NUR 414A Depression

Which pre-electroconvulsive therapy intervention will the nurse implement for a hospitalized client with depression? 1.Restrict the client smoking for 12 hours. 2.Enforce nothing by mouth (NPO) status for 16 hours. 3.Limit the client's participation in unit activities for 24 hours. 4.Assure that an electrocardiogram is performed within 24 hours.

4

what is st johns wort

-an OTC antidepressant that can be effective -must be careful about what else pt is taking bc it has TONS of interactions -FDA does not monitor it, risk for pt to take different doses if they get it from different manufacturers and aren't careful

must have at least 5 s/s DAILY to be diagnosed with major depressive disorder

-irritability or depressed mood most of the day -decreased interest or pleasure in activities -weight change (5%) or appetite change -change in activity level -guilt/worthlessness -fatigue or loss of energy -diminished ability to think/concentrate or more indecisive -thoughts of death/suicide

what does the nurse do PRIOR to electroconvulsive therapy for the pt?

-maintain NPO after midnight OR 4 hrs before treatment -obtain baseline vitals -request pt to void -remove hairpins, contact lenses, dentures, etc -administer pre-procedure meds: short-acting anesthetic and muscle relaxant

what does the nurse do DURING electroconvulsive therapy for the pt?

-monitor BP, HR, O2 sat -monitor seizure activity by watching foot movement -administer O2 mask -electrical stimulis administered

what do you do as the nurse in regards to nutrition for major depression?

-monitor nutritional intake and weight, provide support -stay with pt during meals to assess and ensure intake

what types of activities are appropriate for a pt with major depression in the inpatient setting?

-begin pt with one-to-one activities -engage pt in gross motor activities (walking), then small groups, then large groups -achievable activities with easy mastery to increase self-esteem

what do you do for a pt who has a plan?

-do not leave them alone -provide one-on-one supervision -provide safety from suicidal actions -form "no-suicide" contract

The nurse is creating a plan of care for a client diagnosed with depression whose food intake is poor. The nurse should include which interventions in the plan of care? Select all that apply. 1.Assist the client in selecting foods from the food menu. 2.Offer high-calorie fluids throughout the day and evening. 3.Allow the client to eat alone in the room if the client requests to do so. 4.Offer small high-calorie, high-protein snacks during the day and evening. 5.Select the foods for the client to be sure that the client eats a balanced diet.

1, 2, 4

A depressed client verbalizes feelings of low self-esteem and self-worth typified by statements such as "I'm such a failure. I can't do anything right." How should the nurse plan to respond to the client's statement? 1.Reassure the client that things will get better. 2.Tell the client that this is not true and that we all have a purpose in life. 3.Identify recent behaviors or accomplishments that demonstrate the client's skills. 4.Remain with the client and sit in silence; this will encourage the client to verbalize feelings.

3

A moderately depressed client who was hospitalized 2 days ago suddenly begins smiling and reporting that the crisis is over. The client says to the nurse, "I'm finally cured." Based on the client's behavior and statement, which intervention should the nurse include in the plan? 1.Suggesting a reduction of medication 2.Allowing increased "in-room" activities 3.Increasing the level of suicide precautions 4.Allowing the client off-unit privileges as needed

3

The nurse is developing a plan of care for a client with depression who is scheduled to have electroconvulsive therapy. Which problem is a priority for this client? 1.Fear 2.Anxiety 3.Risk for aspiration 4.Distorted body image

3

The nurse is reviewing the record of a client scheduled for electroconvulsive therapy (ECT) to treat depression. Which medical diagnosis, if noted on the client's record, would indicate a need to contact the psychiatrist scheduled to perform the ECT? 1.Type 2 diabetes mellitus 2.Peripheral vascular disease 3.Recent myocardial infarction 4.Newly diagnosed hyperthyroidism

3

A hospitalized client is started on a monoamine oxidase inhibitor (MAOI) for the treatment of depression. The nurse should instruct the client that which foods are acceptable to consume while taking this medication? Select all that apply. 1.Figs 2.Yogurt 3.Crackers 4.Aged cheese 5.Tossed salad 6.Oatmeal raisin cookies

3, 5

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

4

what is depression?

