Unit 22: Mood Disorders
Jun has been hospitalized for major depression and suicidal ideation. What statement indicated to the nurse that the client is improving?
"I don't think about killing myself as much as I used to."
The effectiveness of MAOI drug therapy in clients with PTSD can be demonstrated by which of the following client self-reports?
"I'm sleeping better and don't have nightmares." (Rationale: MAOIs are used to treat sleep problems, nightmares, and intrusive daytime thought in individuals with PTSD)
What medications are given by the anesthesiologist before ECT?
1st medication given is PROPOFOL (sedative) and the 2nd medication given is SUCCINYLCHOLINE (muscle relaxant)
A client taking an MAOI antidepressant (isocarboxazid/Marplan) is instructed by the nurse to avoid which foods and beverages?
Aged cheese and red wine (Rationale: they contain tyramine which, when take with an MAOI, can precipitate a HYPERTENSIVE CRISIS)
The client is arrogant and manipulative. In ensuring a therapeutic milieu, the nurse does what?
Agree on a CONSISTENT approach among the staff assigned to the client (no bargaining)
While on lithium, it takes 7-10 days to control hyperactivity. What drug class is appropriate to give to patients during this time period?
Antipsychotics (Rationale: controls hyperactivity before lithium effects start to fully manifest)
What else are SSRIs indicated for?
Anxiety, eating disorders, OCD
What kind of psychotic features do clients with depression have?
Auditory Hallucinations (voices telling them to kill themselves)
What other mood disorder is ECT indicated for besides depression?
Bipolar Disorder (possibly Schizophrenia)
A child with bipolar disorder also has ADHD. Which disorder would you stabilize first?
Bipolar disorder would be stabilized first before medication for ADHD
Dennis has a lithium level of 2.4 mEq/L. The nurse immediately would assess the client for which of the following signs or symptoms?
Blurred Vision (Rationale: mild lithium toxicity = 1.5-2.5 mEq/L and experience blurred vision, muscle twitching, severe hypotension, and persistent nausea and vomiting)
The nurse is evaluating a client diagnosed with bipolar disorder in the home environment following discharge two weeks ago from an inpatient unit. The nurse assesses the client for what behaviors that are expected at this time?
Calm, focused exchange of self-care information with nurse (Rationale: this demonstrates control of the bipolar disorder, WHICH IS EXPECTED following discharge from an inpatient setting)
What demographic has the highest risk for depression and suicide?
Caucasian Older Men
Using cognitive-behavioral therapy, which treatment would be appropriate for a client with depression?
Challenging negative thinking (Rationale: this therapy includes identifying and challenging a client's negative conditions; identify and change destructive or disturbing thought patterns that have a negative influence on behavior and emotions)
A female client who's at HIGH RISK for suicide needs close supervision. What is the best way to ensure the client's safety?
Check the client frequently at irregular intervals throughout the night (rationale: prevents the client from predicting when observation will take place)
The nurse is teaching a client and her family about the causes of depression. What causative factor should the nurse emphasize as the MOST significant?
Chemical Imbalance (Rationale: chemical imbalance of neurotransmitters in the brain is the most significant factor in depression)
What is an activity that is appropriate for a client with mania?
Cleaning (Rationale: client's excess energy can be rechanneled through PHYSICAL activities that are NOT COMPETITIVE)
The nurse understands that electroconvulsive therapy (ECT) is primarily used in psychiatric care for the treatment of what?
DEPRESSION
In a day treatment program, a manic client is creating considerable chaos, behaving in a dominating and manipulative way. What is an appropriate nursing intervention?
Describe acceptable behavior and set realistic limits with the client
A client taking the MAOI, phenelzine (Nardil) tells the nurse that he routinely takes all of the medications listed. Which medication would cause the nurse to express concern and therefore initiate further teaching?
Diphenhydramine (Benadryl) (Rationale: OTC meds used for allergies are contraindicated because they will increase sympathomimetic effects of MAOIs, possibly causing a HYPERTENSIVE CRISIS)
The nurse is teaching a group of clients about the mood-stabilizing medication, lithium carbonate. Which class of medications should she instruct the clients to avoid because of the increased risk of lithium toxicity?
Diuretics (Rationale: diuretics would cause sodium and water excretion, which would increase the risk of lithium toxicity; should increase fluid intake and maintain normal intake of sodium if on lithium)
What mood disorder is characterized by the client feeling depressed most of the day for a 2 year period?
Dysthymia (Persistent Depressive Disorder or PDD)
Mr. Cruz visits the physician's office to seek treatment for depression, feelings of hopelessness, poor appetite, insomnia, fatigue, low self-esteem, poor concentration, and difficulty making decisions. The client states that these symptoms began at least 2 years ago. Based on this report, what does the nurse suspect?
