Perinatal Mental Health Exam Questions and Answers (Latest Update 2024), Exams of Nursing

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and Answers (Latest Update 2024)

What mothers are at especially high risk of mental health disorders? - Correct Answer ✅Those who discontinue or reduce their doses of antidepressants Incidence of Baby Blues, Depression, and Psychosis - Correct Answer ✅Baby Blues- 80% Depression- 15-20% Psychosis- .1-.3% Baby Blues- General - Correct Answer ✅Crying at silly things Teary Due to hormones Situational life change Clinically Normal Psychosis - Correct Answer ✅During or after the birth Even a little bit later What is the best thing for Postpartum Mental Health Disorders? - Correct Answer ✅Talking about them!

and Answers (Latest Update 2024)

Primary Prevention - Correct Answer ✅Preventive education related to depression prior to, during, and after pregnancy Present ourselves in a way that women want to tell us things Now everyone is screened for it Primary Prevention- Assessment - Correct Answer ✅Listen to women Advise Observe for behavioral changes Screen using objective told Invite/involve partner and family Objectives of Primary Prevention - Correct Answer ✅Improve women's wellness Increase intendedness of pregnancy Educate women/partners about risks Decrease amenable risk factors

and Answers (Latest Update 2024)

Why is the depression discussion sometimes avoided? - Correct Answer ✅Don't want to scare women Stigma or shame related to depression Psychology of Pregnancy - Correct Answer ✅Developmental crisis- upheaval followed by positive resolution Intensification of unresolved family of origin issues Increase in self esteem and self absorption Protector of the fetus All of this gets stirred up, but not necessarily pathological Developmental Crisis - Correct Answer ✅Biologically and emotionally Upheaval and Change - Correct Answer ✅Most do okay Origin Issues - Correct Answer ✅"Will I be just like my Mom?" OR "I will never be like my Mom!"

and Answers (Latest Update 2024)

Normal Self Absorption - Correct Answer ✅Eat right, exercise, rest VS Heavy jobs, career, and child care demands Protector of the fetus - Correct Answer ✅Family becomes involved Culture and family dependence may be positive or negative Normal or Abnormal Anxiety in pregnancy - Correct Answer ✅Normal Normal or Abnormal Poor Sleep in pregnancy - Correct Answer ✅Normal Normal or Abnormal Struggling with a loss of independence - Correct Answer ✅Normal

and Answers (Latest Update 2024)

Normal or Abnormal Anxiety getting in the way of every day activities - Correct Answer ✅Abnormal Normal or Abnormal Not getting out of bed - Correct Answer ✅Abnormal Normal or Abnormal Not wanting to touch the baby - Correct Answer ✅Abnormal Normal or Abnormal Having visions of harming the baby - Correct Answer ✅Abnormal Loss of sleep with pregnancy and a newborn - Correct Answer ✅Normal occurrence but mothers need to realize this and move on with their lives and not dwell on it Risk Factors- Psychosocial - Correct Answer ✅Single status

and Answers (Latest Update 2024)

Marital instability Poor social support Adverse life events Unplanned pregnancy Ambivalence towards pregnancy Low socioeconomic/uninsured status SSRI and Pregnancy - Correct Answer ✅Change over medication to something that is more accepted in pregnancy Typically not as well received but zoloft works well in pregnancy If a woman's medication is contraindicated in pregnancy what should she do and not do? - Correct Answer ✅Do: look at other brands and talk to care provider about other options Don't: stop taking the medication Untreated Depression in Pregnancy - Correct Answer ✅Pain/Suffering and/or "robbed of the joy"

and Answers (Latest Update 2024)

Family discord Poor appetite/Nutrition Self medication Impaired judgment Anxiety Insomnia Poor appetite/ Nutrition leads to - Correct Answer ✅Weight loss/ Gain Self Medication= - Correct Answer ✅Increased use of ATOD Impaired Judgment= and leads to... - Correct Answer ✅Noncompliance with prenatal care Leads to preterm labor/preterm birth and low birth weight

and Answers (Latest Update 2024)

Methods to treat Depression in Pregnancy - Correct Answer ✅Counseling with Medication therapy Don't let them self medicate- over/under eating, abusing exercise, drugs, or alcohol Examples of statements made by the Depressed Woman - Correct Answer ✅I'm so irritable I have been on the couch... I haven't showered I am always in my pajamas Other maternal effects of untreated depression - Correct Answer ✅Psychosis Suicidal ideation/suicide Impaired maternal- infant bonding Postpartum depression Screening for Depression in Pregnancy - Correct Answer ✅Optional time for screening as women have early, frequent contact with healthcare providers

and Answers (Latest Update 2024)

