n222 week 3 (quiz 3 info)

Reasons for someone to not try and commit suicide

Sense of responsibility to family Pregnancy Religious beliefs Satisfaction with life Positive social support Access to health care Effective coping skills Effective problem-solving skills intact reality testing

Low _____ levels are related to depressed mood a. serotonin b. dopamine c. euphoria

Seritonin

A nurse is caring for a patient who is manifesting confusion, hyperreflexia, tachycardia, high blood pressure, and diaphoresis. The nurse concluded that the patient is experiencing _____ _____. (A serious drug reaction.)

Serotonin syndrome

An adolescent girl is admitted to the psychiatric unit for observation due to clinical depression. The nurse should give highest priority to which of the following findings? A. She has a lot of arguments with her parents. B. She gave her favorite necklace to her best friend. C. She is getting C's in school.

She gave her favorite necklace to her best friend.

Nurses came for a client following the loss of a partner due to terminal illness. Identify the sequence of angles five stages of grief does the nurse should expect the client to experience. Select the stages of grief in order of occurrences all steps must be used. AA. Developing awareness. B. Restitution. C. Shock n disbelief. D. Recovery E. Resolution of the loss.

Shock and disbelief Developing awareness Restitution Resolution of the loss Recovery

Contraindication of selegiline use?

Stop using 10 days before a surgery because of its adverse effects on blood pressure. and in children younger than 12 years and patients of any age with pheochromocytoma.

Some risk factors for suicide

Suicidal ideation with intent Diagnosis of Schizophrenia Old age Male gender Lethal suicide plan History of suicide attempt Co-occurring psychiatric illness Hopelessness Panic attacks Feeling of shame or humiliation Impulsivity Aggressiveness

Which of the following factors increases a patient's risk for depression? a. When the whole community does not believe in depression. b. When the mother had depression. c. When they are in middle socioeconomic class.

When the mother had depression.

Are women or men more likely to be diagnosed with depression?

Women are more likely to be diagnosed with depression than men

Does a history of suicide attempts put someone at higher risk of actually completing suicide?

Yes

Is serotonin syndrome a life threatening

Yes if not given Bromocriptine or Cyproheptadine soon enough

A nurse is came for a client who lost the guardian to cancer last month. The client states, I still have my garden of the doctor would have made a diagnosis sooner. Which of the following responses will the nurse make? A. You sound angry, anger is a normal feeling associated with loss. B. I think you feel better if you talked about your feelings with a support group C. I understand just how you feel. I feel the same, and my guardian died. D. The other members of your family also feel this way.

You sound angry, anger is a normal feeling associated with loss

What is Transcranial magnetic stimulation (TMS)?

a noninvasive treatment modality that uses MRI-strength magnetic pulses to stimulate focal areas of the cerebral cortex

What is Hospice?

a program committed to making the end of life as free from pain, anxiety, and depression as possible

adverse effect of St. Johns Wort

photosensitivity, skin rash, rapid heart rate, GI distress, and abdominal pain

Primary nursing intervention meaning

prevention strategies that include providing information and education to at risk population

Three levels of nursing intervention

primary secondary tertiary

What is commonly known that with depression there are _______ disorders.

psychiatric

In an acute care mental health facility, a nurse is admitting a patient who's feeling depressed, sad, moody, and anxious. What risk should the nurse prioritize to assess?

suicide risk

Suicide is the ____ leading cause of death in the US

tenth

What is suicide?

the act of intentionally taking one's own life

What is Euthanasia?

the act of painlessly ending the lives of individuals who are suffering from an incurable disease or severe disability

TCAs will not be given to which pts

those with heart problems elderly

What is St. John's Wort used for?

treat mild to moderate depression

Bupropion (Wellbutrin) USE

treats DEPRESSION (Enhances release of Norepinephrine and Dopamine (NDRI)) used for ADHD as a psychostimulants used as a smoking sensation aid

A patient who has major depressive disorder and was prescribed citalopram two weeks ago reported to you that his appetite improved but still feeling a bit lonely, tearful with difficulty of sleeping. You should explain that citalopram may take several ______ to reach full benefit.

weeks (2-3)

KÜBLER-ROSS'S STAGES OF DYING depression

withdrawal, crying, and grieving

Will client be NPO 4+ hours before ECT

yes

complications with ECT

- Reactions to Anesthesia - ECG Changes- Cardiopulmonary clearance required before administration - Headache, muscle soreness, and nausea - Relapse of depression - Short-term Memory Loss and Confusion (expectation)

A nurse is providing teaching for a client who is scheduled to receive ECT for the treatment o major depressive disorder. Which of the following client statements indicates understanding of the teaching? a. "it is common to treat depression with ECT before trying any medications." b. I can have my depression cured if I receive a series of ECT treatments." c. "I should receive ECT once a week for 6 weeks." d. "I will receive a muscle relaxant to protect me from injury during ECT."

