Nursing Care of Clients with Mood Disorders – Flashcards

One or more depressive episodes in which there is at least two weeks of depressed mood or loss of interest along with at least four of the following symptoms: changes in weight or appetite insomnia or hypersomnia psychomotor agitation or retardation fatigue or loss of energy feelings of worthlessness or excessive guilt decreased ability to think or concentrate recurrent thoughts of death or suicide

One or more manic or mixed episodes usually alternating with Major Depressive Episodes

Elevated, expansive, or irritable mood lasting at least a week or requiring hospitalization Three of the following symptoms present (four if the mood is only elevated): inflated self-esteem or grandiosity decreased need for sleep talkative or pressured speech flight of ideas or racing thoughts distractibility increased goal-directed activity or agitation excessive involvement in risky behaviors

Criteria are met for both a Manic Episode and a Major Depressive Episode (except for duration) nearly every day for a one week period Severe enough to impair functioning, require hospitalization and/or psychotic features

One or more Major Depressive Episodes accompanied by at least one Hypomanic Episode Hypomanic Episode is not as severe as a Manic Episode in that it does not cause marked impairment in functioning, require hospitalization, or include psychotic features

Depressed mood most of the day for more days than not for at least two years While depressed two or more of the following symptoms are present: poor appetite or overeating insomnia or hypersomnia low energy or fatigue low self-esteem poor concentration or difficulty making decisions hopelessness

Numerous episodes of hypomanic episodes and numerous episodes of depression that do not meet the criteria for Manic Episodes or Major Depressive Episodes Lasts at least two years

One of eight adults experience Major Depression in his or her lifetime Lifetime risk for men = 7-12% Lifetime risk for women = 20-30% WHO estimates depression will be the second leading cause of disability by 2020 Depression accompanies many medical conditions

Affects 1% of population Bipolar I equal in men and women Bipolar II more common in women

Genetic factors Loss Low self-esteem Neurotransmitter and endocrine imbalances Cognitive distortions Psychosocial stressors Hopelessness Medical conditions and medications (See table on p. 295.)

Risk for suicide Hopelessness Disturbed thought processes Low self-esteem Ineffective coping Imbalanced nutrition Disturbed sleep patterns Self-care deficit Sexual dysfunction

Suicide assessment and precautions Spend time with the client even if he or she does not feel like talking Convey hopefulness but do not try to "cheer up the client" Acknowledge client's feelings of sadness and pain Administer antidepressant medications per MD's orders and monitor for therapeutic and side effects. Educate patient and family about depression and antidepressant medication and/or ECT

Encourage client to attend Cognitive Therapy Group Provide structure and opportunities for client to participate in activities and reinforce achievements and social interaction Help client identify strengths Help client identify and plan for pleasurable activities

Encourage nutritious diet to meet nutritional requirements Engage client in regular exercise such as a 30 minute walk each day Promote healthy sleep patterns by interventions such as decreasing daytime napping and using relaxation techniques at bedtime Encourage client to perform as much of his or her personal hygiene and grooming independently and assist as needed with what the client is unable to do Help client identify stressors, problem-solve, and expand coping strategies

Prevent harm to self or others Promote adequate fluid and food intake Promote normal sleep patterns Set limits on dangerous, disruptive, or intrusive behaviors Encourage client to speak more slowly and focus on one topic at a time Administer mood stabilizing medications per MD's orders and monitor for therapeutic and side effects Help client set realistic goals

Provide reality orientation Confront grandiosity and promote positive, but realistic self-esteem Do not allow clients to initiate romantic relationships or engage in sexual activities on the unit Guide client in completing personal hygiene and grooming independently and assist as needed Provide patient and family education about Bipolar Disorder, its treatment, and signs of relapse

Behavior is specific and observable Positive and negative reinforcement increase a behavior Punishment, response cost, and extinction decrease a behavior Behavioral contracting frequently used in nursing care situations Cognitive behavioral treatment focused on here and now and are short term approaches (6-20 sessions)

Focuses on the relationship between thoughts, feelings, and behaviors Correcting cognitive distortions Client collaborates and learns the process Cognitive restructuring strategies - monitoring thoughts and feelings, examining evidence and alternatives, decatastrophizing, reframing, thought stopping

Biofeedback Relaxation training Systematic desensitization Flooding Role playing Social skills training Anger management Token economy