Dysthymic Disorder
The nurse is caring for a client with depression who had not responded to antidepressant medication. The nurse anticipates what treatment measure may be prescribed?
Electroconvulsive Therapy (ECT)
Why does suicide have an increased risk early in antidepressant treatment?
Energy level increases during antidepressant therapy and clients may have the energy to go through with the suicide (most suicides occur within beginning of improvement)
The nurse is assigned to care for a suicidal client. INITIALLY, Which is the nurse's HIGHEST priority?
Exploring the nurse's own feelings about suicide (Rationale: nurse's beliefs, values, and attitudes toward self-destructive behavior influence responses to a suicidal client; nurse must initially explore personal feelings about suicide to avoid conveying negative feelings to the client)
Rendell is admitted in an acute psychiatric unit. He suddenly tells the nurse about his plans for suicide. What is the nurse's priority?
Follow agency protocol for suicide precautions (Rationale: Nurse must act to safeguard the client from danger, including self-harm implementing the specific agency protocol for suicidal precautions that would best protect the client)
What kind of seizure is induced in ECT?
Grand Mal Seizure
To further assess a client's suicidal potential, what should the nurse be especially alert to the client's expression of?
Helplessness and Hopelessness (Rationale: expression of these feelings may indicate that this client is unable to continue the struggle of life)
A client on Lithium has diarrhea and vomiting. What should the nurse do FIRST?
Hold the next dose and obtain an order for a stat serum lithium level (Rationale: diarrhea and vomiting are manifestations of Lithium toxicity)
What is the goal of cognitive therapy with depressed clients?
Identify and change dysfunctional patterns of thinking
Mark is diagnosed with major depression and spends the majority of the day lying in bed with the sheet pulled over his head. Which of the following approaches by the nurse would be the most therapeutic?
Initiate contact with the client FREQUENTLY' (Rationale: lets the client know that he is important to the nurse; this will positively affect the client's self-esteem)
Malou is diagnosed with major depression and spends the majority of the day lying in bed with the sheet pulled over his head. What approach by the nurse would be the MOST therapeutic?
Initiate contact with the client frequently (Rationale: this lets the client know that he is important to the nurse)
What's an appropriate nursing intervention for seasonal depression?
Light Therapy
What is the first line therapy for bipolar disorder?
Lithium
The client who was admitted to the hospital seemed rather depressed. We came to later find out that her son died a year ago. The client said, "I can't even talk care of my baby. I'm good for nothing." Which is the appropriate nursing diagnosis?
Low self esteem R/T failure in role performance (Rationale: A sense of worthlessness may accompany depression; negative self-evaluation)
During ECT, the client receives oxygen by mask via positive pressure ventilation. Why is positive pressure ventilation necessary during ECT?
MUSCLE RELAXANTS given to prevent injury during seizure activity DEPRESSES RESPIRATIONS
What is classified as an Axis I disorder by the DSM-IV-TR?
Major Depression
Which is the HIGHEST priority in the post-ECT care?
Monitor respiratory status (Rationale: a side effect of ECT which is life-threatening is a respiratory arrest)
The nurse is caring for a female client who has suicidal tendencies. When accompanying the client to the restroom, what should the nurse do?
Observe her (Rationale: nurse has a responsibility to continuously observe the acutely suicidal client)
The nurse is aware that which client is at HIGHEST risk for suicide?
One who PLANS a violent death and has the means readily available (Rationale: highest risk for suicide = one who PLANS a violent death; client has a SPECIFIC PLAN)
Margaret is diagnosed with bipolar disorder. She is extremely hyperactive and has lost weight. What is one way to promote adequate nutritional intake for Margaret?
Provide HIGH CALORIE, nutritious finger foods and snacks that she can eat "on the run"
For a male client with dysthymic disorder (PDD), which of the following approaches would the nurse expect to implement?
Psychotherapeutic approach (Rationale: ECT is for MDD)
What method would a nurse use to determine a client's potential risk for suicide?
Question the client DIRECTLY about suicidal thoughts
Which method would a nurse use to determine a client's potential risk for suicide?
Question the client DIRECTLY about suicidal thoughts
Clara is under evaluation for imminent suicide risk, which information given by her would be most significant?
Reference to suicide as best solution to identified problems (Rationale: Individual who talks about suicide as a solution to a problem is at HIGH RISK)
What is a priority intervention in the care of a suicidal client?
Remove all potentially harmful items form the client's room
A client tells the nurse, "Everyone would be better off if I wasn't alive." Which nursing diagnosis would be made based on this statement?