"I will receive a muscle relaxant to protect me from injury during ECT." (succinylcholine is administered to reduce risk of injury during induced seizure activity)

A charge nurse is discussing TMS with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? A. "TMS is indicated for clients who have schizophrenia spectrum disorders" B. "I will provide postanesthesia care following TMS." C. "TMS treatments usually last 5-10 minuets." D. "I will schedule the client for TMS treatments 3-5 times a week for the first several weeks."

"I will schedule the client for TMS treatments 3-5 times a week for the first several weeks."

KÜBLER-ROSS'S STAGES OF DYING denial and isolation

"It can't be!"

KÜBLER-ROSS'S STAGES OF DYING Bargaining

"Just let me do this first!"

KÜBLER-ROSS'S STAGES OF DYING anger

"Why me?"

Which statement shows a nurse has empathy for a patient who made a suicide attempt? A. "You must have been very upset when you tried to hurt yourself. "B. "It makes me sad to see you going through such a difficult experience." C. "If you tell me what is troubling you, I can help you solve your problems." D. "Suicide is a drastic solution to a problem that may not be such a serious matter."

"You must have been very upset when you tried to hurt yourself.

Which statement shows a nurse has empathy for a patient who made a suicide attempt? A. "You must have been very upset when you tried to hurt yourself." B. "It makes me sad to see you going through such a difficult experience." C. "If you tell me what is troubling you, I can help you solve your problems." D. "Suicide is a drastic solution to a problem that may not be such a serious matter."

"You must have been very upset when you tried to hurt yourself." (always give a therapeutic response)

A client with a diagnosis of depression says to the nurse, "I should have died. I've always been a failure." Which therapeutic response should the nurse make to the client? A. "I see a lot of positive things in you." B. "You still have a great deal to live for." C. "Feeling like a failure is part of your illness." D. "You've been feeling like a failure for some time now?"

"You've been feeling like a failure for some time now?

How does the Onset of Dysthymic Disorder during teanage years show?

"always felt this way" being depressed is normal way of functioning (may have periods of full-blown major depressive episodes)

Mirtazapine - Remeron normal range

(15 - 45 mg/d)

Nefazodone - Serzone normal range

(200 - 600 mg/d)

A nurse is looking after a patient who lost his partner 5 years ago. The patient kept his partner's closet untouched since her death. The patient's action indicates the patient is experiencing _____ grief.

(The condition of delayed, distorted, and/or unending reactions to normal grief.) Maladaptive

TMS (transcranial magnetic stimulation) adverse reactions

- After the procedure, patients may experience a headache and lightheadedness - Most of the common side effects of TMS are mild and include scalp tingling and discomfort at the administration site

Key Assessment Findings for a pt with major depressive disorder

- Depressed Mood; Anhedonia; Anergia - Anxiety; Psychomotor agitation; Psychomotor retardation - Somatic complaints -headaches, malaise, backaches (manifestations of pain as this continues) - Vegetative signs of depression -change in bowel movements; eating habits, sleep disturbances, disinterested in sex - Chronic Pain

Nursing Interventions for pts with major depressive disorder

- Sit with them in silence/ Spend time with the patient - Self-care -Monitor ADL's and encourage independence as much as possible - Make time to be with the client, even if he does not speak - Give the client sufficient time to respond when holding a conversation due to a possible delayed response time - Maintenance of a safe environment

Nursing Administration for SSRI , TCAs and MAOs

- Therapeutic effects may not be experienced for 1 to 3 weeks. Full therapeutic effects may take 2 to 3 months - Therapy usually continues for 6 months after resolution of manifestations and it may continue for a year or longer. - Sudden discontinuation can result in relapse - Suicide prevention is facilitated by prescribing only a week's worth of medication for an acutely ill client and only prescribing 1 month's worth of medication at a time especially with TCA which have a high risk for lethality with overdose23 - Antidepressant-induced suicide is mainly associated with clients under the age of 25.

What is Palliative care:

- reducing pain and suffering, helping individuals die with dignity - Makes every effort to include the dying patient's family members - Includes home-based programs today, supplemented with care for medical needs and staff

TMS (transcranial magnetic stimulation) procedure

- takes about 30 minutes and is typically ordered for 5 days a week for 4 to 6 weeks. - Patients are awake and alert during the procedure

Active-duty military personnel complete suicide at the rate of ____ per day

1

OTHER RISK FACTORS FOR DEPRESSIVE DISORDERS ARE AS FOLLOWS:

1. Unmarried (no significant other) 2. ACEs-history of childhood trauma 3. Post -partum period 4. female gender 5. Chronic illness 6. History of loss 7. Substance abuse 8. Age greater than 45 or older 9. Less college education

Difference between Passive euthanasia and Active euthanasia

1. treatment is withheld 2. death deliberately induced

% of people with clinical depression who commit suicide?

