Wednesday, July 17, 2024

Nursing Care Plan For Major Depressive Disorder

Nursing Care Plan For Depression 1

Major Depressive Disorder, Nursing Mental Health CE Course Example

Nursing Diagnosis: Disturbed Thought Process related to biochemical/ neurophysical imbalance secondary to depression as evidenced by impaired insight and judgment, poor decision-making skills, difficulty handling complex tasks, confusion and disorientation, inability to do activities of daily living as normal

Desired Outcome: The patient will be able to regain appropriate mental and physical functioning.

Nursing Care Plan For Depression 4

Chronic Low Self-Esteem

-Overgeneralizations-Self-blame Cognitive distortions promote negative, erroneous self- and world-perceptions. Concentrate on the flaws. Assuming that people do not approve of me. Without any genuine evidence that the assumptions are valid, for example. Making a general rule out of a single fact or incident. Consistently blaming oneself for everything that goes wrong.
Assess nonverbal communication, such as body posture and facial expressions. Movements, eye contact, mannerisms, and the use of touch are all examples of nonverbal communication. Nonverbal communication accounts for a significant amount of communication. As a result, it is incredibly vital. Touch conveys information about how it is received and how at ease the person is with it to be touched.
Encourage simple, direct discussion of physical changes in a straightforward and factual manner Give honest feedback and discuss it. Rehabilitation services, for example, may be an option in the future. Allows the client to start putting actual modifications into themselves in a welcoming and positive atmosphere.

Types Of Depressive Episodes

Depression can be characterized from mild to severe and may vary from person to person. Mayo Clinic identify specific features for each type of depressive episodes, such as:

1. Anxious distress depression accompanied by bizarre restlessness on worrying about upcoming events or fear of getting out of control.

2. Mixed features are presented by elevated self-esteem, talkativeness, and hyperactive during the attack of depression .

3. Melancholic features unresponsiveness to stimuli that give pleasure or excessive, inappropriate guilt over pleasure during a severe depressive episode.

4. Atypical features a depression that seeks temporary relief from binge eating, attending happy events, oversleeping, and over sensitivity to rejections.

5. Psychotic features depression accompanied by hallucinations and delusions.

6. Catatonic features depression manifested by fixed or inflexible posture.

7. Peripartum onset the depression that occurs during pregnancy or postpartum stage.

8. Seasonal pattern moods affected by sudden changes in season, resulting in depression, which may be reduced by sunlight exposure.

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Health Teaching And Health Promotion

Patient education has a profound impact on the overall outcome of major depressive disorder. Since MDD is one of the most common psychiatric disorders causing disability worldwide and people in different parts of the world are hesitant to discuss and seek treatment for depression due to the stigma associated with mental illness, educating patients is very crucial for their better understanding of the mental illness and better compliance with the mental health treatment. Family education also plays an important role in the successful treatment of MDD. Psychoeducation plays a significant role in improving patient compliance and medication adherence. Recent evidence also supports that lifestyle modification, including moderate exercises, can help to improve mild-to-moderate depression.

Nurses can also provide education about the side effects and expected treatment response when patients are prescribed anti-depressant medications. Important points of education include:

  • Initially, it takes 2 – 4 weeks to see improvement in symptoms do not discontinue the medication unless you have talked to your provider
  • Notify the provider or go to the hospital immediately for suicidal thoughts
  • Side effects may include tiredness, sexual dysfunction, weight gain, dry mouth, nausea, and more
  • Do not stop taking anti-depressants abruptly for any reason. Discuss with provider tapering off medication may be required to avoid withdrawal symptoms

Nursing Care Plan For Depression 5

Nursing Care Plan for Depression

Spiritual Distress

Nursing Diagnosis:Spiritual Distress related to death or dying of self or others, chronic illness of self or others, life changes, lack of purpose in life, pain, and self-alienation, or sociocultural deprivation secondary to depression as evidenced by expression of intense feelings of guilt, hopelessness and helplessness, expression of being abandoned by or having anger towards God, expressing concern with the meaning of life or death or belief systems, expression of lack of hope, meaning, or purpose in life, forgiveness of self, peach, serenity, and acceptance, inability to pray, express previous state of creativity or participate in religious activities, lack of interest in art, questioning the meaning of ones own existence, refusion to interact with families, friends or religious leaders and searching for a spiritual source of strength.

