. *Constipation *S/S: Vegetative signs of depression: Grooming and hygiene deficiencies, significantly reduced appetite, changes in sleeping, eating, elimination, and sexual patterns **Outcomes: Increases baseline personal care each day, reports adequate sleep, eating and elimination normalize, returns to a normal level of physiologic activity.

Ch. 14- (CLICKER QUESTION) Hypersomnia

Which assessment finding in a patient with major depression represents a vegetative sign?

Ch. 14- (CLICKER QUESTION) "You look really sad. Have you ever thought of harming yourself?"

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

Ch.14-Assess behaviors in a patient with depression in regard to each of the following area: behavior, mood, feelings and emotions, thought processes, and thought content perception

•Behavior/Affect: Anergia •Mood: Depressed mood and anhedonia •Emotions: Anxiety; feelings of worthlessness, hopelessness, guilt, anger, helplessness •Thoughts/Perceptions: delusions and/or hallucinations

Ch.25-Explain key elements of suicide precautions and environmental safety factors in the hospital

•Use (and count) plastic utensils •No private room; keep door open at all times. •Jump-proof and hang-proof bathrooms •Lock doors to non-patient areas •Monitor for and remove potentially harmful gifts. •In patient's presence, assess belongings and search patient for harmful objects. •Ensure that patients do not bring or leave harmful objects.