15%of people with clinical depression commit suicide

Women are _____ times more likely to try and commit suicide

3

The rate of significant depressive symptoms are _______ higher in Veterans than that of the general population

31%

Suicide is the ____ leading cause of death in the US in ages 15-24

3rd

Man are ___ times likely to die by suicide

4

Suicide is the ____ leading cause of death in the US in ages 10-14

4th

Suicide is more than ______ times higher among patients with schizophrenia than in the general population

50

When veterans are included in the count, the rate is 1 suicide every _____ minutes

80

Suicide is the ____ leading cause of death in the US in ages 45-64

8th

What is Vagus Nerve Stimulation?

A surgery to implant VNS is typically an outpatient procedure. A pacemaker-like device is implanted surgically into the left chest wall

This is discussing routine follow-up needs with a client who has a new prescription for valproate. The nurse should inform the client of the need for routine monitoring for which of the following? A. AST/ALT & LDH. B. Creatine and bun. C. White blood cell and granulocyte counts. D. Blood sodium and potassium.

AST/ALT & LDH

What foods should be avoided when taking MAO: PHENELZINE

ATI: Due to risk of hypertensive crisis, avoid foods with tyramine (ripe avocado or figs, fermented or smoked meat, liver, dried or cured fish, most cheeses, some Beer and wine and protein dietary supplements) •Avoid all medication including otc without discussing them with the provider

This is caring for a client who is experiencing extreme mania due to bipolar disorder. Prior to the administration of the thin carbonate. The clients lithium blood level is 1.2 MEQ/L which of the following action should the nurse take? A. Administer the next dose of lithium carbonate as scheduled. B. Prepared for administration of aminophylline. C. Notify the provider for a possible increase in the dosage of lithium carbonate. D. Request a stat repeat of the cleanse lithium blood levels

Administer the next dose of lithium carbonate a schedule (during manic episodes lithium blood level should be between 0.8 to 1.4.)

A nurse is conducting a class for a group of new elites nurses on care for clients who are at wrist for suicide. Which of the following information should the nursing include in the teaching? A. The clients, verbal threats of suicide is attention, seeking behavior. B. Interventions are ineffective for clients were really wanting to commit suicide. C. Using the term suicide increases the clients risk for suicide attempts. D. A no suicidal contract decreases the clients risk for suicide.

Ain't no suicidal contract, decreases the clients risk for suicide

A client with depression is in group therapy. When it's clients turn, he does not respond to the question. Which of the following actions should the nurse take before repeating the question to the client? a. Move on to the next patient first. b. Ask the patient what he thinks. c. Allow the patient to collect his thoughts.

Allow the patient to collect his thoughts.

TCAs (tricyclic antidepressants)

Amitriptyline (Elavil) is an example. Anticholinergic effects and orthostatic hypotension may occur.

A nurse is looking after a patient who was admitted 2 days ago for treatment of depression. The patient stopped her current activities and went to the nurses station and told the nurse that there is no reason for her to live anymore. Which of the following actions should the nurse take? a. Notify the patient's family and request a visitor to stay with the patient until thoughts of suicide are gone. b. Escort the patient to her room and allow her to rest before resuming activity. c. Ask the patient if she has a plan to commit suicide.

Ask the patient if she has a plan to commit suicide. ( its a specific question that the nurse should include when assessing a patient who has possible suicidal ideation. )

Assessment tools for diagnosing depression in a client

Beck Depression Inventory The Hamilton Depression Scale The Zung Depression Scale The Geriatric Depression Scale The Patient Health Questionnaire-9

A nurse is leading up your group discussion about the indications of ECT. Which of the following indication should the nurse include in the discussions? A. A borderline personality disorder. B. Acute withdrawal related to a substance use disorder. C. Bipolar disorder with rapid cycling. D. Dysphoric disorder.

Bipolar disorder with rapid cycling

Medications given to treat Serotonin Syndrome

Bromocriptine Cyproheptadine

States that passed legislation allowing for assisted suicide include:

California : "End of Life Option Act" (2016) Vermont: "Patient Choice and Control at End of Life Act" Oregon : "Death With Dignity Act" (1998 -1st state)• Washington "Death With Dignity Act"Montana: Decriminalized

SSRIs side effects: "SSRI"

Can cause sexual disfunction lose weight when first starting medication, but then will cause the pt to gain weight

In clients who have past suicidal ideation or past attempts what is something that needs to be done when they are in a facility?

