Nursing Study Guide: Depression

One of the biggest challenges facing the adult nurturing and caregiving patient populations is depression.
Careers and unemployment can both cause toxic stress in some people. Without positive well-being, a corrosive anxiety builds. Negativity can wind itself into behavior and thinking patterns.
The nurse in the Emergency Room and the nurse in the long term care facility will see depression at work in patients. And especially the home health nurse will see private pain and suffering on the part of their primary charges. Each kind of nurse will have to develop a technique for intake, analysis, interaction and treatment with a patient diagnosed with depression.

No longer is depression a disorder without a face. Tragedies in almost every state have appeared in bold face type. As a workplace hazard, across the United States,  an incident of violence or self-harm,  involving a depressed and mentally disordered person increases every day.

Nurse intake workers must carefully evaluate patients prone to addictive habits such as smoking, drinking, abuse of controlled substances, or unchararacreristic or destructive behavior.

The use of chemical substances and pharmaceuticals the treatment of depression has given rise to is a concern for many socially oriented activist groups and health maintenance organizations.

A variety  of caregiving professions, such as nurses, counselors, physicians, specialty providers, and treatment experts have been wrestling with the health problem that depression poses for centuries.
Today depression problems can cause an airline captain to plummet his plane and its passengers to their deaths. The depressed conductor of a rail train can lose focus and wreck the train cars, throwing everyone aboard off the track to injury or worse. Depression and other mental health issues are now squarely on the public eye.

First described in the literature of Freud as a “malaise”, postJungian medical practitioners regularly recognized symptoms of the disorder as far back as the early 1900’s. What became a cocktail party anecdote at first began to gain steam in the medical community. By the time World War One, military doctors were inventing wartime medications to combat this strange phenomenon.

Depression can present similarly in persons by unusual or destructive behavior, excessive alcohol and drug use, mood swings, or chemical imbalances in the blood. Lab tests can screen for these indicators,. which is why Emergency Room admissions will usually have a toxicity panel and blood gas analysis ordered before key triage decisions are made

It is the numbing of depressive individuals’ “inner world” that leads to an addiction to sleeping pills, diet pills, pain pills. and other abuses of limited- schedule prescriptipn medication.

Also, certain incidences of depression syndromes can affect people experiencing a significant life event. PTSD survivors survive traumatic combat ecperiences even though all persons with PTSD did not share the same exact event.

Depression can be suffered among persons who live similar but disparate lives. Today, patients can employ various strategies and methods to combat depression and the behaviors it exacurbates and the condition it worsens.

The patient groups and subgroups, as well as pools of invidividuals who have shared a significant life event, can fall into varying levels of depressive behavior.

People who survived the 9/11 terrorist attack on New York, for example, may have experienced a kind of depression called “survivor’s guilt.” Sufferers of this and many other types of depression are urged tovtalk to support groups and seek treatment from a licensed and qualified healthcare provider.

Nurses will often observe the symptoms of depression in both long-term and acute-care patients. In many cases, an acute-care life event such as a stroke, a heart attack, or a seizure might be triggered from conditions linked to depression.
The patient’s health and safety are paramount at all times. High blood pressure, drinking, drug abuse, atypical personality traits and characteristics of self harm might signal the presence of a depressive person or a depression disorder. Information regarding past treatments of depression be available in the medical chart.
The professional and care plan interventions for depression also can be psychological. A trained medical professional can analyze the patient’s history and recommend coping strategies. Together with a psychologist, the patient can try exercises aimed at breaking down the supporting anxieties of the depressive condition.
One thing a medical expert on treating depression will do is examine what circumstances or scenarios trigger the patient’s depression. Gaining perspective on one’s life and using physical and mental energy can give a patient a more level understanding of exactly a threat really is.
Mental health professionals have worked hard to remove the stigma of depression.Encouraging a patientbto get treatment is a much more effectice intervention.
After a treatment referral is done, outreach to a qualified provider is made. This depressopn therapist can devise techniques that eliminate the focus on negative patterns, self-destructive behavior, and developing a sad or poor attitude that can lead to a negative spiral.