Desired Outcomes:

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Nursing Diagnosis For Depression

The Dark Side of Being Blue

It is okay not to be okay. A feeling of being sad or blue once in a while is normal and expected to human nature. Be that as it may, depression is an unorthodox notion. WebMD suggested that 5 symptoms of depression which concurrently experienced for at least 14 days, characterized from mild to severe, are called major depression, major depressive disorder, or clinical depression.

Nursing Assessment For Nursing Care Plan For Depression And Anxiety

Cultural belief is a very common cause of anxiety. Therefore, assess for any stressful condition that is related to anxiety. Notice how the patient is trying to overcome his anxiety? Ask them how they get anxious, which makes them anxious and how they usually respond to anxiety. Ask the patient, Do you think you are anxious right now?

Also Check: What Is The Depression Treatment Device

Nursing Care Plan For Depression 3

Risk for Self-directed Violence

Nursing Diagnosis: Risk for Self-directed Violence related to loneliness, social isolation, helplessness, hopelessness, anhedonia, severe personality disorder, psychosis or substance abuse secondary to depression possibly evidenced by suicidal behavior , previous attempts of violence, having a suicidal plan that is clear and specific , having the energy to carry out the suicidal plan when depression begins to lift.

Desired Outcomes:

  • The patient will seek help when encountering self-destructive impulses.
  • The patient will demonstrate a behavioral manifestation of absent depression.
  • The patient will demonstrate satisfaction with social circumstances and attainment of life goals
  • The patient will not inflict harm on herself/ himself or to others.
  • The patient will identify at least 2-3 people he/she can seek out for support and emotional guidance whenever he/she is feeling self-destructive prior to discharge.
  • The patient will identify support and support groups with whom he/she is in contact within a month.
  • The patient will verbalize that he/she wants to live.
  • The patient will demonstrate compliance to medication or treatment plan within the next 2 weeks.
  • The patient will start constructing plans for the future.
  • The patient will demonstrate alternative ways in dealing with negative feelings and emotional stress.

Causes And Risk Factors Of Depression

How to care for Mood Disorders as a Nurse… Nursing Care Plan

The causes of depression vary, but they can be clustered through the following:

  • Biological differences. Depressed patients tend to have changes in the biologic structure of their brains.
  • Changes in brain chemistry. Neurotransmitters are essential chemicals responsible for the communications between neurons in the brain. Changes in the levels of these chemicals play a vital role in the mood stability of the patient and the effect of treatment for depression.
  • Hormonal imbalance. Some hormones may trigger changes in a patients mood. Such instances can occur for women on post-partum, people on birth control medications, or on patients with thyroid problems.
  • Inherited traits. Patients whose relatives or family members have experienced depression are more prone to develop its symptoms.
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    Practice Quiz: Major Depression

    Quiz time about the topic! For more practice questions, visit our NCLEX practice questions page.

    1. Which patient would the nurse expect to prepare for ECT?

    A. A female patient with dysthymic disorderB. An elderly male with major depressive disorder and a history of strokeC. A middle-age, female patient with major depression and an immediate risk of suicide.D. A female patient with depression and hypomania due to cyclothymic disorder

    2. How long should a depressive episode last for it to be considered for diagnosis?

    A. 7 daysB. more than 10 daysC. 2 weeks

    D. Stroke

    1. Answer: C. A middle-age, female patient with major depression and an immediate risk of suicide.

    ECT may be used to treat major depression as well as certain psychotic disorders, particularly in situations of severe depression when psychotherapy and medications have been ineffective, when ECT poses a lower risk than other treatments do, or when the patient is at an immediate risk for suicide.

    2. Answer: C. 2 weeks.

    Major depression is a syndrome of a persistently sad mood lasting 2 weeks or longer.

    3. Answer: A. MAOIs.

    This is the reason why this drug class is rarely used.

    4. Answer: C. Scrabble.

    Noncompetitive activities should be promoted for these patients.

    5. Answer: B. Suicide.

    It occurs in 15% of untreated cases.

