Understanding Depression
Is of paramount importance for nursing students for several crucial reasons:
Recognition and Assessment: Depression is a prevalent mental health disorder with various manifestations. Nursing students need to recognize its signs and symptoms to conduct thorough assessments. Identifying subtle changes in mood, behavior, and physical well-being enables early intervention, leading to improved patient outcomes.
Communication and Empathy: Nurses are often the frontline caregivers, spending extended time with patients. Understanding depression fosters effective communication and empathy. Nursing students can learn how to approach sensitive discussions, offer emotional support, and create a therapeutic nurse-patient relationship..png?width=1200&height=630&name=nclex%20review%20for%20angina%20(2).png)
Patient Safety: Depression increases the risk of self-harm and suicidal ideation. A solid understanding equips nursing students to assess suicide risk, implement safety measures, and collaborate with mental health professionals to ensure patient safety.
Medication and Treatment: Many patients with depression receive pharmacological interventions. Nursing students need to comprehend various antidepressant medications, their mechanisms, potential side effects, and interactions to administer them safely and educate patients about their treatment.
Incorporating a comprehensive understanding of depression into nursing education lays a foundation for compassionate, competent, and effective nursing care, ensuring that nursing students can make a meaningful impact on the lives of patients dealing with this challenging condition.
Overview for Depression
State of low mood and aversion to activity that can affect a person’s thoughts, behaviors, feelings, and sense of wellbeing
General Information for Depression
1. Can be mild, moderate, or severe
a. Mild: lasts 2 weeks or less
b. Moderate: more persistent, negative thinking and suicidal thoughts may occur
c. Severe: intense and pervasive, may include delusions and hallucinations
Assessment for Depression
1. Some combination of the following symptoms may be present, especially in major depressive disordera. Depressed mood most of the day
b. Diminished interest or pleasure in activities
c. Significant unintentional weight loss
d. Insomnia or hypersomnia
e. Psychomotor agitation
f. Fatigue or loss of energy
g. Feelings of worthlessness, or excessive or inappropriate guilt
h. Difficulty concentrating or making decisions
i. Recurrent thoughts of death or suicide, with or without a plan
j. Low self-esteem
k. Feelings of hopelessness
l. Poor appetite or overeating
2. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
Therapeutic Management for Depression
1. #1 priority is assessing the risk for self-harm:“Have you had any thoughts of hurting yourself?”
a. If they say yes then ask, “do you have a plan?”
2. Ensure a safe environment
a. Removing anything from their room that they could potentially use to harm themselves
3. Promote appropriate intake – focus on higher- calorie foods frequently
a. They may go long periods without eating so maximize intake when they actually do eat.
4. May need reminding/encouragement to maintain basic personal hygiene (ADL’s)
5. Encourage expression of feelings and focus on their strengths
6. Validate their feelings of loss/frustration/sadness
7. Promote spending time with them to show them they are a priority to you
8. Engage the client in activity toward progress
a. One-on-one situations, eventually progressing to group discussions
b. Start with gross motor activities
c. Suggest activities that are easy to complete, non-competitive, and that offer a sense of accomplishment when complete ( coloring, drawing, playing cards, easy games)
9. Promote appropriate sleep-wake cycles
Nursing Care Plan for Depression
Patient Profile:
John Smith, a 72-year-old male, is admitted to the medical-surgical unit following hip replacement surgery. He has a history of major depressive disorder (MDD) and has been non-compliant with his antidepressant medication for the past few months. John's wife reports that he has been increasingly withdrawn, experiencing persistent sadness, and losing interest in activities he once enjoyed. His appetite has significantly decreased, leading to weight loss, and he struggles with disrupted sleep patterns. John's social interactions have diminished, and he expresses feelings of worthlessness and guilt.
Assessment:
Upon assessment, John appears physically frail and emotionally detached. He exhibits a flat affect, minimal eye contact, and slouched posture. He reports feeling hopeless about his recovery after the surgery and expresses thoughts of being a burden to his family. John's affective and cognitive symptoms align with those of a major depressive episode.
Diagnosis:
John's presentation aligns with the diagnostic criteria for major depressive disorder. His persistent low mood, anhedonia, physical symptoms, and cognitive distortions contribute to the diagnosis.
Interventions:
Collaborative Care: The medical and psychiatric teams collaborate to address both John's surgical recovery and his depressive symptoms. This interdisciplinary approach ensures that his physical and mental health needs are attended to simultaneously.
Medication Management: John's psychiatrist reviews his medication history and adjusts his antidepressant medication regimen. Close monitoring of medication effectiveness and potential side effects is essential.
Psychotherapy: Individual psychotherapy sessions are introduced to provide John with a safe space to express his feelings, work through negative thought patterns, and develop coping strategies. Cognitive Behavioral Therapy (CBT) is particularly effective in addressing the distorted cognitions associated with depression.
Family Involvement: John's wife is educated about the nature of depression and its impact on her husband's recovery. She learns how to provide emotional support and encourage John's engagement in enjoyable activities.
Nutritional Support: John's decreased appetite and weight loss are addressed by collaborating with a dietitian to ensure he receives proper nutrition during his recovery. Nutritional deficiencies can exacerbate depressive symptoms.
Activity Engagement: Occupational therapists engage John in meaningful activities that align with his interests and abilities. Engaging in activities can boost his mood and provide a sense of accomplishment.
Safety Assessment: Given John's expression of worthlessness and thoughts of being a burden, a thorough assessment of suicidal ideation is conducted. A safety plan is developed, involving regular check-ins with nursing staff and mental health professionals.
Outcomes:
Over time, with the combined efforts of medical and psychiatric teams, John's depressive symptoms gradually improve. His engagement in therapy helps challenge his negative thought patterns, and medication adjustments contribute to stabilizing his mood. He becomes more socially interactive and gains a renewed interest in participating in activities. As John's physical health improves following his surgery, his overall well-being sees significant enhancement.
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Depression
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