Risk for Self-Directed Violence
A client hears voices telling him that he is a terrible person who would be better off dead. What would be a priority nursing diagnosis for the nurse to select for the care plan?
Risk for Violence, Self-directed (Rationale: Suicide watch = safety is PRIORITY)
A client with bipolar disorder, manic type, exhibits extreme excitement, delusional thinking, and command hallucinations. What is a priority nursing diagnosis?
Risk for other-directed violence
A client tells a nurse, "Everyone would be better off if I wasn't alive." What nursing diagnosis would be made based on this statement?
Risk for self-directed violence (suicide)
What nursing diagnosis should be focused on when dealing with patients with depression?
Risk for self-directed violence (suicide)
The nurse is aware that extremely depressed clients seem to do best in settings where they have what?
Routine Activities (Rationale: A simple daily routine is the best, least stressful, and least anxiety-producing)
What is the first line therapy for depression?
SSRIs
Joe who is very depressed exhibits psychomotor retardation, a flat affect, and apathy. The nurse in charge observes Joe to be in need of grooming and hygiene. What nursing action would be most appropriate?
STATING to the client that it's time for him to take a shower (Rationale: client is preoccupied in his depression and has decreased energy; the nurse should present the situation, "It's time to shower" and assist the client with personal hygiene to preserve his dignity and self-esteem)
An individual with depression has a deficiency in which neurotransmitters? (Biogenic amine theory)
Serotonin and norepinephrine (Antidepressant medications increase the levels of serotonin and norepinephrine)
A 27-year-old writer is admitted for the second time accompanied by his wife. He is demanding, arrogant, talks fast, and hyperactive. Initially, the nurse should plan what care for this manic client?
Set realistic limits to the client's behavior (Rationale: the client is hyperactive and may engage in injurious activities; a quiet environment and consistent and firm limits should be set to ENSURE SAFETY; clear and CONSISTENT limits and expectations minimize the potential for the client's manipulation of staff)
John with manic episodes is taking lithium. Which electrolyte level should the nurse check before administering this medication?
Sodium (Rationale: Lithium is chemically similar to sodium. If sodium levels are reduced, such as from sweating or diuresis, lithium will be reabsorbed by the kidneys, increasing the risk of toxicity. Clients taking lithium shouldn't restrict their intake of sodium and should drink adequate amounts of fluid each day. It is also important to monitor patients for dehydration and lower the dose when there are signs of infection, excessive sweating, or diarrhea. Toxic levels are when the drug level is more than 2 mEg/L)
The client says to the nurse, "Pray for me" and entrusts her wedding ring to the nurse. The nurse knows that this may signal what?
Suicidal Ideation
The nurse is assessing James who is diagnosed with bipolar disorder. What would the nurse find a history of?
Symptoms of mania that may or may not be followed by depression
A client with bipolar disorder exhibits manic behavior. The nursing diagnosis is Disturbed Thought Processes R/T difficulty concentrating, secondary to flight of ideas. What nursing outcome would indicate improvement in the client?
The client speaks in coherent sentences (Rationale: speaking in coherent sentences indicates that the client's concentration has improved and his thoughts are no longer racing)
Isabel with a diagnosis of depression is started on imipramine (Tofranil) 75 mg by mouth at bedtime. What should the nurse tell the client about this drug?
This medication may initially cause tiredness, which should become less bothersome over time. (Rationale: Sedation is a common early adverse effect of imipramine, a tricyclic antidepressant, and usually decreases as tolerance develops)
If a patient is admitted for depression or bipolar disorder, what's one lab that will initially be ordered?
Thyroid Function
Why is Robinul (anti cholinergic) given before ECT?
To dry out secretions and PREVENT ASPIRATION
Combined effects of genetic, biochemical, and psychosocial influences that play a part in why depression occurs
Transactional Model
When assessing a female client who is receiving tricyclic antidepressant therapy, which of the following would alert the nurse to the possibility that the client is experiencing anti cholinergic effects?
Urine retention and blurred vision
What activity would the nurse recommend to the client who becomes very anxious when thoughts of suicide occur?
Using exercise bicycle (exercise)
What self-measure would be most helpful as a strategy to decrease the occurrence of mood disorders?
Verbalizing rather than internalizing feelings (Rationale: individuals who develop mood disorders often have difficulty expressing feelings)
What demographic is more prevalent to becoming depressed?
Younger women (adolescence) and older Caucasian men
What is the most common comorbid condition in children with bipolar disorder?
attention deficit hyperactivity disorder
What is a common side effect in ECT?
short term memory loss
