An illness that involves the body, mood, and thoughts and that affects the way a person eats, sleeps, feels about himself or herself, and thinks about things
Nursing Assessment.
A. Identify risk factors/high risk groups
B. Assess all at-risk groups using a standardized depression screening tool and documentation score.
C. Perform a focused depression assessment on all at-risk groups and document results. Note the number of symptoms; onset; frequency/patterns; duration (especially 2 weeks); change from normal mood, behavior, and functioning
D. Obtain/review medical history and physical/neurological examination.
E. Assess for depressogenic medications (e.g., steroids, narcotics, sedative/hypnotics, benzodiazepines, antihypertensives, H2 antagonists, beta-blockers, antipsychotics, immunosuppressives, cytotoxic agents).
F. Assess for related systematic and metabolic processes (e.g., infection, anemia, hypothyroidism or hyperthyroidism, hyponatremia, hypercalcemia, hypoglycemia, congestive heart failure, kidney failure).
G. Assess for cognitive dysfunction.
H. Assess level of functional ability.
Interventions:
1. Institute safety precautions for suicide risk as per institutional policy (in outpatient settings, ensure continuous surveillance of the patient while obtaining an emergency psychiatric evaluation and disposition).
2. Remove or control etiologic agents:
a. Avoid/remove/change depressogenic medications.b. Correct/treat metabolic/systemic disturbances.
3. Monitor and promote nutrition, elimination, sleep/rest patterns, physical comfort (especially pain control).
4. Enhance physical function (i.e., structure regular exercise/activity; refer to physical, occupational, recreational therapies); develop a daily activity schedule.
5. Enhance social support (i.e., identify/mobilize a support person(s) [e.g., family, confidant, friends, hospital resources, support groups, patient visitors]); ascertain need for spiritual support and contact appropriate clergy.
6. Maximize autonomy/personal control/self-efficacy (e.g., include patient in active participation in making daily schedules, short-term goals).
7. Identify and reinforce strengths and capabilities.
8. Structure and encourage daily participation in relaxation therapies, pleasant activities (conduct a pleasant activity inventory), music therapy.
9. Monitor and document response to medication and other therapies; readminister depression screening tool.
10. Provide practical assistance; assist with problem solving.
11. Provide emotional support (i.e., empathic, supportive listening, encourage expression of feelings, hope instillation), support adaptive coping, encourage pleasant reminiscences.
12. Provide information about the physical illness and treatment(s) and about depression (i.e., that depression is common, treatable, and not the person's fault).
13. Educate about the importance of adherence to prescribed treatment regimen for depression (especially medication) to prevent recurrence; educate aboutspecific antidepressant side effects due to personal inadequacies.
14. Ensure mental health community link-up; consider psychiatric, nursing home care intervention
Evaluation of Expected Outcomes
A. Patient
1. Patient safety will be maintained.2. Patients with severe depression will be evaluated by psychiatric services.3. Patients will report a reduction of symptoms that are indicative of depression. A reduction in the GDS score will be evident and suicidal thoughts or psychosis will resolve.4. Patient’s daily functioning will improve.
B. Health care provider
1. Early recognition of patient at risk, referral, and interventions for depression, and documentation of outcomes will be improved.
C. Institution
1. The number of patients identified with depression will increase.2. The number of in-hospital suicide attempts will not increase.3. The number of referrals to mental health services will increase.4. The number of referrals to psychiatric nursing home care services will increase.5. Staff will receive ongoing education on depression recognition, assessment, and interventions
9 Nanda Specific Nursing Diagnosis and Care Plans for Depression
1. Risk for self-directed violence / Risk for Suicide
2. Ineffective coping
3. Hopelessness
4. Social isolation
5. Imbalanced Nutrition, Less Than Body Requirements
6. Self-care deficit
7. Low self-esteem
8. Ineffective sexuality patterns
9. Spiritual distress
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