Mental Health Chapter 11, 12, 13
who is considered a survivor of suicide and what are they at risk for?
-family and friends of anyone who commits suicide -they are at risk for long term emotional distress, especially related to guilt and anger
What is the the therapeutic level for most pts?
0.5-1.2 mEq/L
What are some common nursing diagnoses for patients with bipolar disorder?
1. Anxiety 2. Ineffective coping 3. Imbalanced nutrition; less than body requirements 4. Self-care deficit 5. Sleep pattern disturbed 6. Thought process disturbed
What are some nursing interventions for pts with depressive disorders?
1. Identify small, achievable goals the patient can meet. 2. Encourage pt to speak about his/her concerns without judgement 3. encourage independence 4. Avoid activities that might tax memory or concentration 5. Monitor for compliance with meds 6. Encourage participation in activities 7. Promote a trusting relationship 8. Encourage the pt to challenge negative thoughts 9. Promote physical activity where possible 10. Promote self-esteem *********IF PATIENT GIVES ANY CLUES OF CONTEMPLATING SUICIDE, NOTIFY OTHER TEAM MEMBERS AND THE PHYSICIAN IMMEDIATELY.
What are some primary interventions for a patient in mania?
1. Maintenance of safety 2. promotion of health 3. medication compliance
If your patient's serum level is 1.5-2.0 some symptoms of toxicity would be:
1. blurred vision 2. ataxia ( can't walk straight) 3. tinnitus (ringing in the ears) 4. n/v/d
Leading to toxicity the blood levels can become elevated in
1. dehydration 2. profuse sweating 3. chronic diarrhea
If the patient's serum level is 2.0-3.5 symptoms of toxicity would be:
1. excessive output of dilute urine 2. increased tremors 3. muscle irritability 4. confusion
what are some nursing interventions for a patient that is considered suicidal?
1. monitoring frequently 2. safety and keeping any potentially harmful objects away from the patient 3. communication 4. suicide contracts to inform the caregivers before taking any action to harm themselves 5. discharge planning and follow up appointments
If the your patient's serum level is greater than 3.5 symptoms of toxicity would be?
1. seizures 2. coma 3. oliguria (not peeing at all) 4. arrhythmias 5. cardiovascular collapse
What can Lithium toxicity cause?
1. tremors 2. confusion 3. seizures 4.coma 5. death
How long do symptoms have to last to receive a diagnosis of major depressive disorder?
2 weeks - but often last much longer
what is the age group has the highest rates for suicide?
45-54
What are some medical conditons associated with depression?
***STROKE***(ESPECIALLY FRONTAL LESIONS) Heart attack dementia adrenal disorders diabetes cancer hypothyroidism brain tumors parkinson's disease multiple sclerosis chronic pain chronic kidney disease
Anticonvulsant drugs have an adverse effect of ______________
INCREASED RISK OF SUICIDE. ***MONITOR YOUR PATIENT CLOSELY FOR WORSENING DEPRESSION AND SUDICIDAL THOUGHTS/BEHAVIORS
Postpartum onset depression is classified as____________
a major depressive disorder with the same classic cluster of symptoms with the addition of lack of interest in the baby which can progress to rejection of the baby and lead to a psychotic state
What happens in hypomania phase?
a person may be highly productive, so this disorder might not get diagnosed.
EXAMPLES OF TRICYCLICS
amitriptyline (Elavil) nortriptyline (Pamelor) desipramine (Norpramine)
What kind of nutritonal therapy may help a patient with mild depression?
avoiding caffeine, sugar, and alcohol or adding servngs of whole grains and veggies.
what predominates as the cause of bipolar disorder?
biological theories
Antidepressants are also used to treat depression associated with
bipolar disorders, schizophrenia, and dementia
What should the nurse monitor for in pts receiving Lithium.
blood levels for toxicity
What is Bipolar I disorder?
classic image of bipolar disorder-a full syndrome of manic symptoms and most likely depression episodeds
What can depressive disorders contribute to in the elderly?
confusion and social withdrawal and can lead to a misdiagnosis of dementia ( sometimes called pseudodementia) These pts need multidiciplinary assessment to obtain correct diagnosis and treatment.
Depressive disorders all have similar symptoms, but how do they vary?
duration, timing, and presumed etiology
What are some clues that the patient may have bipolar disorder?
early onset, family history, recurrent depressions, repeated loss of efficacy of antidepressants, and hyperactivity during depressive episodes
What are some symptoms of the manic phase?
easily distracted little need for sleep (pt may feel rested after 3hrs of sleep) poor temper control, easily agitated and irritable reckless behavior and lack of self-control (drinking/drugs, binge eating Poor judgement sex with many partners spending sprees elevated mood hyperactive increased energy racing thoughts, ideas excessive talking high self-esteem very involved in activities
When severely depressed patients do not respond to drugs or psychotherapeutic approaches what kind of therapy maybe suggested?
electroconvulsive therapy
what does short term cognitive behavioral therapy do?
helps to develop new strategies to alter negative thinking
Common nursing diagnoses in those at risk for suicide:
hopelessness violence to self anxiety ineffective coping disturbed self concept spiritual distress altered thought process
Seasonal depression is thought to be related to the_________
hormone melatonin
what does prevention of suicide focus on?
identifying people who display warning signs and risk factors, and providing them with support and interventions
What role does the presence of substance abuse play in relation to pt with bipolar disorder?
increases the negative outcomes and can confuse the illness presentation.
What can depression lead to?
it can change or distort the way a person sees himself, his life, and those around him.