    Bipolar Disorder Nursing Care Plans Diagnosis And Interventions

    Bipolar Disorder NCLEX Review and Nursing Care Plans

    Bipolar disorder is an affective and mood disorder characterized by its chronicity and complexity. Patients with this disorder manifest with two poles of mood states, the manic and depressed states. A lesser degree of these mood states such as hypomania and mixed states may also be observed in these patients.

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    Treatment For Bipolar Disorder

    Treatment of bipolar disorder depends on the patients mood state and thus involves establishing the diagnosis of mania or hypomania and defining the patients current mood state.

    Mood stabilizers and antipsychotics are the mainstays of pharmacotherapy for acute manifestations, with combination treatment showing better results than a single drug class alone.

    Prevention of relapses is the goal for long-term management while electroconvulsive therapy is considered in treatment-resistant episodes.

    Nursing Care Plans For Depression


    Before creating a nursing care plans for depression we are learning about depression. Depression is an affective disorder characterized by a sad mood, lack of ideas, and psychomotor retardation.

    Depression is characterized by

    • Loss of interest and pleasure in usual activities is common
    • Physical activity or restlessness
    • Changes in sleeping, eating, and libido
    • Nursing diagnosis for depression

    Also Check: What Is A Depressive State

    Nursing Approach To A Depressive Episode

  • Value the individual as a person with unique values and beliefs
  • Respect personal space
  • Build therapeutic nurse-patient relationship in a non-judgemental way through active listening and simple questioning
  • Monitor the persons physique ask regarding sleeping pattern, weight fluctuations and fluid status
  • Monitor the persons cognition ask regarding interaction and conversation with others
  • Monitor the persons behaviour notice if the person is showing evident signs of self-neglect and psychomotor retardation
  • Keep a continuous risk-assessment, including risk of self harm and suicide
  • Nursing Care Plan For Bipolar Disorder 1

    Risk For Violence Self-Directed or Other-Directed

    Nursing Diagnosis: Risk for Violence self-directed or other-directed related to the patients manic state secondary to imbalances in the patients biochemical/neurological processes as evidenced by aggressive speech and actions and threats of hurting people thrown to others and to self.

    Desired Outcome: The patient will be able to control emotions and impulses and will not be a threat to himself/herself and others around him/her.

    Read Also: How Many Medications Are There For Depression

    Signs And Symptoms Of Bipolar Disorder

    Patients with bipolar disorder present with a depressive or manic state although some may also present with a feature from both.

    Manic State
    Disregard of social etiquettes Elevated or euphoric moodExtreme lability Pressured speechDelusions Easy distractibility Sad or elegiac mood with sad affectSlow or soft speechDelusions Negative thoughts and ruminationsOveremphasis of symptoms

    Types Of Bipolar Disorder

    Major Depressive Disorder: Carefully Listening for Patient Cues

    Types of bipolar and related disorders vary depending on the manifestation and duration of the depressed and manic state of the patient.

    • Bipolar I disorder At least one manic episode is experienced with precedent or subsequent hypomanic or major depressive episodes.
    • Bipolar II disorder At least one major depressive episode and at least one hypomanic episode.
    • Cyclothymic disorder Less severe depressive symptoms and hypomania that may have occurred once during childhood and once during adolescence.

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    Major Depression Nursing Diagnosis & Care Plan

    Depression is a mood disorder characterized by intense and persistent feelings of sadness and a loss of interest or enjoyment in things once loved. Major depressive disorder affects how you think and feel and can cause severe emotional symptoms and even thoughts that life isnt worth living anymore.

    Major depression can affect not only the emotional aspect of ones life but the physical as well. Patients may stop caring for their hygiene, experience insomnia or sleep too much, overeat or barely eat leading to weight loss or gain.