At this point ending isolation and developing resources to prevent downswings in mood is a key dual goal. Gaining control of flexibility and less destruction to extremes can allow a person with depressive tendencies to steer themselves away from harmful behavior and towards goal-centric future rewards.

Handling Patient Visitors

Until you see the light in a patient’s eye, when their relatives come, how their face lights up, you just haven’t lived. The sum total of life is right there. The programmatic dynamic of parents raising children is reversed. The residents (parents) now received the care from visitors (children). It is a singular statement in every individual patient’s case what kind of care they get from family members. Just as people look the other way in a community when children are abused, a low-level nursing home gathers the neglected ones together. It takes a compassionate care nurse approach to make sure patients don’t feel neglected or overwhelmed.

Nurses in any pay range should report any examples of abuse to their nursing manager or as an anonymous complaint to the regional ombudsman. The County Health Facilities Director may also take an anonymous complaint alleging abuse. Nurses in acute care and skilled nursing should counseled to look out for signs and symptoms of abuse and should make an assessment in the chart accordingly. If patients should complain of missed medications, pain, unusual symptoms or worries concerning their care, the charge nurse should be notified.

The sliding scale of who and what family members come to visit is one nurses will become familiar with. Some visitors only show up once a year, on birthdays or anniversaries. Some people bring the whole family, and it can be overwhelming for a recovering patient or fragile resident. Sometimes visitors bring children or babies to encourage the older resident or family member to enjoy the family life absent in a skilled nursing facility or acute care hospital.

Nurses should make sure visitors should wash their hands before skin or physical contact with the patient, administer or deliver no medications or narcotics, and otherwise observe infection control best practices at all times in and around the patient‘s room and bathroom. Visitors and family, friends and relatives may not realize that resident of a skilled nursing facility or patients in acute care are extra vulnerable to viruses, colds, and other communicable diseases. Diabetic patients should be discouraged from overdoing it indulging on special “treats’ that can harm their health and change their blood sugar and cause a crisis.

Others come every weekend, and bring things or even help with the physical care and chores of a nursing home patient. usually, among nurses, this will reflect the status of a patient’s relationship to the visitor. Nurses should be vigilant if a patient shows a marked dejection after certain visitors come, or a tendency to depression after no visitors come. Such patients should be redirected to group activities or have the activities director contact relatives and suggest a family visit.

While financially the nurses know and differentiate between cash-pay residents and Medicaid or Medicare recipients, technically there should be no cognizance of the patient’s status when treating them or attending their bedside needs. health care should be available to everyone regardless of the ability to pay. By seeing the way the patients are treated, some nurses also differentiate between patients who receive visits and those who do not. This can be an unfair but persistent bias.

There is one simple rule for this: the family members and visitors of a nursing home patient will track neglect or have conversations with the patients where criticisms or reports might reach the ears of others. It is essential in some cases to keep frequent visitors’ parents (patients) well cared for, as the family member will appear at any time all day, or stay during significant parts of the day during one single shifts. That one family member will not see the effort the nurses put forth for the rest of the shift for the rest of the floor, but they can make enough noise t bother the managers and owners of the facility for months.

It is hard to watch a CNA or LVN favor a patient or set of patients whose relatives frequently visit, while the ones who need contact and pepping up most fall to the end of the range. One can watch a single nurse neglect a patient’s bed, person, or dignity outright, and hustle to the next room to cascade attention and caregiving on the least in need patient in the place. But this is what happens when nurse managers do not periodically refresh the training and motivation of nursing staff.

Any nursing home patient that has a visit from a relative or friend, social worker or investigator from the county health department, must have them sign in to the visitor’s register. there is usually a physician’s room or private area where an investigator can conduct I interviews or research charts. Additionally, medical records staff will make themselves available t assure any visitor they receive the most assistance possible.

The Changing Vision of Nursing

†Today nurses face challenges in the nursing world their predecessors never did. The slightest mistake can end up on YouTube. A crotchety patient might become a vexatious litigant. And worst of all, you could make a career ending mistake.

