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Depression is:
- 4th leading cause of diable in US
- Occurs early as age 3
- Elderly- Major Health Problem from undiagnosed
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Depressive D/O MDD
- Changes in Px level of function
- Significant Distress or impairment in social or other functioning levels
- 5 or more depressive symptoms nearly everyday for most waking hours over 2week period
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Depressive D/O DD
- Occurs over 2 years
- Significant distress or impairment or social occupational or other areas
- 2 or more depressive symptoms
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Risk Factors: Depression:
- Prior Hx
- Family Hx
- Hx of suicide or Fhx of suicide
- Female
- Age <40
- Postpartum
- Medical Illness
- Absence of social support
- Negative stressful life events
- Active ETOH or substance Abuse
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Nursing Process Application: Assessment
- Safety
- Cognitive
- Behavioral
- Physical
- Affect/Mood
- Thought Process
- Psychosocial
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Plannes Care for Depressed pt.
- #1= Safety
- Planning Geared toward phase of depression and symptoms present
- Combo of therapy most effective
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Nursing Interventions
- Acute Phase: Reduction of depressive symptoms & restoration of psychosocial and work function. MAY REQUIRE HOSPITALIZATION
- Continuation Phase: Prevention of relapse through pharmacotherapy education & depressive-specific psychotherapy
- Maintenance Phase: Prevention of further episodes
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Specific Interventions for Depression
- Counseling/Communication
- Health-Teaching
- Self-Care Activities
- Milleu Therapy
- Psychopharmacology
- ECT- p269
- Complementary & Integrative Approaches
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Psychopharmacology- SSRI
- Celexa
- Lexapro
- Prozac
- Luvox
- Paxil
- Zoloft
- First line of Tx
- Decreased risk of lethal overdose
- SE: agitation, insomnia, ha, NV, sexual dysfunction, hyponatremia
- Taper off slowly, quick stopped (dizziness, insomnia, agitation)
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Psychopharmacology- TCAs (-il)
- Elavil
- Anafranil
- Norpramin
- Adapin, Sinequan
- Tofranil
- Aventyl, Pamelor
- Vivactil
- Can worsen cardiac condition
- SE: Dry mouth, constipation, urinary retention, blurred vision, orthostatic hypotension, cardiac toxicity, sedation, tachycardia)
- Anticholinergic Effect
- High Sedation
- Non-addictive
- Lethal Overdose
- Contraindications: cardiac d/o, elevated intraocular pressure, urinary retention, hyperthyroidism, sz d/o, liver/kidney d/o
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Psychopharmacology- MAOIs
- Nardil
- EMSAM patch
- Parnate
- SE: wt gain, edema, insomnia, agitation, confusion, nausea
- Avoid tyramine rich foods (avocados, soybean, figs, bananas, smoked fermented meats liver, bologna, pepperoni, salami, smoked or cured fish, all chesse, yeast extract, chianti wine, imported beer, soy sauce)
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