Psych Exam III (from blueprint)

cdunbar4's version from 2017-02-07 20:32

Neurobiology of Depression

Question Answer
Decreased level of serotonin is associated with which symptoms of depression? disruption of appetite, sleep, and sexual dysfunction, impulsivity, aggression, and suicide.
Decreased levels of norepinephrine is associated with which symptoms?fatigue, apathy, cognitive, disturbance, slowness in information processing, and poor memory.
Decreased levels of dopamine is associated with what symptoms?lack of pleasure and psychomotor retardation
Two main neurotransmitters affected by depressionnorepi and serotonin
Decreased dopamine theoryless dopamine = less pleasure and functioning. Dopamine is associated with emotions, coordination, voluntary judgment normally.
Increased levels of acetylcholinehigh levels = depression


Question Answer
Dysthymia aka Persistent Depressive Disorderdown in the dumps; similar symptoms as MDD, but only happen intermittently
How long can dysthymia last in children and adults?Can be continuous in children for 1 year and 2 years for adults.
Major Depressive DisorderMust have 5 of the specific clinical findings which must occur every day for a minimum of 2 weeks (and lasts for most of the day).
MDD: clinical findingsanhedonia; social & occupational impairment (2 weeks worth); no history of manic behavior or psychotic features; no connection to medical issues or substance abuse.
Dysthymia (PDD) or MDD can be episodic?MDD
What are the commonalities of PDD and MDD?↓ social and emotional functioning
PDD or MDD more severe?MDD-it is incapacitating
PDD or MDD more chronic?PDD (no remissions for greater than 2 months signifies chronic aspect of the disorder)
Symptoms of Depressionanhedonia, grief, guilt ,self-injury, psychomotor retardation.
Vegetative sx of depressioninsomnia, loss of appetite, over activation of stress hormones
Factors that may lead to depression (generally speaking)Female gender; postpartum; active alcohol/substance abuse; personality trait of hypersensitivity to negative stimuli; family hx of MDD; childhood maltx; hx of suicide attempts; comorbidity; lack of social support; widowed, separated or divorced marital status; lower socioeconomic status; lower educational achievement; unemployment; stressful life events that cause loss of self-esteem, or feelings of entrapment.

Nursing Care Depression

Question Answer
Assessmentrefer to pt.’s risk factors, any previous instances of depression. Subjective data: refer to cardinal s/s of depression. Objective: affect, behavior, cognitive, physiological.
Standardized screening tools usedHamilton Depression Scale; Beck Depression Inventory; Geriatric Depression Scale
This type of therapy is extremely important for implementation of patient-centered careMileu therapy
Key aspects of Mileu Therapysuicide risk, self-care, communication (Important to keep sentences simple, not long and comprehensive so that they can stay focused), maintenance of safe env’t, counseling, problem solving, ↑ coping mechanisms, changing negative thinking to positive, ↑ self-esteem, assertiveness training, using available community resources.
Psychotherapycognitive behavior therapy; dialectical behavior therapy; group; family; interpersonal.
Alternative therapyLight; Electroconvulsive Therapy (ECT); Transcranial Magnetic Stimulation (TMS); Vagus Nerve stimulation (VNS).
Discharge teachingsreview manis of depression with client/family in order to ID relapse; reinforce intended effects & potential adverse effects of meds; explain benefits of clients adherence to therapy; exercise 30 minutes 3-5 times daily each week (this improves depression, releases endorphins)

Drugs for depression

Question Answer
SSRIssertraline, citalopram, fluoxetine: few SE; Watch for serotonin syndrome (HTN, tremors, sweating, hyperpyrexia, ataxia) DNU with St. John’s Wort.
Barbituatesphenobarbital *Rarely used today d/t high tolerance; depresses CNS at all levels
Tricyclicsamitriptyline: Watch SE of anticholinergic effects! Inhibits reuptake of NE & Serotonin
MAOI'sphenezeline: ↑’s availability of NE, Dopamine & Serotonin. AVOID: foods with tyramine (aged cheese, red wine, soy sauce, salami, bananas, fermented sausages, liver→ can cause HTN CRISIS: parasthesias, sedation/insomnia, anticholinergic effects
Atypical antidepressantsbuproprion: inhibits reabsorption of serotonin & NE; DNU with MAOIs
SNRI'svenlafaxine, duloxetine: DNU with MAOI’s; SE=nausea, sweating, constipation & ↓ appetite