    Causes And Risk Factors Of Bipolar Disorder

    Bipolar disorder may be associated and may be caused by different factors such as the following:

  • Biological Factors
    • genetic factors chromosomes 18q and 22q are highly associated with bipolar disorder.
    • neuroanatomy the areas that may be affected in bipolar disorder include the prefrontal cortex, anterior cingulate cortex, hippocampus, and amygdala.
    • structural and functional imaging neurodegeneration is observed in subcortical regions such as the thalamus, basal ganglia, and the periventricular area in patients with bipolar disorder.
    • biogenic amines neurotransmitters said to be involved in the pathophysiology of bipolar disorder include dopamine, serotonin, and norepinephrine.
    • second messengers second messengers such as cyclic adenosine monophosphate and cyclic guanosine monophosphate are affected by mood stabilizers through alteration in g proteins or guanine binding nucleoproteins that interact with the receptors that produce these second messengers.
    • hormone regulation imbalance increased csf somatostatin levels in mania are observed which is to be expected because somatostatin inhibits dopamine and norepinephrine release.
  • Psychosocial Factors
    • Stressors a patients experience of significant life stressors may facilitate a cascade of events leading to neuronal changes observed in bipolar disorder.
    • Traits Other personality traits such as obsessive-compulsive or borderline personality traits are associated with depressive states in bipolar disorder.

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    Nursing Care Plan For Bipolar Disorder 4

    Interrupted Family Processes

    Nursing Diagnosis: Interrupted family processes related to the patients uncontrollable behavior that may harm other members of the family secondary to nonadherence to pharmacologic management of the bipolar disorder as evidenced by the family showing signs of dysfunction, inability to cope, and the family members inadequate knowledge regarding the disorder and the management plan.

    Desired Outcomes:

    • The patients family will be more involved in managing the patients condition, and will be better educated regarding the disorder and its management.
    • The patient will be capable of better coping when the patient is showing signs of manic or depressive behaviors.
    Nursing Interventions for Bipolar Disorder Rationale
    Spend time with the family to determine and address the familys needs. Educate the family about the disease, the pharmacologic intervention , and the presence of support groups for the family. Family members must be able to understand the manifestations of the patient especially when he/she becomes out of control in order to prevent the occurrence of dysfunction in family ties.

    Nursing Care Plan For Bipolar Disorder 2

    Major Depression Nursing Care Plans Nurseslabs

    Impaired Social Interaction

    Nursing Diagnosis: Impaired Social Interaction related to the patients manic state secondary to imbalances in the patients biochemical/neurological processes as evidenced by poor interactions with others, inability to form meaningful relationships, and poor attention span.

    Desired Outcome: The patient will be able to verbalize thoughts when they become uncontrollable and will be doing activities without manifesting inappropriate behaviors.

    Nursing Interventions for Bipolar Disorder Rationale
    The patient may be encouraged to involve themselves in activities that require social interaction when less manic. When less manic, exposing patients to social situations helps develop his/her social skills. However, this should be done non-competitively as competition stimulates aggressive behavior and may trigger manic episodes.
    Provide the patient with a calming environment with fewer stimuli, such as an environment with dim light and soft music. Fewer stimuli mean lesser distractibility and lesser trigger for manic episodes.
    Solitary activities must also be encouraged such as writing, taking photos, painting, or walking. Solitary activities help release stress and minimize triggers for manic episodes and distractibility.

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    The Following Nursing Interventions For Depression Are As Follows:

    Assess the client for clinical symptoms of depression. The symptoms should not be because of bereavement, a medical condition, drug abuse, or prescription medication.

    Assessment may encompass several aspects like:

    • Clients appearance may show disheveled hair and clothes in low tone colors. Posture may be stooped and dull facial expression, reddened eyes from the previous crying, furrowed brow, or worried frown. The client may also be agitated. Note nonverbal behaviors for the avoidance of eye contact and consistency of mouth smile.
    • Note how the client responds verbally. The pace of your nurse-client interaction may be slow since he may lack the interest in the topic or have low motivation to talk to other people.
    • Observe and check for any physical complaints. Often, a client with depression will reveal some physical problems like constipation, anorexia, headache, and sleep disturbances- which are often associated with the emotional effects of the disease.
    • Assess his behaviors. The most common behavioral symptom is being agitated. The client may also be withdrawn or isolates themself due to low self-esteem, has impulsive overeating, drinking, or other vices, and sometimes gets himself into fights.
    • And also assess his feelings. A marked apathy, lack of humor, and irritability are common.

    Provide Depression Nursing Interventions:

    Depression comprises most of the cases in mental health units, and our role in the recovery is essential. Gaining the clients trust could make access to the potential realization of his strengths and limits as a person. That is why providing nursing care to a client with clinical depression is not easy because of some emotional outbursts and the like, so one should be aware of yourself prior to developing interaction with a depressed client.

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