Row 1
Ch. 14
Ch. 14
Learning card (no points)
Areas to assess
Thought process, thought content or perceptions, insight and judgement, cognitive changes
--Thought process: poverty of thought, responses slow or absent
-- Thought content or perception: delusions or hallucinations may be present, negative or pessimistic thoughts or beliefs
-- Insight and judgement: judgement is poor, indecisveness
-- Cognitive changes: decreased ability to think and/or concentrate, decreased ability to process information.
Learning card (No points)
Interventions (very important, must know)!
--Priority: establish TRUST--Suicide and homicide risk assessment
-- Self-care deficits: assist until the client can be independent, give reminders
-- Nutrition: Offer small, high-calorie snacks frequently, encourage socialization with meals, involve client to choose foods/drinks, weight weekly
-- Sleep: OFFER REST PERIODS, sleep hygiene, decaffeinated coffee/tea
--Elimination: Monitor I/O's and bowel habits, offer high fiber foods, encourage PO fluids, evaluate the need for a laxative.
Learning card (no points)
MORE INTERVENTIONS!
--Communication: Make observations, use simple and concreate words, allow time for pt to respond, listen for covert messages and ask about suicide plans, avoid reassurance or minimizing perception of feelings.
-- Encourage activities and exercise
-- Help client question negative assumptions
-- Identify cognitive distortion and reframe perceptions
-- Identify coping skills and teach healthy coping skills
-- Encourage supportive relationships and give referrals
Learning card (no points)
Tx: therapies for MDD
--Brain stimulation therapies (Electroconvulsive therapy (ECT): used for severe cases; effective but not first-line therapy, informed consent: Monitor VSs, airway after procedure. Usually 2-3 txs and Vagus Nerve stimulation (VNS): may boost neurotransmitters).
--Psychological therapies: Individual therapy--CBT (coping skills and meds), interpersonal therapy, behavioral therapy and Group therapy (peer support).
What is the main class of drugs we use to tx MDD?
Antidepressants
What are some teaching points for your pt that is taking SSRIs?
--Avoid: St. John's Wort, TCAs, or MAOIs (can cause serotonin syndrome; Avoid alcohol.
-- Common s/e: fatigue, N/D, sexual dysfunction, dizziness, tremors
-- Monitor: hepatic, renal, and blood tests regularly
-- Do not abruptly stop, may cause discontinuation syndrome
-- Takes 4-6 weeks to work on mood
-- Report: sudden shift in mood and/or energy (report SI to team), rash, sore throat, anorexia or weight loss, severe HA
(1) What needs to be included when assessing a patient for depression (tools, different assessment)?
--Suicide risk assessment
--Patient health questionnaire-9 (PHQ-9), Beck depression inventory
--Assess the client's hx of depression and any txs that were effective or not.
-- Assess support system, family, significant others, and the need for information and referrals.
(1) Name the SSRIs
(2) Can you stop these abruptly? What can happen if you do?
(3) What is an herb that should be avoided if taking SSRI's?
(300 points added if correct)!
(1) Citalopram, Escitalopram, Fluoxetine (Prozac), Paroxetine, Sertraline
(2) No, can cause discontinuation syndrome (causes a variety of symptoms: nausea, insomnia, fatigue, and achiness).
(3) St. John's Wort
(1) What is the drug that is a NDRI (antidepressant)
(2) What the contraindications?
(3) When should you not take this NDRI?
(300 points added)!
(1) bupropion (Wellbutrin)
(2) contraindicated: with eating and seizure disorders
(3) Do not take when detoxing from substances due to seizure risk
(1) Name the TCAs (antidepressants)
(2) What are the S/Es of these drugs?
(200 points added)!
(1) amitriptyline (Elavil), amoxapine, desipramine (Norpramine), doxepin, imipramine,, maprotiline, nortriptyline, protriptyline
(2) More potent than SSRIs, anticholinergic, Lethal in overdose!
(1) Name the MAOIs (antidepressants)
(2) What is contraindicated with these drugs?
(200 points added)!
(1) Isocarboxazid, Phenelzine (Nardil), Tranylcypromine sulfate (Parnate)
(2) Contraindicated: with SSRIs, TCAs, tyramine-foods/drinks, OTC decongestants.
(2) Name some symptoms of MDD.
(2) depressed mood, anhedonia (inability to experience joy or pleasure), significant weight loss or gain without intentions, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy (anergia), feelings of worthlessness or excessive guild, decreased concentration, recurrent thoughts of death or suicidal ideations.
Areas to assess
What would there appearance look like?
What about there behavior would we be looking at?
What about there mood?
What about there feelings and emotions?
What about there affect?
What about there speech?
(200 points added if correct)!
--Appearance: poor grooming
-- Behavior: anergia, restlessness, vegetative signs of depression, sleep disturbances, elimination changes, low libido
--Mood: sense of sadness, angry, irritable, anxious, apathetic
-- Feelings and Emotions: worthlessness ("I'll never amount to anything"), guilt, helplessness, anger (could be seen as self-destructive behavior), anhedonia
-- Affect: constricted, blunted, or flat
-- Speech: slow and soft
(2) What are the signs of this syndrome?
(3) What are the interventions?
(200 points added if correct)!
(1) Rare but life-threatening adverse effect while taking SSRIs, SNRIs, and SARIs. Potentially fatal drug-induced condition caused by too much serotonin in synapses in the brain. Pts present with a combination of neuromuscular, autonomic, and mental status symptoms
(2) Signs: hyperactivity, tachycardia, delirium, fever, HTN, seizures, tonic rigidity, abd pain, death
(3) Interventions: D/C offending agent, Give cyproheptadine, or propranolol (serotonin-receptor blockade)
(1) Name the SNRIs (antidepressants)
(2) What can happen if you abruptly stop these meds?
(3) What should you monitor closely?
(200 points added)!
(1) Desvenlafaxine, duloxetine, venlafaxine
(2) Discontinuation syndrome
(3) Monitor BP
(1) Name the SARIs (antidepressants)
(2) What are potential S/Es?
(200 points added)!
(1) Nefazodone, Trazodone, Vilazodone, Vortioxetine
(2) Report priapism, life-threatening liver failure, serotonin syndrome