Check on them more than once an hour, and know that they are at higher risk of actually committing suicide the next time they try

ECT pre-procedure work up care

Chest X ray (head, neck and spine) blood work, ECG (Cardiopulmonary clearance) • Witness the consent • Check vital signs especially BP • Benzodiazepines are discontinued since they interfere with the seizure • Severe HTN should be controlled (Increased HTN happens right after) • Any cardiac conditions should be monitored and treated before the procedure • Monitor VS and mental status before the procedure • Insert IV Line • MEDICATION

Nurse is assisting with the development of protocols to address the increasing number of suicide attempts in the community. Which of the following intervention should the nurse include as a primary intervention? Select all that apply. . A. Conducting a suicide risk screening on all new clients. B. Creating a support group for family Marrisa clients who completed suicide C. Educating high school teens about suicide prevention. D. Initiating 121 observation for a client who is current suicidal ideation E. Teaching middle school educators about warning indications of suicide

Conducting a suicide risk screening on a new clients Educating high school teams about suicide prevention Teaching middle school educators about warning indicators of suicide

S/S of serotonin syndrome

Confusion tachycardia high fever seizures

A nurse is planning care for a client falling surgical implantation of the VNS device. The nurse should plan to monitor which of the following adverse effects? Select all that apply. A. Voice changes. B. Seizure activity. C. Disorientation. D. Cough. E. Neck pain.

Cough and neck pain

This is admitting a client who has a new diagnosis of bipolar disorder, and scheduled to begin live in therapy. When, collecting a medical history from the clients caregiver, which of the following statements is a priority to report to the provider? A. Current medical conditions include diabetes that is controlled by diet. B. Recent medication's include a course of prednisone for acute bronchitis. C. Current vaccinations include a flu vaccine last month. D. Current medication's include FUROSEMIDE for congestive heart failure.

Current medications include FUROSEMIDE for congestive heart failure

MAOI's: client teaching

DO NOT EAT Avocado Aged cheese Beer/ B6 (tyramine), Beef, Banana Caffeinated Coffee, Chocolate, Chicken liver Fermented foods Pickles and preserved food and meat Red wine Soy sauce, sour cream Smoke Fish / meat

KÜBLER-ROSS'S STAGES OF DYING

Denial and Isolation: "It can't be!" Anger: "Why me?" Bargaining: "Just let me do this first!" Depression: withdrawal, crying, and grieving Acceptance: a sense of peace comes

Charge nurse is reviewing Kubler Ross, five stages of grief with a group of new license nurses. Which of the following stages to the nurse include in the teaching? Select all that apply. A. Disequilibrium. B. Denial. C. Bargaining. D. Anger. E. Depression.

Denial, bargaining, anger, and depression

A nurse is caring for a patient who decided to stop taking Paroxetine 3 days ago due to G.I. upset and decreased in libido. The patient mentioned flu-like symptoms, dizziness, increased anxiety, insomnia and sensation of pins and needles on extremities. What is the patient experiencing?

Discontinuation syndrome (results from stopping SSRIs too quickly)

Management and Prevention of Serotonin Syndrome

Discontinue medication Provide - Benzodiazepine or Anti-serotonergic agents: Periactin, Sansert, Inderal• Dantrium for relieving muscle rigidity and hyperthermia

A unique component of _____ grieving is experiencing a loss that cannot be shared.

Disenfranchised

Issues with SSRI and Discontinuation Symptoms

Dizziness Nausea Pins and needles Zappers (Prozac may not cause discontinuation symptoms due to longer half-life of 4 to 6 days and stay in your system for 16 weeks)

What are possible side effects of nortriptyline therapy that the nurse should discuss with the client? a. Stupor and dry mouth. b. Dry mouth and constipation. c. Muscle breakdown and weakness.

Dry mouth and constipation.

What test should be done before giving TCA to a pt?

EKG

A client is scheduled for ECT what family teaching should the RN focus on? A. Education on the importance of airway maintenance. B. Education on the client's memory loss C. Education on the use of Brevital as anesthesia D. Education on the purpose of ECT

Education on the client's memory loss

Electroconvulsive Therapy (ECT)

Electric current is passed through the brain. and is Unilateral or bilateral Indication: severe depression, acute mania, psychotic symptoms, acutely suicidal Treatment is 3 times a week until the course of 6-12 treatments is completed Provider informs consent. If ECT is involuntary, the provider can obtain consent from next or kin or a court order Causes generalized seizure (tonic-clonic)• Contraindication: ICP and recent MI• Side effects: transient short-term memory loss• Not a cure

during ECT procedure pt care

Electrodes are applied to the scalp Client receives 100% oxygen during and after ect Ongoing cardiac monitoring is provided including BP, ECG and SaO2 After 15 min, clients are expected to become alert about 15 mins following ECT

What is deep brain stimulation (DBS)?