A prolonged feeling of helplessness, hopelessness, and sadness

when can depression occur

after a loss, including loss of self-esteem, end of relationship, death of loved one, or traumatic event

how do you ask a depressed pt if they want to self-harm?

ask directly! "have you thought of hurting yourself?"

patients who SHOULD NOT receive electroconvulsive therapy

pt with recent MI, stroke, or intracranial mass lesion

describe mild depression

triggered by external event and follows normal grief reaction, lasts LESS THAN 2 WEEKS

what do you do as a nurse in regards to sleep patterns for major depression?

-monitor and decrease stimuli at bedtime -encourage relaxation techniques -spend time with pt before bed to increase comfort and minimize feelings of isolation

what do you do as a nurse in regards to hygiene for major depression?

-monitor for general hygiene and self care deficits -if hygiene and self care worsens, may indicate worsening depression -provide prompts to encourage ADLs

what safety considerations are needed for the pt with depression?

-monitor the pt who start antidepressant for increased mood -risk for suicide, ask directly if they plan to hurt themselves -do not leave pt alone for extended period of time -form no suicide contract -if pt has plan, 1 on 1 supervision

what does the nurse do AFTER electroconvulsive therapy for the pt?

-transported to recovery area -pt wakes 15 min after procedure: talk to pt, re-orient, obtain vitals -return to nursing unit when pt is: 90% O2 sat, vitals stable, mental status is satisfactory -before giving fluids/foods/meds assess for gag reflex

A client diagnosed with depression is scheduled to receive 3 sessions of electroconvulsive therapy. The nurse should tell the client that he or she will likely start to see improvement in approximately what time frame? 1.1 week after the 3rd treatment session 2.3 weeks after the treatment sessions begin 3.Midway between the 2nd and 3rd treatment session 4.8 weeks after the treatment sessions are completed

1

The nurse is preparing a client with depression for electroconvulsive therapy, which is scheduled for the next morning. Which interventions would be included in the preprocedural plan? Select all that apply. 1.Have the client void. 2.Obtain an informed consent. 3.Administer tap water enemas. 4.Avoid discussing the procedure. 5.Remove dentures and contact lenses. 6.Withhold food and fluids for 6 hours.

1, 2, 5, 6

A client diagnosed with depression is not eating adequately and at times even refuses to eat at all. What should the nurse plan to do to meet the client's nutritional needs? 1.Force foods and fluids. 2.Restrict social activities until food intake is increased. 3.Promptly provide snacks and meals when the client requests them. 4.Provide small, frequent meals that include the client's food preferences.

4

what do you do as the nurse in regards to altered thought processes for major depression?

-remind pt when they felt better/were successful -spend time with pt to convey their worth and value -encourage pt to discuss losses/changes in life situation -encourage pt to express sadness or anger and allow adequate time for verbal responses -respond to anger therapeutically

what areas need to be assessed for major depression?

-risk for harm -activities -nutrition -hygiene care -sleep patterns -altered thought processes

Which statement made by a severely depressed client requires the nurse's immediate attention? 1."Feeling better really isn't important to me anymore." 2."No one can really understand what I've had to deal with." 3."I really don't like the way that new depression pill makes me feel." 4."I've not been the least bit interested in socializing since my divorce."

1

A hospitalized client has begun taking bupropion as an antidepressant agent. The nurse determines that which is an adverse effect, indicating that the client is taking an excessive amount of medication? 1.Constipation 2.Seizure activity 3.Increased weight 4.Dizziness when getting upright

2

The nurse assigned to care for a female client diagnosed with acute depression would be appropriate in making which statement to the client? 1."You look lovely today." 2."You're wearing a new blouse." 3."Don't worry; everyone gets depressed once in a while." 4."You will feel better when your medication starts to work."

