N244 Test 2

Mood Disorders: 2 ends of spectrum - - depression (lowest) hypomania (middle) mania (highest above hypomania) Mood Disorders: Mania - -over the top energetic (bipolar) Mood Disorders: Depression may be comorbid with the following - --anxiety disorders -psychotic disorders (schizophrenia) -substance use disorders: can have substance induced mood disorder -eating disorders -personality disorders Mood Disorders: Clients w/ depression are at high risk for suicidality especially if the client has: - -- family history of suicide attempts -anxiety disorder -panic attacks -poor self esteem -lack of social support -chronic medical condition Mood Disorders: MDD: single/recurrent depressive episodes clients w/ depression have symptoms everyday for 2 WEEKS including: - --depressive mood -insomnia/hypersomnia -indecisiveness -suicidal ideation -suicide attempts -increased or decreased motor activity (psychomotor retardation) -inability to feel pleasure: anhedonia -wt changes Mood Disorders: Different types of depression: MDD with psychotic features - -may experience auditory hallucinations and delusions - Mood Disorders: Different types of depression: MDD with Postpartum onset - --begins 4 weeks after childbirth -may include delusions -puts infant at high risk Mood Disorders: Different types of depression: seasonal characteristics - -SAD -occurs during winter NUR244 NUR244 -may be treated with light therapy Mood Disorders: Different types of depression: Dysthymic Disorder - -- milder form of depression w/ early onset -begins in childhood or adolesence -lasts at least 2 years in length for adults - contains at least 3 clinical findings of depression -may turn into MDD later on Mood Disorders: Different types of depression: Premenstrual disorder - -PMDD -associated w/ leutal phase of menstrual cycle -emotional lability + persistent or severe anger Assessments for depression: 2 Major things to look for - --family history -previous personal history -(understanding that in elderly patients, depression can look like dementia): like memory loss, confusion, etc. - Assessments for depression: In children and adolescents - --this age range can have comorbid conditions and may meet the criteria for more than 1 mental health disorder Assessments for depression: Characteristics of good mental health in children - --ability to interpret reality -positive self concept -ability to cope w/ stress and anxiety in age appropriate way -mastery of developmental tasks ability to express oneself spontaneously and creatively -ability to develop and maintain satisfying relationships Depression Manifestations in Children: - - -feelings of sadness -loss of appetite -nonspecific complaints related to health -school performance dropping -taking risks -irritable behavior Depression Risks in adults: - --stressful life events -presence of medical illness -being a female in the post-partum period -poor social support network -comorbid substance use disorder -being unmarried (depression may be primary disorder or it may be response to another physical or mental health disorder) NUR244 NUR244 Subjective Data for depression: - --Anergia (lack of energy) -Anhedonia ( lack of interest in activities) -anxiety -feelings of slugishness -vegetative feelings, include change in eating patterns (anorexia, increased in dysthymia, PMDD), change in bowel habits, change in sex drive -somatic (no underlying cause) reports: fatigue, GI changes, pain Objective data for depression (physical assessment findings): - --Affect: pt appears sad and blunted -poor grooming/lack of hygiene -psychomotor retardation -social isolation -slowed speech, decreased verbalization, delayed response time Clinical care for depression: - --suicidal assessment (top safety priority) - milleu therapy (able to do self care, able to perform activities, encourage to be as independent as possible w/ access to hygiene materials) -can relate therapeutically to client -make observations instead of asking direct questions (say, "I noticed..") -communication simple and concrete -give client time to respond to questions -making sure clients environment is safe -adminsitering meds (signs and symptoms) -teamwork and collaboration Discharge care for clients w depression: - --reviewing manifestations of depression w client and family -identify triggers that increase their depression -teach about adverse side effects of medications -explain benefits of client adherence to therapy -discuss importance of exercise (shorter intervals can be helpful) -give them crisis phone number Bipolar disorder: Characterized by: - --can have mania or hypomania (with compenent of depression -recurrent episodes of depression/ mania -usually emerges in late adolesence/ early adulthood (can be misdiagnosed as ADHD) -periods of normal functioning with alternating periods of illness (although some clients can't maintain full functioning) -psychotic, paranoid, bizarre behavior seen in mania -care for client w bipolar will mirror phase of disease client is facing Bipolar disorder: Mania - --elevated, expansive, labile mood NUR244 NUR244 -usually requires hospitalization Bipolar disorder: Hypomania (middle of spectrum) - --less severe episode of mania -lasts at least 4 days -accompanied by 3 or 4 findings of mania -hospitalization usually not required -less impaired Bipolar disorder: Mixed episode - --manic episode and an episode of major depression experienced simeltaneously -impairment in functioning -may require acute admission to prevent self harm or harm to others Bipolar disorder: Rapid cycling - -4 or more episodes of acute mania within 1 year Bipolar disorder: Bipolar I - --you see both full ends of spectrum (swings) -has depression, hypomania, and mania Bipolar disorder: Bipolar 2 - --only has depression and hypomania -never swings into mania Bipolar disorder: Assessment: Risk Factors - --genetics -stressors/ major life changes -neurological disorders/imbalances -substance use disorder (can trigger manic episod