Electrodes are surgically implanted into specific areas of the brain in order to stimulate those regions identified to be underactive in depression

A nurse is caring for a client was on suicide precautions. Which of the following intervention should the nurse include in the plan of care? A. Assigned the client to a private room. B. Document clients behavior every hour. C. Allow the client to keep perfume in her room. D. Ensure that the client swallows his medication

Ensure the client swallow his medication

Other Treatments for Depression other than medication

Exercise Transcranial magnetic stimulation Vagus nerve stimulation Deep brain stimulation Light therapy Herbal Hypericum Perforatum (St. John's Wort)- causes vivid dreams and bleeding and photophobia (mild to moderate depression)

Interventions for ANOREXIA

Finger Foods and Foods from home ESFFEncourage High CHON diet Do not argue. Monitor and record weight Encourage with Reinforcement

The BIG Deal with MAOI

Food interaction containing tyramine which leads to hypertensive crises resulting in intracranial bleed - Drug Interaction - Other antidepressants: (SSRIs, SNRIs, TCA ) - OTC cold and flu medications (Sympathomimetics) - Demerol

Which of the following foods, if chosen by a patient who is taking Isocarboxacid *MAOI), indicates that the patient is following the prescribed diet? a. Prunes b. Aged cheese c. Fresh vegetables d. Sausage

Fresh vegetables

Tightness in the chest is a physical manifestation that is commonly assessed in patients experiencing acute ______. (This is experienced shortly after a loss

Grief

The nurse understand that jumping off a high place is ____ method of suicide.

Hard

A nurse is caring for a client who is major depressive disorder. Which of the following should the nurse identify as a risk factor for depression? Select all that apply. A. Male sex. B. History of chronic bronchitis. C. Recent death, and clients family. D. Family, history, depression. E. Personal history of panic disorder.

History of chronic bronchitis, recent death of clients, family, family, history of depression, personal history of panic disorder

Which assessment finding in a patient with major depression represents a vegetative sign? A. Restlessness B. Hypersomnia C. Feelings of guilt D. Frequent crying

Hypersomnia

MAO Inhibitors: Hypertensive Crisis

Hypertension Occipital headache Neck stiffness and soreness Nausea and vomiting Sweating Fever and chills Clammy skin Dilated pupils

The patient's Duloxetine (Cymbalta) was increased to 120 milligrams daily by the nurse due to increased depression and pain. Which of the following side effects should the patient be informed of? a. Peripheral neuropathic pain. b. Hypertension. c. Arrhythmia.

Hypertension. (S.N.R.I's increases norepinephrine levels, which may cause increased blood pressure.)

A nurse is teaching a client who has a new diagnosis of premenstrual dysphoric disorder or PMDD. Which of the following statement by the client indicates an understanding of the teaching? A. I can expect my problems with PMDD to be worse when I menstruating. B. I should avoid exercising when I'm feeling depressed. C. I'm aware that my PMDD causes me to have rapid mood swings. D. I should increase my caloric intake with a nutritional supplement when I PMDD is active.

I am aware that my PMDD causes me to have rapid mood swings

A patient who has begun taking Amitryptyline (Elavil), is given instructions regarding its use. Which of the following comments would indicate that the patient understands the information? a. I like active exercise, but I won't be able to do it while I'm on this medicine. b. This medicine will make my ears ring. c. I won't eat cheese if one of my visitors brings me some. d. I don't feel any better, but I've only begun taking the medicine for a week.

I don't feel any better, but I've only begun taking the medicine for a week. (Takes 2 weeks for these meds to work)

Nurse is discussing normal grief with a client who recently lost a child. Which of the following statements made by the client indicates understanding? Select all that apply. A. I may experience feelings with resentment. B. I will probably withdraw from others. C. I can expect to experience changes and sleep. D. It is possible that I will expand suicidal thoughts. E. It is expected that I will have a loss of self-esteem.

I may experience feelings of resentment, I will probably withdraw from others, and I can expect to experience changes and sleep

Nursery providing teaching to a client who is new prescription for amitriptyline. Which of the following statement by the client indicates an understanding of the teaching? A. I can expect to experience. Diarrhea while taking this medication. B. I might feel drowsy for a few weeks after starting this medication. C. I cannot eat my favorite pizza with pepperoni while taking his medication. D. This medication will help me lose weight that I have gained over the last year.