Newly licensed LVN nurses and RN nurses can safeguard their careers by following the best practices of their facility and the standard operating procedure of conventional nurses.For nurses to stay ethical and keep their noses clean, vigilance and propriety are necessary.

Good manners toward patients is the best practice. But for peers and other staff as well. Managers can appreciate the benefit of a new hire who is a good example. The spectrum of nursing careers can always include a nurse who is polished,perfect, and professional.

The stereotype of s nurse can be from a TV show or from examples people see over time. A paunchy, chain-smoking nurse tapping away at their phone is dividing their attention span before they clock in. The oversexed stereotype nurses who spends most of heir time socializing will often end up the subject of complaints.And nurses given supervisory roles when their performance is substandard will always suggest unfounded favorirism.

Additionally, nurses can look for good ways to stay motivated and meet personal goals. The stability that a career in nursing can offer provides financial security, as well as a few “chicken soup for the soul” experiences.These are often priceless insights into the human condition.

The payoffs of a career in nursing can be concrete and financial in nature or they can be as abstruse as angels dancing on the head of a pin.But each nursing professional needs to decide for themselves where monetary goals stop and vocational goals begin.

Many nurses find their vocation in helping people. Others ate looking for a way to migrate to another career, such as teaching or business. But the toll that care giving occupations take is becoming more difficult to ignore. Statistics on addiction, drug abuse, Petty crime and white-collar crime in the field of nursing is a well kept secret. Nurses often admit to feeding an addiction while on the job. Nurses fight smoking habits made deadly by their sheer casualness masking a dependence. Nurses can have delayed reactions to many of the experiences by they see and encounter PTSD later.

And some nurses worry about if there will be a nursing field in the future. Technical issues are turning the field of medicine into an adjunct of the insurance industry. How much nursing benefit can decades of dialysis provide? How can pacemakers and stints and implants improve the quality of life?

Decisions are being made every day to extend and lengthen life using equipment and materials foreign to the body’s natural makeup. The safety and longevity of many of these methods requires backups of conventional nurses to oversee and treat complex medical conditions.

This type of scientific leap forward will always need development and monitoring by medical professionals. And as long as people age and have health crises, a nurse ( or several hundred thousand) will be needed. Therefore the future of any nursing career is wide open.

 

Chronic Pain Treatment Plans

Nursing contains treatment of all kinds of patients. A conscientious nurse can track the development of a chronic pain condition by assessing the Quality of Life scale for successive periods. Weighing the patient’s ability to perform daily activities, get dressed, go out, exercise, socialize, and perform productive activities like volunteer work or light labor, is a way to measure the complete index. A nurse or physical therapist should conduct a survey at quarterly or annual periods throughout the patient’s treatment duration to keep up with the wear and tear of natural aging and any other conditions.

Without an acute onset, chronic pain can gather from multiple sources, like arthritis, cramps, and headaches. The frequency and severity of the pain and the time during which the patient suffers becomes the analysis item. As a pain issue develops, these activities or tendencies in daily life will diminish. How much the ability to operate pain-free is not the issue, the ability to compensate or just give up regular activity over multiple areas of daily life is the measure. Consideration of over-the-counter pain medication is another part of the overall chronic pain evaluation.

Medical intervention for chronic pain can be difficult without a concrete diagnosis. Furthermore,  a surgeon or specialist may be reluctant to take on serious procedures with side effects of a potential to overreach the pain being felt by the patient currently. Some of the approaches to chronic pain onset can be less medical and pure common sense. Dyspepsia, GERD, and ulcers can account for some of the pain felt from natural aging. The severity of the onset should be evaluated and treated. Digestive and urinary conditions will reflect the patient’s lifestyle both past and present.

