NURS 249/NURS2488 –CONCEPT GUIDES EXAM 2 2022/2023

Depression Define common symptoms: memory difficulties, suicidal ideations or attempt, poor concentration, worthlessness, helplessness, anhedonia (losing pleasure in things they once loved doing- key symptom people w/ depression have) Major depression causes pt to feel low self- worth Severe – not eating, drinking: offer high protein, high calorie food/drink: around the clock observation (not necessarily 1:1), high risk for suicidal ideation Beck’s Cognitive Triad: people acquire a psychological predisposition to depression through early life experiences. Depressed people process info in neg ways: Negative, self-deprecating view of self: “I really never do anything well; everyone else seems smarter”. Pessimistic view of the world: “Once you’re down, you can’t get up. Look around, poverty, homelessness, sickness, war, and despair are every place you look.” Belief that negative reinforcement (or no validation for the self) will continue: “it doesn’t matter what you do; nothing ever gets better. I’ll be in this stupid job the rest of my life.” Automatic negative thoughts- thoughts that are repetitive, unintended, and not readily controllable. GOAL: change the way the pt thinks help relieve the depressive syndrome. Assist pt in: identifying & testing neg cognition, developing alternative thinking patterns, rehearsing new cognitive and behavioral responses. Risk for suicide- Questions to ask, High vs low risk (Ch 23) Identify current feeling states, ask directly: if yes frequency, duration, & intensity, ask if they have a plan, determine lethality of the plan how detailed, how lethal, availability of means, gather info about risk factors, history of suicide attempts, Nursing Diagnosis (Table 15-2) Physical Interventions (Table 15-5) Institutional protocol- creating a safe environment, keep records of pt behavior, suicide precautions (1:1, ***maintain arm length away*** ), keep record of pts activity q15, no-suicide contract, encourage pt to talk about their feelings. Medications- Classes: SSRI, TCA, MAOIs SSRIs (selective serotonin reuptake inhibitors)- blackbox warning (chance of increasing suicide ideation – constantly assess for that – pts need to be aware of this and communicate feelings w/ someone) first line tx for depression Citalopram (Celexa), fluoxetine (Prozac). Education: when starting it, do NOT start it within 14 days (2 weeks) of an MAOI. SSRIs can cause serotonin syndrome (rare but can happen)- hyperactivity, seizures, restlessness, confusion, rapid HR & BP, dilated pupils, unconsciousness, high fever MAOIs- always talk w/ provider before starting any OTC vitamin or anything like that (certain herbal meds or vitamins contain tyramine – MAOIs inhibit that break down tyramine in liver); avoid avocado, soy sauce, hard cheeses, pepperoni) tyramine free diet. ****Cause hypertensive crisis- severely elevated BP!!!!!!!! Phenelzine, isocarboxide – when taking phenelzine, always speak to pharmacist prior to taking OTC meds. Has food/drug interactions. TCAs- common