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Test1_Chapter 12D

Depression-Chapter 12

Anhedonia Loss of pleasure in things that they once had pleasure in
What is depression usually related to? LOSS - loss of job; loss of body part; loss of loved one. This causes client to have a loss of interest in life's activities & have a negative view of the world
What are other causes of depression? changes in levels of norepinephrine (decrease) and steroids (increase); loss of self-esteem leading to hopelessness, helplessness & pessimisn towards self & others
Mild Depression: How do they look? They GAIN weight - they have crying spells - they are irritable/anxious - they have no energy - they need help with self-care in acute stages.
Severe Depression: How do they look? They LOSE weight - there are no more tears with severe depression - they are irritable/anxious - they have no energy.
Why might people with depression be irritable? Why might they have feelings of helplessness & hopelessness? Irritable due to a DECREASE in serotonin. REPRESSIVE GUILT leads to feelings of helplessness & hopelessness
Should the nurse encourage the depressed patient to interact with others or just let them be alone? The nurse wants to PREVENT ISOLATION because the depressed like to be alone. The nurse should find the patient and get them to do something. INTERACTING WITH OTHERS actually makes the cleint feel better, even if they don't want to do it.
Can depressed patients make SIMPLE decisions? NO - give them options to narrow down decision. Don't ask, "What do you want for lunch?" Instead ask, "Do you want a turkey or ham sandwich?"
The nurse should be care with giving ________ to depressed patients. Compliments - these may make the client feel worse.
If the patient is severely depressed, what may be the best thing for the nurse to do? If severely depressed, sitting with the client and making no demands may be the best thing that you can do.
When caring for a depressed patient, the nurse's first priority is ________. SAFETY - because of the increased risk of suicide.
As depression lifts, what happens tp suicide risk? It INCREASES because now they have the energy to actually act on suicidal feelings.
A sudden change in mood toward the better may indicate__________. That the client has made the decision to kill himself.
**NURSING PRIORITY** Be aware of special times when a client might be suicidal such as: 1. when suddenly cheerful 2. when there is less staff avaliable 3. upon arising in the morning 4. during a busy routine day
Who is particularly at risk for suicide? The ELDERLY (older than 45 years old) and the ADOLESCENTS (younger than 19 years old).
Who tends to be very successful at suicide by using very letal methods? MALES (elderly men) - are more likely to successfully commit suicide.
Suicide Danger Signs: Use the "SAD PERSONS SCALE" The more areas checked, the higher the risk (ranges from 0 [lowest risk] to 10 [highest risk]): S - Sex A - Age D - Depression P - Previous suicide attempt E - Ethanol (Alcohol) abuse R - Rational thinking (impaired) S - Social support lacking O - Organized plan N - No spouse S - Sickness (especially chronic)
What is an example of "lacking social support?" An example would be a client with sexual identity conflicts
Can depressed clients have delusions/hallucinations? YES
Are depressed clients thoughts sped up or slowed? SLOWED - so the nurse should change the way she communicates with the client - slow down when speaking to the client and give them time to process the info - the nurse should sit in silence and wait longer for a response from the client.
What kind of sleep disturbance does a client with MILD depression have? HYPERSOMNIA (sleeps all the time)
What kind of sleep disturbance does a client with MODERATE to SEVERE depression have? INSOMNIA
Sleep disturbances are common in depressed clients. Generally, they have: Difficulty falling asleep, difficulty staying asleep, or have early morning wakefulness
Other s/s of a depressive patient are: They cannot concentrate, fatigue, lack of appetite, constipation, decrease in libido, and/or either agitation or retardation in movements
What can the nurse do to provide safety and protection from self-destruction in a depressed client? 1. Remove potentially harmful objects (e.g., belts, sharp objects, matches, lighters, strings, etc...) 2. Maintain a one-to-one relationship and close observation 3. Have client make a written contract stating he or she will not harm themself
What can the nurse do to provide for physical needs of nutrition and rest/activity? 1. Assess for changes in weight 2. Encourage increased bulk & roughage in diet along with sufficient fluids if client is constipated 3. Provide for adequate amt of exercise & rest 4. assist w/ hygiene & personal appearance
What should nurse look for when assessing changes in weight? Weight loss - because weight loss may indicate deepening depression
What should the nurse encourage discourage the client from doing during the day? The nurse should encourage the client not to sleep during the day.
How should the nurse approach a client with depression? The nurse should convey a kind, pleasant, interested approach to promote a SENSE OF DIGNITY & SELF-WORTH in the client. [help them experience ACCOMPLISHMENT because it will increase their self-esteem]
What feelings should the nurse encourage the depressed client to express? Encourage expression of ANGRY, GUILTY, or DEPRESSED feelings. The nurse should support the client in the expression of their feelings by allowing them to respond in their own time.
A nurse must devise a plan of therapeutic activities & provide the client w/ a written time schedule b/c they often have impaired decision making & need structure in their life. When should the nurse schedule activities for a MODERATELY depressed client? The client who is moderately depressed feels best EARLY IN THE DAY so this would best time for the moderately depressed individual to participate in activities.
A nurse must devise a plan of therapeutic activities & provide the client w/ a written time schedule b/c they often have impaired decision making & need structure in their life. When should the nurse schedule activities for a SEVERELY depressed client? The client who is severely depressed feels best LATER IN THE DAY so this would best time for the severely depressed individual to participate in activities.
What age does MAJOR DEPRESSION usually occur at? Is MAJOR DEPRESSION seen in more women or men? How is MAJOR DEPRESSION differentiated? May occur at any age. It is more often seen in women than in men. It is differentiated as either a single episode or a recurring type.
**NURSING PRIORITY** Depressed clients are particularly vulnerable to constipation as a result of psychomotor retardation.
**NURSING PRIORITY** Depression & suicidal behaviors may be viewed as anger turned inward on the self. If this anger can be verbalized in a nonthreatening environment, the client may be able to resolve these feelings, regardless of the discomfort involved.
*****NCLEX HINT***** NEVER pick an answer that says "OBSERVE" when dealing with a depressed client. Pick the answer that involves SEEKING OUT THE PATIENT!!!!!!!!!! Seek out the patient because they won't see you out! Try to get them involved in an activity.
*****NCLEX HINT***** ALWAYS confront suicide DIRECTLY!!!! Even if you slightly suspect a person is suicidal, CONFRONT THE PATIENT!!! This is one of the only times the nurse can ask a psych patient a "closed-ended" question
What is the medical treatment for a client suffering with depression? The nurse can administer antidepressent medications to the client and/or assist in electroconvulsive therapy (ECT)
Created by: jhrobins99