Nurses will come into contact with more acute situations of pain management. Injuries from car accidents, home mishaps, personal assaults, and sport injuries can be the beginning of a long lasting problem specific to the injured area or muscle system. Nociceptive pain involves muscle ends or actual end-of-system muscle fiber failings. Neuropathic pain is when the combined system failure results in sensation sof pain as symptoms of a larger disorder. Nociceptive pain and neuropathic pain form the basis of a category called somatogenic pain.

Psychogenic pain is a different type of chronic pain. When emotional or psychological issues and incidents form a repetitive or acute syndrome, psychogenic pain results. When a patient presents with pelvic pain of unknown origin, recurring headaches with no previous history of same, unusual facial pain of a typical frequency & duration, and/or low back pain, psychogenic pain should come to mind. Analysis of a patient’s daily schedule or habits will determine what unusual set of pain symptoms are unusual in sum.

Somatoform disorders are more mystifying and belong to the area of the professional psychoanalyst. The chronic pain markers for a somatoform patient are symptoms of pain that don’t match a patient’s current diagnoses or atypical recurrence of symptoms between stable schedule of medical or therapeutic intervention. As a nurse, is it a duty to report potential symptom and cycles of behavior to the case manasger or primary care physician. The worst that will happen is that you are overreaching, the best case scenario is that you have alerted key medical staff to a serious condition.

So, the nurse in charge of a patient or patients with chronic pain disorders should approach each patient with an individuality based on their own activity patterns and socializing habits. The deconditioning that occurs with a chronic pain sufferer is that they become “hermits”, staying alone in their pain cycles. Refusing to go out and refusing to continue with participation in group events and other healthy social exchanges can exacerbate pain. Long-term care facilities (or “nursing homes” ) often maintain a varied calendar of activities just to solve this problem.

A good nurse will challange her patient to set daily, weekly, or monthly goals to become more active, socialize with others, join a  group, and keep up improving exercise habits. A nurse may choose to give diet hints or have the dietary nutritionist meet with the chronic pain patient to underscore the importance of key food “do’s and don’ts.” The chronic pain patient must learn that anything that sets off blood pressure and systemic response triggers chronic pain events. Therefore keeping  a”low profile” in the battlefield of dietary tempations to binge, and fighting the inclination to slouch on the couch are what nurses should motivate their patients about.

It should be mentioned that many patients, especially aging patients of chronic pain, will insist on viewing themselves as a poor reflection of whom they “used” to be. But trying to keep up with the vision in the rear-view mirror is unhealthy and intimidating for the best of us. Some gentle persuasion to positively change the self-image and project and promote a more confident and updated idea of themselves will help patients cope with their current conditions. Aging in our culture has become more of a norm and in some areas has been acknowledged as a socially and economically powerful demographic.

Sufferers of chronic pain should be observed and monitored for unusual changes in behavior and habits. A nurse should become aware if a TV-addict patient suddenly shuns the TV room. Perhaps the patient known for her morning promenade starts sleeping in. A nurse should become concerned if a patient stops taking care of themselves, letting down personal standards of grooming or dressing. A supportive nurse will notice if their long-time patient is irritable and unreasonable over minor issues and becomes snappish with nursing staff the patients are known to prefer.

A chronic pain sufferer may be showing signs of depression due to lack of participation in many formerly “normal” activities. This is similiar to the depression felt by cancer patients. Chronic stress has been linked to fibromyalgia as well. A supportive nurse will observe if their regular patients sense a change in their lives and how they feel that they can’t quite pin down. Patients may verbalize unusual feelings or stressful responses to everyday queries. This can be an result (masquerading as a symptom) when chronic pain remains untreated capably.

The responsible and ethical treatment advice for a nurse who perceives a patient suffering pain is not to provoke an incident or disagreement. The supportive nurse will not try to spar or argue with a patient suffering from nerve endings already being pricked by uncontrolled chemical and electrical charges. A patient will not enjoy being prodded by a younger, more pain-free individual about why they are losing sleep or just how much more or less pain they feel than an hour ago.