2

The nurse is describing the medication side and adverse effects to a client who is taking amitriptyline (tricyclic antidepressant). Which information should the nurse incorporate in the discussion? 1.Consume a low-fiber diet. 2.Increase fluids and bulk in the diet. 3.Rest if the heart begins to beat rapidly. 4.Walk if you have difficulty urinating because this is a normal side effect.

2

The nurse is performing a follow-up teaching session with a client discharged 1 month ago. The client is taking fluoxetine. Which information would be important for the nurse to obtain during this client visit regarding the side and adverse effects of the medication? 1.Cardiovascular symptoms 2.Gastrointestinal dysfunctions 3.Problems with mouth dryness 4.Problems with excessive sweating

2

The nurse is teaching a client who is being started on imipramine (tricyclic antidepressant) about the medication. The nurse should inform the client to expect maximum desired effects at which time period following initiation of the medication? 1.In 2 months 2.In 2 to 3 weeks 3.During the first week 4.During the sixth week of administration

2

A client receiving tricyclic antidepressants arrives at the mental health clinic. Which observation would indicate that the client is following the medication plan correctly? 1.Client reports not going to work for the past week. 2.Client complains of not being able to "do anything" anymore. 3.Client arrives at the clinic neat and appropriate in appearance. 4.Client reports sleeping 12 hours per night and 3 to 4 hours during the day.

3

The nurse is caring for a client who was involuntarily hospitalized to a mental health unit and is scheduled for electroconvulsive therapy. The nurse notes that an informed consent has not been obtained for the procedure. Based on this information, what is the nurse's best determination in planning care? 1.The informed consent does not need to be obtained. 2.The informed consent should be obtained from the family. 3.The informed consent needs to be obtained from the client. 4.The primary health care provider will provide the informed consent.

3

A depressed client on an inpatient unit says to the nurse, "My family would be better off without me." Which is the nurse's best response? 1."Have you talked to your family about this?" 2."Everyone feels this way when they are depressed." 3."You will feel better once your medication begins to work." 4."You sound very upset. Are you thinking of hurting yourself?"

4

A depressed client who appeared sullen, distraught, and hopeless a few days ago now suddenly appears calm, relaxed, and more energetic. Which is the nurse's best initial action with regard to the client's altered demeanor? 1.Continue to assess the client's behaviors and document clearly in the chart. 2.Report to the psychiatrist that the client is adapting to the unit and is feeling safe. 3.Notify the health team of these observations and alert them to the suspicion that the client is contemplating suicide. 4.Engage the client in one-to-one supervision, share with the client the observations that have been assessed, and ask whether the client is thinking about suicide.

4

Which is the appropriate nursing intervention to address the poor nutritional intake demonstrated by a client diagnosed with depression? 1.Weigh the client 3 times per week before breakfast. 2.Explain to the client the importance of a good nutritional intake. 3.Report the nutritional concern to the psychiatrist, and obtain a nutritional consultation as soon as possible. 4.Arrange for the client to receive several small meals daily, and plan to be present while the meals are being served.

4

what is the best intervention for depression?

consistent exercise!

treatment for depression includes (broad)

counseling antidepressants electroconvulsive thearpy

describe major depressive disorder

depressed mood or loss of pleasure in activities for 2+ WEEKS

loss if followed by grief and mourning. if not resolved, what results?

depression

describe the thought process of pt with major depression during a depressive episode

judgment poor, indecisive, slowing down

why does a depressed pt who has recently started an antidepressant need to be monitored closely?

may have enough energy now to perform a suicidal act

what is psychomotor retardation

more common in depression, slow moving

describe moderate depression

persists over time; pt experiences sense of change and often seeks help

what is psychomotor agitation

person constantly moving, wringing of the hands, agitated, pacing, biting nails -- tension reliving activities

what health promotion (primary, secondary, tertiary) and health teaching is needed for depression

primary- education on avoiding depression with adequate nutrition, exercise, healthy habits, etc secondary- screenings tertiary- meds and therapy health teaching- know when s/s are worse and when to ask for help