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NUR2488 / NU249 – Exam 2 Concept Guide

Mood:

Depression

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Define common symptoms- memory difficulties, suicidal, worthlessness, helplessness,

anhedonia-loss of pleasurable in things they once loved, anergia-lack of energy. Severe=not

eating or drinking. Given up. High protein, high calorie diet. Around the clock observation,

suicide=1on1.

Beck’s Cognitive Triad (p. 250)

• 1.A negative, self-deprecating view of self: “I really never do anything well; everyone

else seems smarter.”

• 2.A pessimistic view of the world: “Once you're down, you can't get up. Look around,

poverty, homelessness, sickness, war, and despair are every place you look.”

• 3.The belief that negative reinforcement (or no validation for the self) will continue: “It

doesn't matter what you do; nothing ever gets better. I'll be in this stupid job the rest of

my life.”

Risk for suicide- Questions to ask,

Are you feeling suicidal? Do you have a plan? Do you have the means?

High vs low risk (Ch 23)

Nursing Diagnosis (Table 15-2)

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Risk for suicide, self-mutilation, decisional conflict, impaired memory, acute confusion,

ineffective coping, interrupted family process, risk for impaired parent/infant/child attachment,

ineffective role performance, hopelessness, chronic low self-esteem.

Physical Interventions (Table 15-5)

Nutritional interventions (high calorie meals for those not eating), encourage sleep, emphasize

self-care measures.

MedicationsClasses:

SSRI- first line! black box warning=increase suicidal ideation. Selexa, fluoxetineProzac. Don’t

start within 14 days of last MAOI dose=serotonin syndrome-hyperactivity, seizures

Citalopram† Celexa

Common side effects

include:

Minimal interaction

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with other drugs,

minimal weight

gain, sedation

Possible initial anxiety

NUR2488 / NU249 – Exam 2 Concept Guide

Escitalopram†Lexapro

• •Headache, which usually

dissipates in a few days

• •Nausea, which usually

dissipates in a few days

• •Sleeplessness and/or

drowsiness during day,

which usually dissipates in

a few weeks

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• •Tremors and/or dizziness

• •Sexual problems: reduces

sexual drive, problems

having and enjoying sex

• •Agitation, feeling jittery

and nervous; rare serotonin

syndrome; rare activation

of suicidal ideation

Minimal interaction,

sedation, and weight

gain

Possible initial anxiety

18 yr or older; 12-17 yr

for MDD

Fluoxetine† Prozac Activating

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(energizing)

Possible interaction

with other drugs, initial

anxiety

8 yr or older

Fluvoxamine Luvox 8 yr or older for OCD

only

Paroxetine† Paxil Good antianxiety

benefit

Weight gain, interacts

with other meds,

contraindicated in

pregnancy

Sertraline† Zoloft

TCA= amitryptiline, imipramine .anticholinergic effects, get dr attention for urinary retention.

Cardiotoxicity with overdose

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