I might feel drowsy for the first few weeks after starting this medication

A nurse is assessing a client who has expressed suicidal thinking. Which of the following statements would indicate that the client is at highest lethality? a. There is nothing left for me in this life. I just wish I could die. b. I tried to kill myself last year at this time by swallowing a bottle of aspirin. This time I'll swallow a whole bottle. c. God has called on me to come to him. He commands me to jump off the bridge tomorrow. d. I'm just useless. I want someone to take me out and shoot me

I tried to kill myself last year at this time by swallowing a bottle of aspirin. This time I'll swallow a whole bottle.

A nurse is working with a client who has recently lost her guardian. The nurse recognizes that which of the following factors influence is a clients, grief and coping ability? Select all that apply. A. Interpersonal relationships. B. Culture. C. Birth order. D. Religious beliefs. E. Prior experience with loss

Interpersonal relationships, culture, religious beliefs, and prior experience with loss

What is the only route of injection for Selegiline?

It is applied to the thigh which is the only possible route for selegiline

Does evaluation continue through the whole nursing process or just at the end with a client who has suicidal ideations?

It is ongoing

How long does it take for antidepressants to fully work in a client?

It takes a minimum of two weeks for the antidepressant drugs to work in a client

% of people with depression who are diagnosed

Less than half of depressed patients seek medical help, Of those who present for treatment only half are accurately diagnosedEarly treatment for depression can result in improved outcomes.

I know she's caring for a client who states, I plan to commit suicide. What are the long assessment should the nurse identify as a priority? A. Clients, educational and economic background. B. Lethality of method, and availability of means. C. Quality of the client social support. D Perry clients insight into the reasons for the decision

Lethality of the method and availability of means

Do psychostimulants make you gain or lose weight?

Lose weight

seritonin syndrome

May occur with increase in dose or adding another medication which increases serotonin

A nurse is assessing a client immediately following an ECT procedure. Which of the following findings should the nurse expect? Select all that apply. A. Hypotension. B. Paralytic ileus. C. Memory loss. D. Polyuria. E. Confusion.

Memory loss and confusion

Are men or women more likely to commit suicide?

Men are more likely to complete suicide

What will be monitored during ECT?

Monitor heart during ECT

A nurse is assessing a client who is major depressive disorder. The nurse should identify that which I find client statements is an overt comment about suicide? Select all that apply. A. My family would be better off if I'm dead B. The stress in my life is too much to handle. C. I wish my life is over. D. I don't feel like I can never be happy again. E. If I kill myself in my problems will go away

My family will be better off if I am dead I wish my life is over If I kill myself and my problems will go away

Country who have legalized assisted suicide

Netherlands• Belgium• Switzerland• Colombia • Luxembourg• Japan• Albania• Germany

_____ treatments for depression include transcranial magnetic stimulation, vagus nerve stimulation, and electroconvulsive therapy.

Nonpharmacological

What is the onset of symptoms for Substance - Induced Mood (Depressive) Disorder

Onset of symptoms occurs during or within 1 month of a patient initiating use of a substance or medication.

A nurse is caring for a client who is taking PHENELZINE for which of the following manifestations to the nurse monitor is an adverse effect of this medication? Select all that apply. A. Elevated blood glucose level. B. Orthostatic hypotension. C. PRIAPISM D. Hypomania E. Bruxism.

Orthostatic, hypotension and hypomania

What are some other comorbidity's that someone can have with depression?

Panic disorder Anxiety disorders Borderline personality disorder Schizophrenia Substance abuse Schizoaffective disorder OCD Eating disorders

A patient is experiencing ________ loss when she states, "I was devastated when my husband moved to another country. My entire world fell apart. They say he just moved and it's not like he died, but it's tough. Nobody understands me." (Uniquely defined by the person experiencing the loss & is less obvious to other people.)

Perceived

This is working in an acute mental health unit and admitting a client who is major depressive disorder and comorbid anxiety disorder. Which of the following actions is the nurses priority? A. Place in the client on one to one observation. B. Assisting the client to perform ADL C. Encouraging the client to participate in counseling. D. Teaching a client about medication adverse effects.

Place a client on one to one observation

Nurse is discussing are the indications of toxicity with a client who has a new prescription for lithium carbonate for bipolar disorder. The nurse should include which of the following manifestations in the teaching? Select all that apply. A. Constipation B. Polyurea. C. Rash. D. Muscle weakness E. Tinnitus.

