Depressive Disorders
Symptoms of depression
Anhedonia (lack of ability to experience pleasure) - fatigue - sleep disturbances (trouble sleeping or over sleeping) - changes in appetite feelings of hopelessness or worthlessness persistent thoughts of death or suicide inability to concentrate or make decisions - change in physical activity
Which question would be a priority when assessing for symptoms of major depression?
"You look really sad. Have you ever thought of harming yourself?"
other treatments for depression
- ECT (electroshock therapy) - transcranial magnetic stimulation - vagus nerve stimulation - deep brain stiumulation - light therapy - st. john's wort (do not mix this wit antidepressant - exercise
3 phases of depression
- acute phase (6-12 weeks) - continuation phase (4-9 mo) - maintenance phase (1+ years)
Areas to assess
- affect - thought processes - mood - feelings - physical behavior - communicaiton - religious beliefs and spirituality
side effects of ECT
- anesthesia (slight confusion) right after procedure - temporary confusion - headache (may give Darvicet, otherwise they are NPO)
what to promote:
- counseling and communication - health teaching and promotion - promotion of self-care activities - teamwork and safety
Biological factors
- genetic - biochemical (stressful events) - alterations in hormonal regulation - inflammatory process - diathesis stress model
planning geared towards
- patient's phase of depression - particular symptoms - patient's personal goals
contraindications for ECT
- recent MI - brain tumor, increased ICP from hydrocephalus for ex
evaulation
- suicide ideation - intake - sleep pattern - personal hygiene and grooming - self-esteem - social interaction with others
Nursing Diagnosis
-risk for suicide (safety is always highest priority) - hopelessness - ineffective coping - social isolation - spiritual distress - self care deficit
Psychological factors
cognitive theory learned helplessness
ECT - length of treatment
electroconvulsive therapy - consent form has to be signed - 6-8 treatments 3 times a week
ECT procedure
hooked up to EKG and EEG, pulse ox, BP machine and HR - bilateral or unilateral electrode on head - done after 5 minutes
Which assessment finding in a patient with major depression represents a vegetative sign?
hypersomnia
medication during ECT procedure
muscle paralyzer - mouth block in the mouth to prevent from biting tongue and keep airway open - causes them not to breath on their own - to keep patient from getting fractures and jerking around
Is ECT usually the first line of treatment?
no - will first go through a series of medications first
how does ECT work?
not exactly sure, causes grand mal seizures. theory is that it rearranges the neurotransmitters in the brain
what is ECT for?
patients with extremely psychotic/manic phases - most used for depressed patients - very well for elderly patients
Major Depressive Disorder
persistently depressed mood lasting a minimum of 2 weeks
A patient with major depression walks and moves slowly. Which term should the nurse use to document this finding?
psychomotor retardation
outcome identification recovery model
recovery model - focus on patient's strengths - treatment goals mutually developed - based on patient's personal values and needs
SSRI's
selective serotonin reuptake inhibitors - first line therpy for antidepressant
what medication is given before an ECT?
short acting sedative (sodium penatol or versed) - if asthma, will give them an inhaler before go under
improvement of ECT seen
usually in the first 2-3 days - meds will probably be continued