NSG 357 EXAM 2 Questions with All Correct Answers

NSG 357 EXAM 2 Questions with All Correct Answers Depressive Disorders Classifications - Answer-dysthymic disorder, premenstrual dysphoric disorder, substance abuse depressive disorder, a depressive disorder associated with another medical condition Major Depressive Disorder - Answer-anhedonia (loss of interest or pleasure in usual activities); four of seven symptoms present: disruption in sleep, appetite, concentration, energy, psychomotor agitation or slowing, excessive guilt or feelings of worthlessness, suicidal ideation; s/s present for at least 2 weeks, no history of maniac behavior Biological factors of major DD - Answer-genetic, biochemical, alterations in hormonal regulation, inflammatory process, diathesis-stress model Diathesis-stress model - Answer-probability of someone developing a disorder due to unfavorable environment (Person A vs Person B example) Psychological factors of major DD - Answer-behavioral, cognitive, developmental Nursing Assessment for DD - Answer-physical: PMH, baseline vitals and labs (WBC, liver function, thyroid function, CBC, urinalysis), appetite, weight change, sleep disturbance, tiredness, decreased energy, fatigue psychosocial: mental status, behavior, coping skills, social history, psychiatric history, trauma assessment, occupational history Medication Choices for Depression - Answer-SSRIs, SNRIs, TCAs, MAOI inhibitors SSRIs, SNRIs, TCAs = block reuptake norepinephrine, serotonin, and/or dopamine MAOIs= inhibit monoamine oxidase which inactivate norepinephrine, serotonin, and dopamine SSRIs - Answer-examples: Fluoxetine (Prozac), Citalopram (Celexa), Sertraline (Zoloft), Paroxetine (Paxil), Escitalopram (Lexapro) pt education: 14-day window w/ MAOIs side effects: headache, nausea, sleeplessness or drowsiness, sexual dysfunction, agitation, serotonin syndrome SNRIs - Answer-examples: Venlafaxine (Effexor), Duloxetine (Cymbalta) contraindications: uncontrolled narrow-angle glaucoma pt education: do not use venlafaxine within 7 days before or 14 days after using an MAOI side effects: headache, nausea, sleeplessness or drowsiness, sexual dysfunction, agitation, serotonin syndrome Serotonin Syndrome - Answer-s/s: tachycardia, HTN, hyperthermia, high fever, dramatic swings in pulse and BP, seizures, unconsciousness, agitation, confusion, dilated pupils, tremors, akathisia, spontaneous muscle clonus, muscle rigidity, diaphoresis, increased bowel sounds/diarrhea TCAs - Answer-examples: amitriptyline hydrochloride (Amitril, Elavil), doxepin hydrochloride (Sinequan), nortriptyline hydrochloride (Aventyl HC1, Pamela) side effects: anticholinergic effects (dries everything out), CNS suppression MAOIs - Answer-examples: tranylcypromine (Partite), Phenelzine (Nardil) patient education: tyramine restriction (beer, wine, cheeses), hypotension, dry mouth, GI upset, urinary hesitancy, headache, insomnia *only drug that treats mood fluctuations (depression in morning, happy in afternoon) Alpha-2 Antagonist (NaSSA) - Answer-example: Mirtazapine *used in combo w/ other drugs *given at night bc causes sedation side effects: sedation, dizziness, weight gain, dry mouth, constipation, change in urinary functioning NDRI (Norepinephrine-Dopamine Reuptake Inhibitor) - Answer-example: bupropion side effects: agitation or anxiety, insomnia, appetite suppression, psychosis contraindications: seizure disorders, bipolar suspicion Trazadone - Answer-MOA: blocks serotonin 2A receptor potently and blocking serotonin reuptake pump less potently side effects: sedation, weight gain, N/V, constipation, dizziness, fatigue, incoordination, tremor Electroconvulsive Therapy (ECT) - Answer-use: severe major depression, bipolar disorder that has not responded to other treatments, malnutrition, catatonia, or suicidality moa: a brief electrical stimulation of the brain while the patient is under anesthesia contraindications: increased intracranial pressure, recent MI, cerebrovascular accident Diagnostic criteria for Bipolar Disorder - Answer-one manic episode or mixed episode AND a depressive episode; s/s: extreme anxiety, agitation, irritability Neurobiological triggers of Bipolar Disorder - Answer-increase in dopamine Assessment of bipolar patient - Answer-expansive, pressure speech, more talkative, impulsive behavior, flight of ideas or racing thoughts, energy increased, impairment only in social and occupational functioning Nursing approach for bipolar patients - Answer-use calm approach, be direct and use simple commands, avoid open-ended sentences, limit interaction time and promote patient's need for space and movement, walk & talk, avoid power struggle Nursing Diagnoses for Bipolar Disorder - Answer-risk for injury, risk for violence, ineffective coping, disturbed thought process, imbalanced nutrition, disturbed sensory perception, impaired social interaction, insomnia