Qwivy | Qwivy.com | www.qwivy.com

NUR2488 / NU249 – Exam 2 Concept Guide

Mood:

Depression

Phases of depression

a. Acute phase (6 to 12 weeks)

i. Directed at reduction of depressive symptoms and restoration of

psychosocial and work function

ii. Hospitalization may be necessary

iii. Biological treatments may be initiated

b. Continuation phase (4 to 9 months)

i. Directed at prevention of relapse through pharmacotherapy, education, and

depression-specific psychotherapy

c. Maintenance phase (1 year or more)

i. Treatment is directed at prevention of further episodes of depression

ii. Medication may be phased out

Define common symptoms

 Qwivy | Qwivy.com | www.qwivy.com

Anhedonia, fatigue, sleep disturbances, changes in appetite, feelings of hopelessness or

worthlessness, persistent thoughts of death or suicide, inability to concentrate or make

decisions, change in physical activity

Anhedonia-inability to experience pleasure in activities that usually produce it

Anergia-lack of energy; passivity, lack of persistence at work or school

Beck’s Cognitive Triad (p. 250)

Beck proposed that people acquire a psychological predisposition to depression through

early life experiences. Depressed people process information in negative ways. The triad

are three negative thoughts that Beck says are responsible for the development of

depression.

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

Sometimes I feel when I think about suicide

When do you think about suicide, do you have a way that you might do this?

Do you have a gun? Have you ever shot a gun?

 Qwivy | Qwivy.com | www.qwivy.com

Sometimes, people in your situation (describe the situation) lose hope; I’m wondering if

you may have lost hope, too?

• Have you ever thought things would be better if you were dead?

• With this much stress (or hopelessness) in your life, have you thought of hurting

yourself?

• Have you ever thought about killing yourself?

High vs low risk (Ch 23)

High risk- lethal suicide attempt or persistent ideation with strong intent or suicide

rehearsal

Low risk- thoughts of death, no plan, intent or behavior

Nursing Diagnosis (Table 15-2)

 Qwivy | Qwivy.com | www.qwivy.com

Risk for suicide, Decisional conflict, Impaired memory, Acute confusion, Ineffective

coping, Chronic low-self esteem, Social isolation, Impaired nutrition

Physical Interventions (Table 15-5)

Nutrition- offer small, high calorie and high protein snacks, weigh patient weekly, offer

choices of food

Sleep- periods of rest after activities, encourage patient to get up and get dressed, reduce

stimuli in the evening

Self-care- give step by step instructions, encourage the use of self care products

Elimination- I&O, high fiber foods, exercise, encourage intake

MedicationsClasses: SSRI, TCA, MAOIs

*Make sure to know specific meds within each class

 Qwivy | Qwivy.com | www.qwivy.com

Depressive Disorders

1. SSRI’s

a. Paroxetine (Paxil)

b. Sertraline (Zoloft)

c. Fluoxetine (Prozac)

d. Fluvoxamine (Luvox)

• First-Line treatment

• Inhibits reuptake of serotonin, allowing more serotonin to stay

in the junction of the neurons

• CNS stimulation (can cause insomnia)

• Long half-life (takes up to 4 wks for therapeutic levels)

• Very little risk of overdose

• Adverse effects: serotonin syndrome, gi bleeding, wt gain,

sexual dysfunction, headache, bruxism

• Taper drug (withdrawal symptoms)

 Qwivy | Qwivy.com | www.qwivy.com