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    Depression Powerpoint

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    joycechicago
    The patient was focusing only on her perceived flaws with her swimsuit, ignoring other potentially positive aspects of swimming like cooling off, exercise, etc. The nurse reframed the situation to help the patient consider a more balanced perspective.

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    Depression Powerpoint

    Uploaded by

    joycechicago
    774 views32 pages
    The patient was focusing only on her perceived flaws with her swimsuit, ignoring other potentially positive aspects of swimming like cooling off, exercise, etc. The nurse reframed the situation to help the patient consider a more balanced perspective.

    Original Description:

    This presentation explains all about depression from a clinical standpoint.

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    The patient was focusing only on her perceived flaws with her swimsuit, ignoring other potentially positive aspects of swimming like cooling off, exercise, etc. The nurse reframed the situation to help the patient consider a more balanced perspective.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    774 views32 pages

    Depression Powerpoint

    Uploaded by

    joycechicago
    The patient was focusing only on her perceived flaws with her swimsuit, ignoring other potentially positive aspects of swimming like cooling off, exercise, etc. The nurse reframed the situation to help the patient consider a more balanced perspective.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 32
    At a glance
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    The key takeaways are about recognizing criteria and terminology for depressive disorders, theories of depression, nursing interventions, suicide, and cultural considerations.

    The DSM-IV-TR criteria for major depressive disorder require at least 5 of the 9 symptoms, including depressed mood or anhedonia, over a minimum 2-week period. The 9 symptoms include depressed mood, anhedonia, weight changes, sleep disturbances, psychomotor changes, fatigue, worthlessness, concentration difficulties, and suicidal thoughts.

    Common symptoms of depression include sadness, hopelessness, helplessness, worthlessness, guilt, anger, fatigue, sleep disturbances, decreased libido, psychomotor changes, and crying.

    Depression

    Objectives
    Recognize DSM-IV-TR criteria

    Recognize terminology for depressive d/os


    Major depressive d/o and dysthymic d/o Theories of depression Nursing interventions Suicide and depression Family and cultural considerations

    Criteria of MDD
    At least 5 out of the 9 criteria, one must be a

    depressed mood or anhedonia over a min 2-wwek period: Depressed mood Anhedonia or apathy Significant change in weight Sleep disturbances Changes in psychomotor activity Fatigue or loss of energy Feelings of worthlessness, guilt Difficulty concentrating, staying focused Suicidal thoughts

    Symptoms of depression
    Apathy

    sadness,
    Sleep disturbances Hopelessness

    Helplessness
    Worthlessness Guilt Anger (fatigue, decreased libido, psychomotor agitation,

    passiveness, crying)

    Subcategories of MDD
    Atypical depression

    Melancholic depression
    Postpartum depression Psychotic depression Seasonal affective disorder (SAD) Dysthymic disorder

    Behavior symptomatic of depression


    Objective signs

    Alterations in activities Alterations in social interactions Alteration of affect Alteration of cognition Alterations of a physical nature Alterations of perceptions

    Subjective signs

    Etiology of depression
    Biologic theories

    Genetic theories
    Endocrine theories Cardiac rhythm theories Psychologic theories of depression

    Drugs that may induce depression


    Analgesics Anticonvulsants Antihypertensives Antiinflammatory agents Antiparkinsonian agents Antituberculosis agents Cardiovascular agents Psychotropic and CNS agents Miscellaneous

    Medical Illnesses associated with Depression


    CNS disorders

    Collagen vascular diseases


    Infections Neoplastic disorders Toxic-metabolic disturbances Other

    Special Considerations
    Working with children and adolescent pts

    Working with older adults


    Cultural, age, gender variables

    Antidepressant Medications
    Tricyclics (TCAs)
    imipramine)
    (amitriptyline, doxepin, desipramine,

    Selective Serotonin Reuptake Inhibitors (SSRIs) (Prozac, Paxil, Zoloft, Luvox)

    Serotonin-Norepinephrine Reuptake

    Inhibitors (SNRIs) (effexor, serzone) Monoamine Oxidase Inhibitors (MAOIs)


    (Nardil, Parnate): low tyramine diet to prevent hypertensive crisis

    Others

    (wellbutrin, trazadone)

    Serotonin Syndrome
    SSRIs+MAOIs= FATAL! Mental status changes, headache Restlessness/agitation Myoclonus Hyperreflexia Diaphoresis Shivering, tremors Ataxia

    Hypertensive Crisis
    (food-drug interaction, drug-drug interaction)

    Headache, stiff neck

    Nausea, vomiting
    Sweating Dilated pupils, photophobia Tachycardia, bradycardia Sudden nosebleed Chest pain

