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Fontanel depression:
Emergency interventions
(Handbook of Signs & Symptoms (Third Edition))
If you detect a markedly depressed fontanel, take the infant’s vital signs, weigh him, and check for signs of shock — tachycardia, tachypnea, and cool, clammy skin. If these signs are present, insert an I.V. line and administer fluids. Have size-appropriate emergency equipment on hand. Anticipate oxygen administration. Monitor urine output by weighing wet diapers.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Major depression:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Depression is difficult to treat, especially in children, adolescents, elderly patients, and those with a history of chronic disease. The primary treatment methods are drug therapy and psychotherapy, particularly cognitive behavioral therapy.
Drug therapy includes tricyclic antidepressants (TCAs) such as amitriptyline, monoamine oxidase (MAO) inhibitors such as isocarboxazid, maprotiline, and trazodone, which has been available for 40 years. A newer class of drugs, the selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, paroxetine, sertraline, bupropion, venlafaxine, and mirtazapine, are equally effective and have more tolerable adverse effect profiles.
TCAs, the most widely used class of antidepressant drugs, prevent the reuptake of norepinephrine or serotonin (or both) into the presynaptic nerve endings, resulting in increased synaptic concentrations of these neurotransmitters. They also cause a gradual loss in the number of beta-adrenergic receptors.
MAO inhibitors block the enzymatic degradation of norepinephrine and serotonin. These agents commonly are prescribed for patients with atypical depression (for example, depression marked by an increased appetite and need for sleep, rather than anorexia and insomnia) and for some patients who fail to respond to TCAs. MAO inhibitors are associated with a high risk of toxicity; patients treated with one of these drugs must be able to comply with the necessary dietary restrictions.
Maprotiline is a potent blocker of norepinephrine uptake, whereas trazodone is an SSRI. The mechanism of action of bupropion is unknown.
Electroconvulsive therapy (ECT) may be considered in particularly severe or drug-resistant depression. Six to 12 treatments are typically needed, although in many cases improvement is evident after only a few treatments. However, ECT has been associated with later short-term memory loss, heart arrhythmias, and seizure activity. Researchers hypothesize that ECT affects the same receptor sites as antidepressants.
Short-term psychotherapy is also effective in treating major depression. Many psychiatrists believe that the best results are achieved with a combination of individual, family, or group psychotherapy and medication. After resolution of the acute episode, patients with a history of recurrent depression may be maintained on low doses of antidepressants as a preventive measure.
Depression may be experienced differently by members of different cultures. For instance, in some Asian cultures, there are more somatic manifestations of depression than overt psychologic signs or symptoms.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Fontanel depression:
Emergency interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
If you detect a markedly depressed fontanel, take vital signs, weigh the infant, and check for signs of shock—tachycardia, tachypnea, and cool, clammy skin. If these signs are present, insert an I.V. line and administer fluids. Have size-appropriate emergency equipment on hand. Anticipate oxygen administration. Monitor urine output by weighing the wet diapers.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Depression, major:
Treatment
(Handbook of Diseases)
Depression is difficult to treat, especially in children, adolescents, elderly patients, and those with a history of chronic disease. The primary treatment methods are drug therapy, electroconvulsive therapy (ECT), and psychotherapy.
Drug therapy
In depression, drug therapy includes tricyclic antidepressants (TCAs) such as amitriptyline, serotonin reuptake inhibitors such as fluoxetine, and monoamine oxidase (MAO) inhibitors, such as isocarboxazid, maprotiline, and trazodone.
❑ The most widely used class of antidepressant drugs, TCAs prevent the reuptake of norepinephrine or serotonin (or both) into the presynaptic nerve endings, resulting in increased synaptic concentrations of these neurotransmitters. They also cause a gradual loss in the number of beta-adrenergic receptors.
❑ After resolution of the acute episode, patients with a history of recurrent depression may be maintained on low doses of antidepressants as a preventive measure.
❑ Selective serotonin reuptake inhibitors, including fluoxetine, paroxetine, and sertraline, are increasingly becoming the drugs of choice. They are effective and produce fewer adverse effects than the TCAs; however, they’re associated with sleep and GI problems and alterations in sexual desire and function.
❑ MAO inhibitors block the enzymatic degradation of norepinephrine and serotonin. These agents are commonly prescribed for patients with atypical depression (for example, depression marked by an increased appetite and need for sleep, rather than anorexia and insomnia) and for some patients who fail to respond to TCAs.
MAO inhibitors are associated with a high risk of toxicity; patients treated with one of these drugs must be able to comply with the necessary dietary restrictions. Conservative doses of an MAO inhibitor may be combined with a TCA for patients refractory to either drug alone.
Maprotiline is a potent blocker of norepinephrine uptake, whereas trazodone is a selective serotonin uptake blocker. The mechanism of action of bupropion is unknown.
ECT
When a depressed patient is incapacitated, suicidal, or psychotically depressed, or when antidepressants are contraindicated or ineffective, ECT is commonly the treatment of choice. Six to 12 treatments usually are needed, although improvement is usually evident after only a few treatments. Researchers hypothesize that ECT affects the same receptor sites as antidepressants.
Psychotherapy
Short-term psychotherapy is also effective in treating major depression. Many psychiatrists believe that the best results are achieved with a combination of individual, family, or group psychotherapy and medication. Therapeutic interventions focus on identifying the patient’s negative thoughts and interpretations and substituting adaptive responses.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Fontanel depression:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Monitor the infant's vital signs and level of consciousness.
▪ Monitor intake and output and watch for signs of worsening dehydration.
▪ Obtain serum electrolyte values to check for an increased or decreased sodium, chloride, or potassium level.
▪ If the infant has mild dehydration, provide small amounts of clear fluids frequently or provide an oral rehydration solution.
▪ If the infant can't ingest sufficient fluid, begin I.V. parenteral nutrition.
▪ If the patient has moderate to severe dehydration, provide rapid restoration of extracellular fluid volume to treat or prevent shock.
▪ Continue to administer I.V. solution with sodium bicarbonate added to combat acidosis. As renal function improves, administer I.V. potassium replacements.
▪ When the infant's fluid status stabilizes, begin to replace depleted fat and protein stores through diet.
▪ Obtain urinalysis for specific gravity and, possibly, blood tests to determine blood urea nitrogen and serum creatinine levels, osmolality, and acid-base status.
Patient teaching
▪ Explain all procedures and treatments to the infant's parents.
▪ Provide emotional support.
▪ Explain ways to prevent dehydration.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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