Polyurea and muscle weakness

A nurse is interviewing a client who has a new diagnosis of persistent depressive disorder. Which of the following findings should the nurse expect? A. Wide fluctuation of mood. B. Report of a minimum of five clinical findings of depression. C. Presence of manifestations for at least two years. D. Inflated sense of self esteem.

Presence of manifestations for at least two years

MAO Inhibitors Antidote:

Procardia (Nifedipine)

A patient with major depression walks and moves slowly. Which term should the nurse use to document this finding? A. Psychomotor retardation B. Psychomotor agitation C. Vegetative sign D. Anhedonia

Psychomotor retardation

Secondary Nursing Interventions

Reduce disease impact, early detection and treatment, health screening / management of suicide crisis

Premenstrual Dysphoric Disorder

Refers to cluster of symptoms that occur in the last week prior to onset of woman's period

Nurses came for a client is prescribed lithium therapy. The client tells of the plan to take ibuprofen for osteoarthritis pain relief. Which of the following statements should the nurse make? A. This is a good choice, ibuprofen does not interact with lithium. B. Regular aspirin should be better choice than ibuprofen. C. Lithium decreases the effectiveness of ibuprofen. D. The ibuprofen will make your lithium levels fall too low.

Regular aspirin should be a better choice than ibuprofen

The depressed client verbalizes feelings of having low self esteem as evidenced by statements of " I'm such a failure and I cant do anything right." The best nursing response would be to: a. Tell the client that this is not true and we all have a purpose in life. b. Remain with the client and sit in silence and allow the client to verbalize feelings. c. Reassure that client that you know how the client is feeling and that things will get better d. Identify recent behaviors of accomplishments that demonstrate skill ability

Remain with the client and sit in silence and allow the client to verbalize feelings.

Depressive Disorder Associated with Another Medical Condition can come from what illness

Result of changes that are directly related to certain illnesses Kidney failure; Parkinson's disease; Alzheimer's disease

Assessment of Suicide Potential: what to check/ ask about

Risk for suicide in patients with major depression is increased in the presence of the following symptoms: Severe Hopelessness Overuse of Alcohol Recent Loss or Separation Past and Serious Suicide Attempts Acute suicidal ideation

Go to meds to treat pts with major depressive disorder

SSRI

3 diffrent meds used for major depressive disorders

SSRI TCAs MAOs

What medication is given before a ECT?

TROPINE SULFATE OR GLYCOPYRROLATE: administered 30 minutes before to decrease secretions that could cause aspiration and to counteract any vagal stimulations (bradycardia) ETOMIDATE OR PROPOFOL VIA IV BOLUD: Short acting anesthetic SUCCINYLCHOLINE: Muscle Relaxant administered to paralyze the client's muscles during the seizure activity

During an intake assessment of a patient who presents to the mental health intake department, one of the symptoms that the client described was social isolation. How would the nurse further explore this? a. "Can you promise me you'll be okay?" b. Tell me what your relationship is like with your spouse. c. "Do you like the way you see yourself?"

Tell me what your relationship is like with your spouse. (the lack of social contacts and having few people to interact with regularly)

A nurse is reviewing the medical record of a client who has a new prescription for PUPROPION for depression. Which of the following findings as a part of the nurse to report to the provider? A. The client has a family, history of seasonal pattern, depression B. The client currently smokes one and a half packs of cigarettes per day. C. The client has a motor vehicle crash last year and sustained a head injury. D. The client has a BMI of 25 and has gained 10 pounds of last year.

The client had a motor vehicle crash last year and sustained a head injury

A charge nurse is discussing the care of a client who has major depressive disorder, or MDD. With a new license nurse, which of the following statements by the newly licensed nurse, indicates an understanding of the teaching? A. Care during the continuation phase focuses on treating continued manifestations of MDD. . B. The treatment of MDD during the maintenance phase lasts for 6 to 12 weeks. C. The client is at greatest risk for suicide during the first weeks of MDD episodes. D. Medication and psychotherapy are most effective during the acute phase of MDD.

The client is at greatest risk for suicide during the first weeks of an MDD episode

Premenstrual Dysphoric Disorder symptoms

They decrease significantly or disappear with the onset of menstruation• Physical discomfort and emotional symptoms similar to MDD (Anger or irritability. Anxiety and panic attacks. Depression and suicidal thoughts. Difficulty concentrating. Fatigue and low energy. Food cravings or binge eating. Headaches. Insomnia.)

I treacherous is discussing mirtazapine with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates understanding? A. This medication increases the release of serotonin and norepinephrine. B. I should tell the client about the likelihood of insomnia while taking his medication. C. This medication is contraindicated for clients of eating disorders. D. Sexual dysfunction is a common adverse effect of this medication.

