BAPTIST HEALTH SCHOOLS OF NURSING
NSG 3036A: PSYCHIATRIC MENATL HEALTH
CARING FOR PEOPLE W ITH MOOD DISORDERS
LECTURE OBJECTIVES:
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Describe various types of mood disorders.
Identify predisposing factors in the development of mood disorders.
Discuss implications of depression related to developmental stage.
Identify symptomatology associated with mood disorders and use this information in client
assessment.
Formulate nursing diagnoses and goals of care for clients with mood disorders.
Identify topics for client and family teaching relevant to mood disorders.
Describe appropriate nursing interventions for behaviors associated with mood disorders.
Describe relevant criteria for evaluation nursing care of clients with mood disorders.
Discuss various modalities relevant to treatment of mood disorders.
Define electroconvulsive therapy.
Discuss indications, contraindications, mechanism of action, and side effects of ECT.
Identify risks associated with ECT.
Describe the role of the nurse in the administration of ECT.
READING ASSIGNM ENT:
Townsend, Chapter 22 & 29
Townsend Pocket Guide, Chapter 7 & Appendix G
LECTURE OUTLINE:
I.
II.
Introduction
a. Epidemiology
i. 19 million Americans suffer from major depression
ii. Gender
iii.
Age
iv.
Social class
v. Race
vi.
Marital Status
vii.
Seasonality
Types of Mood Disorders
a. Depressive Disorders
i. Major Depressive Disorder
1. Single episode or recurrent
2. Mild, moderate, or severe
3. W ith psychotic features
4. W ith catatonic features
III.
5. W ith melancholic features
6. Chronic
7. W ith seasonal pattern
8. W ith postpartum onset
ii. Dysthymic Disorder
1. Early onset
2. Late onset
iii.
Premenstrual dsyphoric disorder
1. Depressed mood
2. Marked anxiety
3. Mood swings
4. Decreased interest in activities during the week prior to menses and
subsiding shortly after the onset of menstruation.
b. Bipolar Disorders
i. Bipolar I Disorder
ii. Bipolar II Disorder
iii.
Cyclothymic Disorder
c. Other mood disorders
i. Due to a medical condition
ii. Substance induced mood disorder
Depressive Disorders
a. Predisposing factors
i. Biological theories
1. Genetics
2. Biochemical influences
3. Neuroendocrine disturbances
4. Physiological Influences
a. Medication side effects
b. Neurological disorders
c. Electrolyte disturbances
d. Hormonal disturbances
e. Nutritional deficiencies
f. Other physiological conditions
ii. Psychosocial theories
1. Psychoanalytical theory
a. Freud
2. Learning theory
a. Learned helplessness
3. Object-loss theory
4. Cognitive theory
b. Developmental implications
i. Childhood depression
ii. Adolescent depression
iii.
Senescence
iv.
Postpartum depression
c. Application of the Nursing Process to Depressive Disorders
i. Background Assessment Data
1. Degree of Severity
a. Transient depression
b. Mild depression
c. Moderate depression
d. Severe depression
2. Nursing Diagnoses
3. Nursing Intervention
a. Protection from harming self
b. Assisting with progression through the grief process
c.
d.
IV.
V.
Enhancing client self-esteem
Helping the client determine ways to take control over his or
her life
e. Assistance in confronting anger that has been turned inward on
the self
f. Ensuring that needs related to nutrition, elimination, activity,
rest, and personal hygiene are met
g. Client/family education
4. Evaluation
Bipolar Disorder (Mania)
a. Predisposing Factors
i. Biological theories
1. Genetics
2. Biochemical influences
3. Electrolytes
4. Physiological influences
ii. Psychosocial theories
1. Psychoanalytical theory
2. Theory of family dynamics
3. Transactional model
b. Application of the Nursing Process to Bipolar Disorder
i. Background assessment data
1. Degree of severity
a. Stage I: Hypomania: symptoms not sufficiently severe to
cause marked impairment in social or occupational functioning
or to require hospitalization
b. Stage II: Acute mania: Marked impairment in functioning of
mood, cognition, and perception, and activity and behavior.
Usually requires hospitalization
c. Stage III: Delirious mania: A grave form of the disorder
characterized by severe clouding of consciousness and
representing an intensification of the symptoms associated
with acute mania
ii. Nursing diagnoses
iii.
Nursing interventions
1. Protection from injury due to hyperactivity
2. Protection from harm to self or others
3. Restoration of nutritional status
4. Progression toward resolution of the grief process
5. Improvement in interactions with others
6. Acquiring sufficient rest and sleep
7. Client/family education
iv.
Evaluation
c. Treatment Modalities for Mood Disorders
i. Psychological Treatments
1. Individual Psychotherapy
2. Group Therapy
3. Family Therapy
4. Cognitive Therapy
ii. Organic Treatments
1. Psychopharmacology
2. Electroconvulsive therapy
Electroconvulsive Therapy
a. Historical Perspectives
i. Insulin coma therapy
ii. IM injections of camphor in oil
b.
c.
d.
e.
f.
g.
h.
iii.
Acceptance
iv.
Estimated 50,000 to 100,000 people in the US receive ECT treatment
per year
Definition
i. The induction of a grand mal (generalized) seizure through the application of
electrical current to the brain. Electrodes are placed on the frontotemporal region
either unilaterally or bilaterally. Stimulation is based on the patient’s seizure
threshold. The seizure duration should be at least 25 seconds.
ii. Required treatments are an average of 6 to 12, but may be as many as 20.
Treatments are administered every other day, three times a week.
Indications
i. Severe Depression
ii. Acute manic episodes of Bipolar affective disorder
iii.
Can induce a remission in some clients who present with acute
schizophrenia
Contraindications
i. The only ABSOLUTE is increased intracranial pressure (from brain tumor,
recent CVA, or Cerebrovascular lesion)
ii. High risk patients include: Myocardial infarction or CVA within the preceding 3
months, aortic or cerebral aneurysm, severe underlying hypertension, or CHF.
Mechanism of Action
i. Unknown. Credibility has been given to the biochemical theory which suggests
there is a result in significant increases in the circulating levels of serotonin,
norepinephrine, and dopamine.
Side Effects
i. Temporary memory loss and confusion
Risks
i. Mortality
ii. Permanent memory loss
iii.
Brain damage
Role of the nurse
i. Thorough physical examination
1. Assessment of cardiovascular and pulmonary status
2. Labs on blood and urine
3. Skeletal history and X-ray should be considered
ii. Informed consent
iii.
Assess mood, level of anxiety, thought and communication patterns,
and vital signs.
iv.
Have the patient void, remove dentures, eyeglasses or contact lenses,
remove jewelry, and hairpins.
v. According to M D’s orders, Atropine sulfate or Robinul are given 30 minutes
prior to the procedure
vi.
In the treatment room, the anesthesiologist administers a muscle
relaxant and a short acting anesthetic (Brevital).
vii.
The client is receiving oxygen during and after treatment
viii.
An airway/bite block is used to facilitate airway patency. Electrodes are
placed on the temples to deliver the electrical stimulation.
ix.
Assist the psychiatrist and the anesthesiologist as required
x. Provide emotional and physical support to the client
xi.
After treatment, remain with the client until fully awake. Vital signs are
taken every 15 minutes for the first hour. Orient the client to time and place and
give them an explanation of what has occurred.