Research shows that women want to have their care provider ask how they were emotionally at every prenatal visit Questions to ask when screening for depression in pregnancy

• Correct Answer ✅How have you been feeling What's been your general mood How are you feeling about becoming a mom How are you eating and sleeping Are you able to enjoy your usual activities Why are depressive symptoms often missed during pregnancy? - Correct Answer ✅They are difficult to distinguish from normal pregnancy related discomforts or are misattributed to normal pregnancy related changes in maternal temperament Treatment of Depression in Pregnancy - Correct Answer ✅Recognition that it exists in pregnancy Cognitive therapy, support groups Antidepressant medications

and Answers (Latest Update 2024)

Barriers to recognition - Correct Answer ✅Not thinking clearly Shame at not being excited about the baby, baby showers, the nursery... Tough it out until delivery Medications are bad --> could hurt the baby --> get addicted Medications for Depression during Pregnancy - Correct Answer ✅SSRIs Paroxetine (Paxil) Multidrug management via psychiatrist SSRIs - Correct Answer ✅Selective Serotonin Re-Uptake Inhibitors Very low risk of birth defects Creates a high pitched cry in the newborn Paroxetine (Paxil) - Correct Answer ✅Risk of congenital heart defects

and Answers (Latest Update 2024)

May require more ultrasounds during pregnancy Multidrug management via psychiatrist - Correct Answer ✅Taper off if desired, many medications later in pregnancy Don't switch medications if working well Most important goals of treatment - Correct Answer ✅Maintaining euthymic mood in the mother and preventing postpartum depression Poor Neonatal Adaptation Syndrome - Correct Answer ✅Happens with SSRI use in pregnancy -Hypotonicity, poor feeding -Transient, mild respiratory distress -Jitteriness, mild tremors -Hypothermia -Weak cry or increased crying -Rare, persistent pulmonary hypertension More likely at higher doses; usually resolve by 24-48hrs

and Answers (Latest Update 2024)

Postpartum Psychiatric Disorders: 3 Sub-classes - Correct Answer ✅Baby Blues -Adjustment reaction with depressed mood Postpartum Major Mood Disorders -Depression and anxiety Postpartum Psychosis -Most severe of the 3 sub-classes -Hallucinations, delusions, irrational thoughts and behaviors Baby Blues - Correct Answer ✅Experienced by 50-80% of new mothers Defined as an "adjustment reaction with depressed mood" Mild and short-lived Lasts a few days to 3 weeks May be more pronounced in primiparous women Baby Blues: Etiology - Correct Answer ✅Psychological adjustment to the rapid role changes of parenting

and Answers (Latest Update 2024)

Hormones (Drop in estrogen and progesterone) Fatigue Worse with sleep deprivation, pain, feeding problems, sick newborn, multiples, over stimulation Pathophysiology of amenorrhea with breastfeeding - Correct Answer ✅Oxytocin --> Progesterone --> NO Estrogen --> NO Ovulation When breastfeeding you don't get a regular period In order for this tow or the baby has to be solely breastfeeding and still waking up during the night to feed This lack of estrogen will also affect the mom's mood and they will not feel themselves Baby Blues- S/S - Correct Answer ✅Mood swings Irritability Weepiness Appetite change Overwhelmed

and Answers (Latest Update 2024)

Difficulty sleeping Feeling let down Anxiety Forgetfulness Baby Blues- Recovery - Correct Answer ✅Social support of family and friends Physical help= care for other siblings, meals Rest= Mother the mother Positive attention towards the baby Support for the partner Red Flags for PPD - Correct Answer ✅Isolation No friends/ family Treatment Options- Baby Blues - Correct Answer ✅Exercise Nutrition/ Vitamins/ Supplements CAM- healing touch, massage, aromatherapy, yoga

and Answers (Latest Update 2024)

PPD - Correct Answer ✅Postpartum Depression 1 in 10 woman Occurs in 1st year Onset 6-12 weeks or earlier 5-20%= 1st depression experience Continuation of depression Risk Factors- PPD - Correct Answer ✅History of depression, anxiety, bipolar disorders Depression or anxiety disorder with pregnancy Previous post part depression Lack of support from partner, family, and friends worsens the above issues PPD Signs and Symptoms - Correct Answer ✅ONE or BOTH must be present to diagnose PPD:

• Reports depressed mood most of day, nearly every day
• Markedly diminished interest or pleasure in all, or almost all, activities

and Answers (Latest Update 2024)

PLUS at least 5 below:

• Significant weight loss or weight gain
• Insomnia, or excessive sleeping
• Psychomotor agitation or retardation
• Loss of energy nearly every day
• Feelings of worthlessness or excessive guilt
• Diminished ability to think or concentrate
• Recurrent thoughts of death Signs and Symptoms have to continue for more than 2 weeks Nursing Care for PPD - Correct Answer ✅Screen everyone postpartum Interventions like getting sleep can assist in treating a number of the problems Assign them a social worker Top 3 signs and symptoms of PPD - Correct Answer ✅Irritability

and Answers (Latest Update 2024)

Emotional Lability Anxiety Screening for PPD - Correct Answer ✅Review prenatal history Be purposeful, ask questions Establish trust Edinburgh Postnatal Depression Scale --> Data must be obtained and interpreted by RN or provider Notify provider of RN findings Edinburgh Postnatal Depression Scale - Correct Answer ✅Educates the woman and her family Validates what she is feeling Systematic and objective Gets her help Consider doing with every postpartum woman as you can't always tell by their appearance

and Answers (Latest Update 2024)

What distinguishes normal postpartum irritability, anxiety, fatigue, and poor concentration from that of a women with PPD? - Correct Answer ✅Duration and Severity What is the major nursing challenge associated with PPD? - Correct Answer ✅Identifying women at risk for suicide What are important things to ask when identifying a woman at risk for suicide? - Correct Answer ✅Does she have a plan? Does she have a weapon? Is it a lethal method? Questions to ask when screening for suicide - Correct Answer ✅Have you thought about hurting yourself? Or the baby? What 4 criteria determine risk for suicide? - Correct Answer ✅Method Availability Specificity

and Answers (Latest Update 2024)

Lethality What factors make the suicide risk increase? - Correct Answer ✅Method complete Available Detailed Treatment of PPD - Correct Answer ✅Social/family support and education Evaluation ASAP and referral for professional and community resources "Talk therapy" Pharmacologic management What is "Talk Therapy" - Correct Answer ✅Cognitive and Behavioral Counseling, psychotherapy, and support groups

and Answers (Latest Update 2024)

What are things to consider when proceeding with pharmacologic management? - Correct Answer ✅Risks vs. benefits with breastfeeding Are concentrations of SSRIs low or high in breastmilk? - Correct Answer ✅LOW Interaction between breastfeeding and newborn when anti- depressants have been taken all throughout pregnancy - Correct Answer ✅The breastfeeding could reduce the severity of withdrawals Will depression or medications hurt the baby more? - Correct Answer ✅Depression Why might depression not respond to medication? - Correct Answer ✅If ti is situational depression Anxiety - Correct Answer ✅Fear that is out of proportion

• Fear may last longer than seems appropriate
• Arises when trigger situation occurs

and Answers (Latest Update 2024)

• Interferes with normal functioning Panic Disorder - Correct Answer ✅Panic attacks and extreme anxiety 10% incidence in postpartum woman Post Traumatic Stress Disorder (PTSD) - Correct Answer ✅Flash back to extremely stressful incident 2-6% incidence Obsessive Compulsive Disorder (OCD) - Correct Answer ✅Recurring worrisome and intrusive thoughts 3-5% Postpartum Psychosis Onset - Correct Answer ✅2-14 days Postpartum Psychosis risk of suicide and infanticide - Correct Answer ✅suicide- 5% infanticide- 4%

and Answers (Latest Update 2024)

Risk factors for Postpartum Psychosis - Correct Answer ✅Untreated bipolar disease Previous postpartum psychosis Severe prenatal stressors Mental S/S for Postpartum Psychosis - Correct Answer ✅Extreme confusion Memory loss Incoherence Paranoia Delusional thinking not based in reality Hallucinations Behavioral S/S for Postpartum Psychosis - Correct Answer ✅Tearfulness Feelings of hopelessness and emptiness Feelings of being removed from baby, other people, and surroundings (Depersonalization) Irrational statements Preoccupation with trivial things

and Answers (Latest Update 2024)

Severe anxiety Extreme agitation or restlessness Insomnia Refusal to eat Interventions for Postpartum Psychosis - Correct Answer ✅Get help urgently and include the family Safety for the mother and baby is priority High risk of suicide and infanticide Needs inpatient stabilization and treatment Breastfeeding may not be safe in poly-drug therapy is required Proactive planning for future pregnancies