How long can the manic phase last?
it can last from days to months (CAUSES SEVERE DISRUPTION IN ALL AREAS OF FUNCTIONING)***
The nurse should remind her pts taking Lithium that____________
it may take several weeks to achieve full therapeutic effect.
what does it mean when a person starts talking about death and suicide or becomes preoccupied with these things?
it signal the patient has ideas of attempting suicide *report this to the charge nurse and do necessary documentation
During hypomania phase there is _____________
less severe hyperactivity
What is major depressive disorder?
major depression is characterized by a combination of symptoms that severely interfere with a person's ability to work, study,sleep, eat, and enjoy once pleasurable activities.
What leads to suicidal ideation?
psychological factors, such as anger turned on oneself; and overwhelming sense of hopelessness, shame, and guilt; and humiliation
What can extreme mania include?
psychotic behaviors such as hallucinations and delusions
what does psychotherapy treatment address?
past losses and stressors
What is dysthymic disorder sometimes called?
persistent depressive disorder
Examples of MAOIs
phenelzine (Nardil) tranylcypromine (Parnate)
Symptoms of a dysthymic disorder include:
poor appetite/overeating insomnia or hypersomnia low energy or fatigue low self esteem poor concentration or difficulty making decisions feelings of hopelessness
Symptoms of major depressive disorders often go unrecognized and be a factor in________________
poor work performance, family conflict, and substance abuse.
What is postpardum depression?
postpardum depression is also called postpartum onset depression and it occurs up to 6 months after childbirth and is a much serious conditon
what is the PRIMARY nursing responsibility?
prevent the suicide
To be diagnosed with major depressive disorder, five or more of these symptoms have to be present for at least a 2-week period that represents a change in functioning
sad mood sleep pattern disturbances increased fatigue increased agitation feelings of guilt or worthlessness weight loss or gain decreased interest in pleasurable activities (anhedonia) decreased ability to think, remember, or concentrate recurrent thoughts of death or suicide
Some target symptoms that anti-depressants treat are:
sadness inability to experience pleasure change in appetite insomnia restlessness poor concentration negative thoughts
Major depressive disorder with seasonal pattern is a depression associated with_______________
seasonal patterns. Symptoms are usually worse during the winter months and subside during spring and summer.
Depressive people usually do what?
see everything with a negative attitude
What is suicide?
self-inflicted death with evidence that the person intended to die
What neurotransmitter is suicide thought to be associated with?
serotonin
what does group therapy address?
socialization and poor self-esteem
What does light therapy consist of?
special lights to be used for certain amounts of time during the day. **Exposure to natural light has been shown to reduce depression and increase alertness
when noticeable improvement in mood occurs, what is it a sign of?
that the person has made a decision that has been causing personal conflict. when the depression starts to lift, the suicidal patient will have more energy to carry out a suicide plan.
Who is light therapy being prescribed for?
treatment of depression in pts with seasonal pattern
True or false: more people die from suicide than homicide?
true
Men with depression maybe_________________
underdiagnosed
Etiology of Depressive Disorders
Chemical Imbalances genetics hormonal factors
What is depression?
Depression is a painful and debilitating illness that affects all area's of one's life
What are some important considerations with Tricyclics?
Major side effects are anticholinergic symptoms requiring close monitoring. These symptoms include DRY MOUTH, URINARY RETENTION, CONSTIPATION, BLURRED VISION, SEDATION. ***Use with extreme caution in the elderly.***
what causes nurses to be forced to report any reasons of suspected suicide?
Meier vs. Ross General Hospital Case
What are some important considerations with MAOIs?
Potentially fatal hypertensive crisis may occur in presence of foods high in tyramine (aged cheeses,red wine, smoked and process meats)
If your pt is taking Lithium it is of importance that you remind them to ______________
STAY HYDRATED BECAUSE LITHIUM TOXICITY CAN DEVELOP QUICKLY IN DEHYDRATION (Patient teaching)
Patients on SSRI's and MAOI's probably should not use
St. John's wort
What herbal supplements may help a patient with mild depression?
St. John's wort, kava, gingko, fish oil, and SAMe
What category did the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) create for individuals who initiated a behavior with the expectation that it would lead to death?
Suicidal behavior disorder
what are some warning signs for suicide?
Verbal suicide threats Expressions of hopelessness and helplessness to see alternatives Previous suicide attempts Talking about suicide methods to which the person has access Saving pills Asking questions/ researching about different methods of committing suicide Daring or risk-taking behavior Personality changes Depression Lack of interest in future plans
What is dysthymic disorder?
a less severe form of depression that is characterized by its chronic nature.
what kind of action can suicide be?
a long-planned or impulsive action
What is cyclothymic disorder?
a chronic disorder marked by multiple episodes of hypomania and depression
What is postpartum "blues"?
a common response a few days after giving birth and may be related to FATIGUE, HORMONE CHANGES, AND ANXIETY.** IT resolves in a short time with REST AND SUPPORT.**
What is dysthymic disorder characterized by?
a depressed mood for most of the day, for more than not, as indicated by either subjective account or observation by others for at least: *2YRS IN ADULTS *1YR IN CHILDREN
What is bipolar disorder?
a disorder characterized by marked shifts in mood, energy, and ability to function, often with profound depressions to periods of hyperactivity or mania with periods of normalcy
How are mania episodes characterized?
a distinct period of abnormal and persistently elevated and expansive, or irritable mood
What is bipolar disorder previously known as?
manic depression
What side effect is most often seen with ECT?
memory loss
What medication are being used as primary treatment for pts with bipolar disorder?
mood stabilizers
what does it mean when the person start giving away personal items?
when someone ha made the decision to end his/her life, it becomes no longer necessary to keep certain things
Who constitutes the largest group of suicides?
white males
Depression is more common in what gender?
women