    Antidepressant Therapy Pointers


    Lag time before symptoms improve

    Monitor for increased suicidal tendencies


    Monitor for cheeking and hoarding Monitor VS Observe for signs of early toxicity Monitor sexual side effects of SSRIs Be aware of drug-drug and drug-food

    interactions

    Treatment Focus
    Safety

    Support
    Structure

    Activity schedule Sample assignments Pleasure and mastery

    Symptom Management

    Milieu Management

    Useful NANDA Diagnoses


    Anxiety Impaired verbal communication Ineffective coping Grieving, anticipatory/dysfunctional Hopelessness Risk for injury Self-care deficit Social isolation Risk for self-directed violence Spiritual distress Disturbed sleep pattern

    Suicide: Risk Factors


    Hopelessness General medical illness Severe anhedonia Male Caucasian or Native American Living alone Prior suicide attempts Under 60 or elderly Unemployed/financial problems

    Suicide Assessment
    Ask about suicidal ideation (does not increase

    suicidal behavior, provides a sense of relief and information) Assess

    Is there a concrete plan? How lethal is the method? Agitation and severe anxiety are warning signs of suicide in bipolar patients Successful response to antidepressants can provide enough energy for depressed pts to commit suicide

    Depression: Interventions
    Accept pt, focus on strengths

    Reinforce efforts to make decisions


    For severe indecision, nurse makes decision Never reinforce hallucinations/delusions Accept anger Spend time with withdrawn patient Provide activities designed for success

    Milieu Interventions
    Opportunity to experience accomplishments and

    receive positive feedback Help avoid embarrassment Supportive group activities Assertiveness training Assistance with grooming and hygiene Brief and frequent interpersonal contacts Assistance with nutrition and sleep Monitor and promote night-time sleep Discourage day-time sleep

    Life Supporting Measures


    Nutrition

    Sleep
    Activities of Daily Living

    Bathing Grooming Mobility

    Support Systems
    Connect patient to existing and new support

    systems

    Family Friends Community agencies

    Immediate Support
    Build trust

    Help with ADLs


    Provide choices Implement cognitive learning techniques

    Becks Cognitive Framework


    Irrational beliefs produce irrational emotions

    and behaviors Change involves changing beliefs in order to change feelings and behaviors Change is a process of rational thinking

    Cognitive Interventions: 5 steps


    Invite pt to participate in a specific activity within own

    capabilities If pt refuses, emphasize importance of stating reason for not accepting the invitation Work together to evaluate validity of pts reasons Test validity of pts ideas by asking the pt to participate in the activity After a successful experience help the pt recognize how a favorable outcome contradicts the pts negative predictors

    Example:
    PT: no. I dont want to get washed up for

    dinner. Itll take too much out of me. I just dont have the energy. Ill feel a whole lot worse than I do now. RN: Youre afraid youll feel more tired as a result of getting washed up. Im just wondering.would you be willing to do an experiment with me?

    Example:
    PT: Oh, I dont know, what is it? RN: Id like you to go to the sink with me. Id

    like you to test out what it would feel like for you to just splash some water on your face.
    PT: That doesnt sound very good to

    mebut I suppose I could do that.

    Hopeless Thinking Pattern:


    PT: No. I dont want to get out of bedIm

    too weaktoo tired. I need the rest. It wont do any good to get up; Ill just feel worse. Whats the use? RN: You seem convinced that you will feel worse if you get out of bed. Youve been in bed for a while nowhas the rest helped you feel any better? PT: NoIll just feel more tired. I just dont have any energy anymore.

    Hopeless Thinking Pattern:


    RN: One thing you know for sure then is that

    you will likely not feel better continuing resting in bed. It is always possible you could feel worse getting up, but do you know that for sure? PT: No, I guess not

    Hopeless Thinking Pattern:


    RN: One of the things we have learned from

    ptrs is that even though it is hard to get started, moving around does tend to give you a lift; that is, you may feel more energy as you walk around. Lets both see what happens when you dangle your feet off the edge of the bed.

    Tunnel Vision (Funneling)


    Viewing only one aspect to the exclusion of everything else. PT: No, I dont want to go swimming. I have a terrible looking suit. It really doesnt fit me very well and I just look awful in it. I couldnt stand for anybody to see me in it. RN: Suppose you had a suit you liked or suppose you werent very concerned about what others would think about your suit. Would be some things about swimming that you would enjoy?

    Tunnel Vision (Funneling)


    PT: Yes. It would be really nice to cool offI

    do like the nice cool temperature of the water. It would probably feel good to get some exercise, too.

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