It should be noted that not every nurse is a fan of supportive behavior. Access to a patient’s medical records and longtime treatment may make them privy to a lot of psychosocial details other nurses may not be aware of. Abusing this trust is not only unethical, but mean-spirited and should cause a nurse to question his or her own profesional motivations. Nurses who perceive other staff persecuting a patient prone to chronic pain with negative remarks, behaviors, or poor  attitude should be reported and re-oriented at once.

 

 

 

 

 

 

Patient Care and PTSD Cases

Nurses looking to get traction in the occupational workplace should be vigilant protecting the rights, privacy, and quality of care given when a PTSD situation arises. Patient care can include special cases, patients whose fears and experiences have traumatized them. These patients come from domestic situations, armed services experiences, violence and sexual assaults, where PTSD clouds the victim’s thoughts with shame, doubt, and a negative spiral of blame and inertia.

A professional nurse should tread carefully and follow the charted behavioral interventions and therapeutic approaches to the letter. Some patients who have genuine elements of PTSD in their makeup may have yet to be diagnosed. Post Traumatic Stress Disorder is a  condition whereby certain other conditions may be affected, such as ulcers, high blood pressure, depression, and more. Nursing practice for such (PTSD) patients includes maintaining a calm, relaxing environment where pain and anxiety are reduced in every way possible.

Disorders like PTSD come from traumatic incidents in the patient’s past, and may be unknowingly triggered without sincere and through querying of the patient’s social profile. A nurse can request a referral from the primary care physician for a psych referral. Any nurse should be careful not to disclose any specific medical information to observers or passersby. This is a HIPPA violation. Nurses should re-orient the PTSD patient (when acting out or presenting symptoms) back to their room and make the assessment in a private setting.

Document carefully any interactions with the patient that cause you concern. Make sure that you follow the best nursing practices when a PTSD incident occurs. When dealing with a patient who is confused, lost, or suddenly bewildered by where they are, or if they forget what they are doing, be prepared. If the PTSD patient shows exaggerated reaction to noise, other patient’s conversation, amplified reaction to nearby distractions, and has poor tolerance to exterior sounds, check with the charge nurse for further instructions. .

The physician’s instructions for treatment should include necessary approaches for environmental comfort. Refer to the patient’s medical chart and care plan for instructions and advice. Patients’ response to their intake survey should indicate what likes and dislikes they will respond to and against. PTSD patients must avoid trigger incidents or scenarios to avoid recurring attacks of anxiety and panic attack crisis.

These behavioral afflictions are defensive disorders the human psyche concocts to shield a person from environmental/mental pain or abuse. This patient will be wary, vigilant, and acutely (and sometimes aggressively) combative against unknown situations. Often sufferers of PTSD are extremely vocal. Nurses can utilize this feature of the patient profile to engage them out of a negative spiral. Redirect the mental focus of the PTSD patient onto a pleasant matter or other topic, such as movies or books, poetry or sports. Avoid discussions of politics or crime.

PTSD is a misunderstood disease which many old-school nurses may scoff at or otherwise fail to evaluate a patient for. Nurses should tread carefully with diagnosed PTSD sufferers and use exceptional patient courtesies to make sure such patients feel insulated from their triggering episodes. PTSD should never be made to feel threatened or stressed. This constitutes patient abuse. Nursing or facility staff who persist in creating tense or uncomfortable incidents, or provoke the patient should be reported both directly to management and reported anonymously to the State Nursing Board or the LVN/Psychiatric Nursing Association.

Incidents which recur in the PTSD patient’s life are the situations with sounds, odors, or persons who spark the Post Traumatic Stress Disorder are responsible for triggering painful situations and outsize scenes within the patient’s room, ward, or floor. Nurses and nursing aides of such patients should make sure all patient needs are addressed during each shift. Lab technicians or phlebotomists new to the patient should be escorted by familiar staff. In this way, proper nursing patient care makes certain that the accidental triggers of a particular trauma do not become re-created and take the patient by surprise.

   PTSD patients rely on skilled nursing staff for optimum recovery outcomes. And more educated consumers will know the difference between incompetent nurses and those who just choose to disregard noted interventions.

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