Bipolar Disorder and Treatment of

Question Answer
Symptoms of bipolar disorder (particularly mania)mood is elevated, expansive or irritable…the indiv. may put their health, safety & well-being at risk through excessive spending, risky activities, self-neglect, inappropriate behaviors & sexual indiscretions.
Nursing Care: Assessmentsymptoms of manic states are usually described according to 3 stages: hypomania; acute mania and delirious mania.
Nursing Care: DiagnosisDepending on which episode pt. is experiencing. Ex: manic excitement, delusional thinking, hallucinations & impulsivity = Risk for violence
Nursing Care: Interventionsacute phase you should focus on safety & physical health, provide a safe env’t; ↓ stimulation w/o isolating client, if possible; be aware of noise, music, TV, & other clients (these can escalate behavior). Sometimes seclusion is necessary for safety concerns though. Maintenance of self-care needs; monitor sleep, fluid intake & nutrition, provide portable/nutritious food bc client may not be able to sit & eat; supervise choice of clothes; give step-by-step reminders for hygiene & dress.
Nursing Care: Communicationuse a calm, matter of fact, specific approach. Give concise explanation, be consistent with expectations & limit setting, avoid power struggles, do not react to client’s comments, listen to & act on legit client grievances, reinforce non-manipulative behaviors, avoid power struggles & do not react personally to client’s comments. Listen to & act on legit client grievances & reinforce non-manipulative behaviors.
Drug class used for bipolar disorderMood-stabilizing agents indicated for prevention & treatment of manic episodes: lithium and anticonvulsants
Lithium MOAmay modulate certain neurotransmitters such as norepi, serotonin, dopamine, glutamate, GABA and stabilizes sx), valproic acid, other antipsychotics.
Lithium SEdrowsy, dizzy, h/a; dry mouth, thirsts, GI upset, n/v; fine hand tremors; hypoTN, arrhythmias, pulse irregularities; polyuria; dehydration; weight gain; pot. for toxicity.
Anticonvulsant side effectsn/v, dizzy, prolonged bleeding time, risk of rash, ↓ efficacy of oral contraceptives; risk of suicide with antiepileptic drugs
Patient teaching anticonvulsantsRefrain from discontinuing the drug abruptly. Report the following symptoms to the physician immediately: skin rash, unusual bleeding, spontaneous bruising, sore throat, fever, malaise, dark urine, and yellow skin or eyes. Avoid using alcohol and over-the-counter medications without approval from physician
Patient/family teaching lithiumtake med regularly; do not skimp on sodium; drink 6-8 glasses of water each day; notify PCP if vomiting or diarrhea occur (or other signs of toxicity occur); have lithium levels checked Q 1-2months by PCP
Therapeutic range lithium 1.0-1.5 (acute mania) and 0.6-1.2 (maintenance)
Initial toxicity lithium (s/s?)blurred vision, ataxia, tinnitus, persistent n/v & severe diarrhea
Interventions lithium toxicityensure client consumes adequate sodium & fluid in diet.


Question Answer
Biological factors in assessmentmay include family history of suicide, physical disorders, such as AIDS, cancer, cardiovascular disease, stroke, chronic renal failure, cirrhosis, dementia, epilepsy, head injury, multiple sclerosis, Huntington’s disease.
Psychosocial factors in assessmentinclude sense of hopelessness, intense emotions, such as rage, anger or guilt, poor interpersonal relationships at home, school, and work, developmental stressors, such a those experienced by adolescents.
Subjective & Objective Data verbal/nonverbal cues; over/covert comments; laceration, scratches & scars; SAD person scale
Nursing care for a client with suicidal ideations (SI) • Nurses who work personally with suicide clients can benefit personally by debriefing, sharing, and collaborating with other health professionals; Suicide precautions include milieu therapy within the facility
SI precautions: supervisiono initiate one-on-one constant supervision around the clock, always having the client in sight and close• Document the client’s location, mood, quoted statements, and behavior every 15 min or per facility protocol
SI precautions: environmental hazards• Remove all glass, metal silverware, electrical cords, vases, belts, shoelaces, metal nail files, tweezers, matches, razors, perfume, shampoo, and plastic bags from the client’s room • Allow client to use plastic utensils to eat • Check the environment for possible hazards such open windows, overhead pipes that are easily accessible • During observation period always check clients hands, especially if they are hidden from sight. • Do not assign to a private room if possible and keep open doors at all times
SI precautions: meds and monitoring client• During observation period always check clients hands, especially if they are hidden from sight. • Do not assign to a private room if possible and keep open doors at all times • Ensure the client swallow all medications• Identify whether or not the client’s current medications can be lethal with overdose. If so collaborate with the provider to have less dangerous medications substituted if possible
SI precautions: visitors and discharge teaching• Restrict the visitors from bringing possible harmful items to the client • Discharge teaching: initiate and have pt. sign or verbalize a no-suicide contract.
Care for survivors after someone has committed suicide• Encourage them to talk about it • Be aware of blaming or scapegoating • Listen to feelings of guilt and gently move them to reality of situation • Encourage family to discuss loved one’s individual relationships & focus on both positive and negative • Everyone will grieve in their own way. • Recognize how it has affected family’s coping mechanisms, look for new and adaptive methods of coping. • ID resources that provide support: religious, support groups, community
Assess potential of violence and safety precautionsPast hx, current diagnosis, & current behaviors

Electroconvulsive therapy (ECT)

Question Answer
IndicationsMDD, Acute manic episode of bipolar, OCD, personality disorders
MOAunknown; biochemical theory that it results in significant ↑'s in circulating levels of serotonin, norepi, & dopamine
Contraindications↑ ICP (from brain tumor, recent CVA or other cerebrovascular lesion; MI, aortic or cerebral aneurysm; severe underlying HTN & CHF
Side effectstemporary memory loss
Risks/ComplicationsPermanent memory loss and brain damage (mortality is rare)
Nursing Role in administration of ECTthorough exam (CV, pulm status, labs, urine, xray); informed consent; assess mood/anxiety level, thought & communication patterns; vitals
Nursing role in preparing the client for treatmentvoid and removing dentures, eyeglasses or contact lenses, jewelry, and hairpins.
Drugs administered via PCP orders approx. 30 min prior to treatmentAtropine sulfate or glycopyrrolate
A client is preparing to undergo electroconvulsive therapy (ECT). Which nursing intervention is appropriate? A. Keep the client NPO 24 hours before the procedure. B. Verify that informed consent has been granted. C. Ascertain that client has dentures securely in place. D. Place side rails down for easy access to the restroom.B?

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