This medication increases the release, serotonin and norepinephrine

Amitriptyline, Amoxapine, Clomipramine, Desipramine, Doxepin, Imipramine, Nortriptyline are classified as ________ antidepressants. 1. SSRI 2. tricyclic 2. MAIs

Tricyclic

A nurse is caring for a patient who is having selegiline. The nurse should teach the patient to avoid eating foods that are high in ________.

Tyramine (Eating these foods while you are using selegiline can raise your blood pressure to dangerous levels.)

Before administering Amitriptyline to a patient with depressive symptoms, determine whether the patient has a history of: a. Eating foods that are pickled and fermented. b. Urinary retention and constipation. c. Any hearing problems like as tinnitus.

Urinary retention and constipation.

Higher-risk methods of suicide includes?

Using a gun, jumping off a high place, hanging, poisoning with carbon monoxide, and staging a car crash.

A patient diagnosed with depression is experiencing change in bowel habits, eating habits, sleep disturbances, and disinterest in sex which are examples of _____ signs.

Vegetative

Un is teaching a client who is a new prescription for IMIPRAMINE how to minimize anticholinergic effects. Which of the following instructions to the nurse include in the teaching? Select all that apply. A. Void just before taking this medication. B. Increase the dietary intake of potassium. C. Wear sunglasses went outside. D. Change position slowly, when getting up. E. Chew sugarless, gum,

Void just before taking this medication Wear sunglasses when outside Chew sugarless gum

Does a pt need to be involuntary or voluntary to get a ECT?

Voluntary status needs to be on a pt

What is Prolonged Grief?

When approximately 10%-20% of survivors have difficulty moving on with their life after 6 months have passed

What is Disenfranchised Grief?

an individual's grief involving a deceased person that is a socially ambiguous loss that can't be openly mourned or supported - Examples: ex-spouse, abortion, stigmatized death (such as AIDS)

Trazadone - Desyrel® use, when should it be administered, and what are some adverse effects, normal range

antidepressant and can be used as a sleep aid It effects males and causes priapism (200 - 600 mg/d)

Side effects of Bupropion (Wellbutrin)

anxiety, agitation, insomnia, nausea, tremor andweight loss

What is light therapy?

application of rays to the skin for the treatment of major depressive disorder or dysphoric disorder due to the changing of the seasons

You are reviewing the prescriptions for a palliative care patient. Which of the following prescriptions would you NOT expect? a. Provide skin care and mouth care. b. Check vital signs every 2 hours. c. Give oxygen via nasal cannula at 2 liters per minute. d. Administer artificial tears as needed.

b. Check vital signs every 2 hours.

What medications should transdermal selegiline be discontinued 2 weeks before hand?

carbamazepine, serotonin reuptake inhibitors, clomipramine, imipramine, tramadol, propoxyphene, methadone, pentazocine, and dextromethorphan.

A nurse along with the staff members, is having a discussion about suicide. A patient saying, "I have a plan that will fix everything," is an example of a __________ statement.

covert

Dysthymic Disorder effects which age groups?

persists for at least two years -Children, adolescents, adults

Bupropion, often used for depression, is effective by utilizing the reuptake of neurotransmitters namely _______ and norepinephrine.

dopamine

What is Grief?

emotional numbness, disbelief, separation anxiety, despair, sadness, and loneliness that accompany the loss of someone we love - Grief is a complex, evolving process with multiple dimensions - More like a roller-coaster ride than an orderly progression of stages

Atypical sub-type of major depressive disorder

excessive sleep or sleepiness, increased appetite, marked fatigue or weakness, mood reactive to environmental circumstances, and extreme sensitivity to rejection

KÜBLER-ROSS'S STAGES OF DYING acceptance

feeling a sense of peace

Which of the following S/S would you see in a client with major depressive disorder?

headaches, malaise, backaches Anhedonia; Anergia constipation disinterested in sex chronic pain

Contraindication of use of Bupropion (Wellbutrin)

history of seizure disorder, head trauma and eating disorders.

Anadonia

inability to experience pleasure

Examples of lower-risk methods for suicide includes?

include cutting one's wrists, inhaling natural gas, and ingesting pills.

Melancholic sub-type of major depressive disorder

insomnia, loss of appetite, lack of reactiveness to environmental circumstances and marked anhedonia

Biggest complication to the use of DBS or deep brain stimulation?

intercranial hemorrhage

Tertiary Nursing Interventions

interventions with the family or friends of a person who committed suicide

Substance - Induced Mood (Depressive) Disorder

marked mood changes from a person's baseline mood associated with the person's exposure to a substance or medication