AssessmentAssessing a client with a depressive disorder focuses on both verbal and nonverbal assessments. As the registered nurse conducts follow-up assessments, findings are compared to baseline admission assessments. Show
The role of the nurse in caring for clients with depression is related to primary nursing care, as well as collaboration with interprofessional team members. As a team member, the nurse may collaborate with psychiatrists, psychologists, licensed social workers, and other health care providers. The scope and practice of each team member is clearly defined within their professional licensure. Psychiatric InterviewThe registered nurse uses specific questions during the client’s admission process based on agency policy. It is also important to consider the impact of culture on a client’s perception of their illness. See suggested “Cultural Formulation Interview Questions” in the “Application of the Nursing Process in Mental Health Care” chapter. Mental Status ExaminationSee Table 7.5a for common findings when assessing a client with a depressive disorder. (See expected findings for these components of a mental status examination in the “Assessment” section in Chapter 4.) Critical findings that require immediate notification of the provider are bolded with an asterisk. Table 7.5a Common Findings During Mental Status Examinations for Clients With Depressive Disorders
Psychosocial AssessmentAs previously discussed in the “Application of the Nursing Process in Mental Health Care” chapter, psychosocial assessment obtains additional subjective data that detects risks and identifies treatment opportunities and resources. Agencies have specific forms used for psychosocial assessment that typically consist of these components[1],[2]:
Screening ToolsScreening tools assess characteristics of specific mental health disorders. The screening tools listed below are examples of screenings, assessments, and question/answer prompts designed to address depressive disorders. These screening tools may be used on admission and at different times throughout the hospital or treatment stay. The findings may be used to compare and contrast client progress within the hospital stay, from a previous admission, or periodically on an outpatient basis. The registered nurse often conducts these tools as a collaborative member of the health care team. Links to Common Screening Tools for Depressive Disorders
Laboratory TestingFor patients with depressive symptoms in the absence of general medical symptoms or findings on examination, the utility of screening laboratory tests has not been demonstrated. Commonly performed screening laboratory tests for new onset or severe depression include complete blood count, serum chemistry panels, urinalysis, thyroid stimulating hormone, rapid plasma reagin (RPR) for syphilis, human chorionic gonadotropin (HCG) for pregnancy, and toxicology screening for drugs of abuse.[3] Routine laboratory monitoring is performed for some clients based on the medications they are taking, such as the following:
Read more about laboratory monitoring required for specific medications in the “Treatments for Depression” section of this chapter. Life Span ConsiderationsLife span considerations influence how the client is assessed, as well as the selection of appropriate nursing interventions. Depressive disorders can be found across the life span from the very young to the very old. Read more about specific disorders in the “Childhood and Adolescence Disorders” chapter or the “Vulnerable Populations” chapter. It is important to individualize all interventions to the age and developmental level of the client. Review developmental stages in the “Application of the Nursing Process in Mental Health Care” chapter. Depression Associated With DementiaIndividuals with dementia are susceptible to depression. refers to a group of symptoms that lead to a progressive, irreversible decline in mental function severe enough to disrupt daily life caused by a group of conditions including Alzheimer’s disease, vascular dementia, frontal-temporal dementia, and Lewy body disease. Alzheimer’s disease is one of the most common forms of dementia. Alzheimer’s disease causes impaired memory and the ability to learn, reason, make judgments, communicate, and carry out daily activities. An early symptom of Alzheimer’s disease can be subtle memory loss and personality changes that differ from normal age-related memory problems. They seem to tire or become upset or anxious more easily. They do not cope well with change. For example, they can follow familiar routes, but traveling to a new place confuses them, and they can easily become lost. In the early stages of the illness, people with Alzheimer’s disease are particularly susceptible to depression.[4] While changes in the brain that cause dementia are permanent and worsen over time, thinking and memory problems can be aggravated by untreated depression.[5] Nurses should report new symptoms of depression in clients who have been diagnosed with dementia. Read more about dementia at the Alzheimer’s Association’s webpage. Reflective Questions
Cultural ConsiderationsReview cultural considerations of care in the “Application of the Nursing Process in Mental Health Care” chapter. Reflective Questions:
DiagnosesMental health disorders are diagnosed by mental health providers using the DSM-5, similar to how medical conditions are diagnosed by trained medical professionals. Nurses create individualized nursing care plans based on the client’s response to mental health disorders. See common nursing diagnoses related to mental health disorders in the “Diagnosis” section of the “Application of the Nursing Process in Mental Health Care” chapter. Risk for suicide is always evaluated for clients with depressive disorders because suicidal ideation is a symptom of depression. Other common nursing diagnoses and sample expected outcomes for clients with depressive disorders are discussed in the following section in Table 7.5b. Outcomes IdentificationSMART outcomes are identified in relation to the established nursing diagnoses for each client. SMART is an acronym for Specific, Measurable, Attainable/Actionable, Relevant, and Timely. Read more about outcomes identification in the “Application of the Nursing Process in Mental Health Care” chapter. Table 7.5b. Common Expected Outcomes for Nursing Diagnoses Related to Depressive Disorders[6]
Planning InterventionsInterventions are planned based on the client’s nursing diagnoses, expected outcomes, and current status. Clients with depressive disorders are monitored closely for risk of suicide, and interventions are planned according to their level of risk. See interventions for clients at risk of suicide in the “Application of the Nursing Process in Mental Health Care” chapter. ImplementationAs discussed earlier in this chapter, a combination of pharmacological treatments and psychotherapies are often an effective approach to treating depressive disorders. There are three phases in treatment and recovery from major depression[10]:
Nurses target interventions based on the client’s current phase of treatment and recovery. Interventions can be categorized based on the American Psychiatric Nurses Association (APNA) standard for Implementation that includes the Coordination of Care; Health Teaching and Health Promotion; Pharmacological, Biological, and Integrative Therapies; Milieu Therapy; and Therapeutic Relationship and Counseling. Read more about these subcategories in the “Application of the Nursing Process in Mental Health Care” chapter. See examples of interventions for each of these categories for clients with depressive disorders in Table 7.5c. Table 7.5c Examples of Nursing Interventions by APNA Subcategories
Nursing interventions are also planned that target common physiological signs of depression and associated self-care deficits. See common interventions for these conditions in Table 7.5d. Table 7.5d Nursing Interventions Targeting Physiological Signs of Depression and Self-Care Deficit[11]
Communication TipsSome clients with depression are so withdrawn they are unwilling or unable to speak. Sitting with them in silence may feel like a waste of time, but nurses should be aware that providing therapeutic presence can be meaningful in supporting the client with depression. Helpful communication techniques for severely withdrawn clients and their rationale are described in the following box. Guidelines for Communication With Severely Withdrawn Individuals[12]
There are several guidelines for counseling individuals with depression, helping them identify current coping skills, and exploring new adaptive coping strategies:
Collaborative Mental Health TreatmentsNurses assist in implementing collaborative interventions based on the client’s treatment plan. Review collaborative mental health treatments and common medications used to treat depression in the “Treatments for Depression” section of this chapter. Patient Education Regarding Antidepressant MedicationsNurses educate clients about their medications, including the manner in which they work, common side effects, and issues to report to their provider. Clients taking antidepressants should also be educated regarding the following considerations[14]:
Supporting Family MembersIt is important to support the family members and significant others who are living with an individual with a depressive disorder. Read tips on living with someone with depression in Figure 7.9.[15] Figure 7.9 Supporting Family Members and Significant OthersEvaluationEvaluation of the client’s progress towards meeting expected outcomes occurs continuously throughout the treatment phase. Evaluation includes comparing results from screening tools, reviewing laboratory results, and monitoring the effectiveness of prescribed medications, treatments, and nursing interventions. Based on the evaluation findings, the nursing care plan may be modified, or new interventions or outcomes may be added. Which assessment should be considered as priority by the nurse caring for a client with major depression?A priority is the patient's safety, including alleviating the risk of suicide. The following list includes interventions for the depressed person: Monitor for suicidal risk.
Which clinical manifestations would the nurse observe in an older client with major depressive disorder?Clinical Manifestations. Depressed mood. ... . Anhedonism. ... . Weight changes. ... . Change in sleep pattern. ... . Agitation or psychomotor retardation. ... . Tiredness. ... . Worthlessness or guilt inappropriate to the situation (probably delusional).. Difficulty thinking, focusing, and making decisions.. Which action is the priority when the nurse is establishing a therapeutic environment for a client quizlet?What is the priority when the nurse is establishing a therapeutic environment for a client? Safety is the priority before any other intervention is provided.
Which of the following is a risk factor for depression?Traumatic or stressful events, such as physical or sexual abuse, the death or loss of a loved one, a difficult relationship, or financial problems. Family history of depression, bipolar disorder, alcoholism or suicide.
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