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    Chapter 14

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    Chapter 14

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    slg233
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    chapter 14

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    chapter 14

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    118 views26 pages

    Chapter 14

    Uploaded by

    slg233
    chapter 14

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 26

    Chapter 14

    Depressive Disorders

    Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

    Major Depressive Disorder

    Persistently depressed mood lasting a minimum of 2 weeks - Symptom include: Anhedonia, fatigue, sleep disturbances, changes in appetite, feelings of hopelessness or worthlessness, persistent thoughts of death or suicide, inability to concentrate or make decisions, change in physical activity

    Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

    Depressive Disorders Classified


    Disruptive mood dysregulation disorder Dysthymic disorder Premenstrual dysphoric disorder Substance abuse depressive disorder Depressive disorder associated with another medical condition

    Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

    Epidemiology

    Leading cause of disability in the United States


    Children and adolescents Older adults

    Comorbidity

    Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

    Etiology

    Biological factors

    Genetic Biochemical
    Stressful life events

    Alterations in hormonal regulation Inflammatory process Diathesis-stress model

    Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

    Etiology (Cont.)

    Psychological factors

    Cognitive theory Learned helplessness

    Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

    Nursing Process

    Assessment

    Assessment tools Assessment of suicide potential Key assessment findings

    Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

    Nursing Process (Cont.)

    Areas to assess

    Affect Thought processes Mood Feelings Physical behavior Communication Religious beliefs and spirituality

    Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

    Nursing Process (Cont.)

    Age considerations

    Children and adolescents Older adults


    Self assessment Feeling what the patient is feeling

    Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

    Question 1
    Which question would be a priority when assessing for symptoms of major depression?
    A. Tell me about any special powers you believe you have. B. You look really sad. Have you ever thought of harming yourself? C. Your family says you never stop. How much sleep do you get?
    Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.
    10

    Question 1 (Cont.)
    D. Do you ever find that you dont remember where youve been or what youve done?

    Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

    11

    Nursing Process (Cont.)

    Nursing diagnosis

    Risk for suicidesafety is always the highest priority Hopelessness Ineffective coping Social isolation Spiritual distress Self-care deficit

    Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

    12

    Nursing Process (Cont.)

    Outcomes identification Recovery model


    Focus on patients strengths Treatment goals mutually developed Based on patients personal needs and values

    Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

    13

    Nursing Process (Cont.)

    Planning Geared toward


    Patients phase of depression Particular symptoms Patients personal goals

    Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

    14

    Nursing Process (Cont.)

    Implementation Three phases


    Acute phase (6 to 12 weeks) Continuation phase (4 to 9 months) Maintenance phase (1 year or more)

    Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

    15

    Nursing Process (Cont.)


    Counseling and communication Health teaching and health promotion Promotion of self-care activities Teamwork and safety

    Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

    16

    Psychopharmacology

    Antidepressants

    Selective serotonin reuptake inhibitors (SSRIs)


    First-line therapy Indications Adverse reactions Potential toxic effects

    Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

    17

    Psychopharmacology (Cont.)

    Tricyclic antidepressants (TCAs)


    Neurotransmitter effects Indications Adverse effects Toxic effects Adverse drug interactions Contraindications Patient and family teaching

    Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

    18

    Psychopharmacology (Cont.)

    Monoamine oxidase inhibitors (MAOIs)


    Neurotransmitter effects Indications Adverse/toxic effects Interactions

    Drugs Food

    Contraindications

    Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

    19

    Case Study

    Your patient was just diagnosed with a major depressive disorder. What medication do you anticipate the health care provider will start the patient on?

    Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

    20

    Case Study (Cont.)

    What side effects might the patient experience?

    Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

    21

    Other Treatments for Depression


    Electroconvulsive therapy (ECT) Transcranial magnetic stimulation Vagus nerve stimulation Deep brain stimulation Light therapy St. Johns wort Exercise

    Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

    22

    Advanced Practice Interventions

    Psychotherapy
    Cognitive-behavioral therapy (CBT) Interpersonal therapy (IPT) Time-limited focused psychotherapy Behavior therapy

    Group therapy

    Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

    23

    Nursing Process (Cont.)

    Evaluation

    Suicide ideation Intake Sleep pattern Personal hygiene and grooming Self-esteem Social interaction

    Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

    24

    Audience Response Questions


    1. 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

    Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

    25

    Audience Response Questions


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

    Copyright 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

    26

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