Depression

Depression Nursing Care Plans Diagnosis and Interventions

Depression NCLEX Review Care Plans

Nursing Study Guide for Depression

Depression is a mood disorder wherein the patient experiences a persistent feeling of loneliness and loss of interest which is otherwise different from usual episodes of sadness.

This disorder greatly affects the person’s thinking, emotions, and behavior, consequently affecting how he/she performs activities of daily living.

Also called major depressive disorder or clinical depression, this mood disorder will require a long-term and comprehensive treatment plan to prevent the development to a more serious and debilitating psychiatric condition.

Signs and Symptoms of Depression

  • Feelings of sadness, emptiness, hopelessness
  • Angry outbursts
  • Easy irritability
  • May appear withdrawn, avoids socializations
  • Loss of interest in most normal activities such as hobbies
  • Sleep disturbances (difficulty sleeping or too much sleeping)
  • Lack of energy
  • Discrepancies in eating habits (either overeating loss of appetite)
  • Restlessness and anxiety
  • Sluggish thinking, speaking
  • Feelings of worthlessness, particularly from past failures
  • Cognitive discrepancies (such as difficulty concentrating or memory faults)
  • Suicidal thoughts
  • Unexplained aches and pains  

Types of Depression

The types of depression according to specifiers include:

1. Anxious distress – A type of depression characterized by having feelings of losing control.  

2. Mixed features – A subtype with features of depression and mania.

3. Melancholic features – Another subtype wherein the patient experiences severe depression and lacking enthusiasm in activities of daily living.

4. Atypical features – Another subtype wherein the patient can be temporarily lifted from depressed moods through happy events, increased appetite, and sensitivity to rejection.

5. Psychotic features – A depression subtype with accompanying delusions or hallucinations.

6. Catatonia – A form of depression characterized by unpurposeful and uncontrollable movement (such as Fixed posturing)

7. Peripartum onset – A subtype encountered during pregnancy or weeks after giving birth (postpartum)

8. Seasonal pattern – A subtype with the changes in season and the amount of exposure to sunlight. 

Causes and Risk Factors of Depression

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

  1. Biological differences. Depressed patients tend to have changes in the biologic structure of their brains.
  2. 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.
  3. Hormonal imbalance. Some hormones may trigger changes in a patient’s mood. Such instances can occur for women on post-partum, people on birth control medications, or on patients with thyroid problems.
  4. Inherited traits. Patients whose relatives or family members have experienced depression are more prone to develop its symptoms.

The risk factors of depression are enumerated below:

  • Depression usually begins during teens, in the 20’s or 30’s, but can occur at any age
  • More commonly diagnosed in women than men
  • Certain personality traits (such as pessimism, low self-esteem)
  • Traumatic events (such as history of sexual abuse, financial problems, accidents)
  • Familial history of depression, bipolar disorder, or suicide
  • Being lesbian, gay, bisexual, or transgender with poor psychosocial support
  • History of mental health disorders (such as eating disorders)
  • Substance abuse (such as alcohol, drugs)
  • Chronic or debilitating illness (such as cancer, heart disease)
  • Medications (such as sleeping pills and birth control medications)

Complications of Depression

  • Excess weight that can lead to heart disease and diabetes mellitus
  • Pain or actual illness
  • Substance abuse
  • Anxiety attacks, social phobias
  • Interpersonal problems (such as problems in family dynamics)
  • Social isolation
  • Suicide ideations or suicide
  • Self-harm or mutilation
  • Premature death brought about by co-morbidities

Diagnosis for Depression

  • Physical exam – to evaluate baseline health of the patient. Some causes of depression may be due to underlying conditions (such as heart disease)
  • Blood tests – to determine the baseline physical health of the patient. An example of which is thyroid function tests in which changes in the levels could indicate thyroid disease.
  • Psychiatric evaluation – a professional evaluation to determine and profile the baseline psychological health of the patient by assessing behaviors, moods, thoughts, and feelings, etc. 
  • DSM 5 – The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will be utilized to properly identify and classify the depression.

Treatment for Depression 

Treating depression involves the following therapeutic regimens:

  1. Medications. Prescribed drugs are given as first line treatment for depression for it acts on the neurotransmitters in a patient’s brain. Examples of the drug classes used for clinical depression are:
  2. Selective serotonin reuptake inhibitors (SSRI)
  3. Serotonin-norepinephrine reuptake inhibitors (SNRI)
  4. Atypical depressants
  5. Tricyclic depressants
  6. Monoamine Oxidase Inhibitors (MAOI)
  7. Psychotherapy. Also known as talk therapy, psychotherapy is utilized to explore depression and other related issues of the patient with the help of a certified mental health physician called a psychiatrist. Some types of psychotherapy include Cognitive Behavioral Therapy (CBT) or interpersonal therapy which aims to develop resilience to stressful situations.
  8. Admission to a mental health care facility. In instances where depression is severe, causing for the patient to inflict harm, patients are institutionalized for further management. Being surrounded and monitored by healthcare workers will mitigate the violent tendencies of the depressed patient.
  9. Other treatment options. If medications and psychotherapy proved to be ineffective in treating depression, some drastic procedures are done to address the condition, which may include:
  10. Electroconvulsive therapy (ECT) – involves passing of electrical currents to the brain with the goal of impacting the functions of the neuron and effects of neurotransmitters.
  11. Transcranial magnetic stimulation (TMS) – a procedure which makes use of brief magnetic impulses sent to the brain to stimulate the neurons involved in mood regulation.

Nursing Care Plans for Depression

Nursing Care Plan 1

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 (ADLs) as normal

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

InterventionsRationales
Assess the patient’s level of confusion.To monitor effectiveness of treatment and therapy.
Assist the patient performing activities of daily living. Consider one-to-one nursing.To maintain a good quality of life and promote dignity by allowing the patient to perform their ADLs while maintaining safety.
Simplify tasks for the patients by using simple words and instructions. Label the drawers with simple words and big letters and use written notes when necessary.Patients with clinical depression may have difficulty handling complex tasks.  
Provide opportunities for the patient to have meaningful social interaction, but never force any interaction.To prevent feelings of isolation. However, forced interaction can make the patient agitated or hostile due to confusion.
Allow the patient to take time and think about what to say or do.To help the patient have enough time to communication and not feel rushed or bothersome.    
Provide gentle instructions to the patient using a step-by-step method. For example: When bathing: “damp your face first using a washcloth, lather soap on hands and gently apply on the face.”Insomnia or hypersomnia as well as having major depression in general can decrease the level of concentration and cognition for the patient, so breaking down tasks into simple steps can help organize thoughts and actions.  
Ensure that the patient takes medications on time and as prescribed.To ensure adherence to medical regimen.

Nursing Care Plan 2

Nursing Diagnosis: Impaired Social Interaction related to social isolation secondary to clinical depression as evidenced by withdrawal from group gatherings or social events, anxiety, impaired perception, inability to meet basic needs and role expectations

Desired Outcome: The patient will demonstrate improved social interaction by increased participation in social events.

InterventionRationale
Explore the patient’s reasons for social withdrawal without judging or giving suggestions at first. Assess the anxiety level of the patient, anxiety triggers and symptoms by asking open-ended questions.To establish a baseline observation of the anxiety level of the patient. Open-ended questions can help explore the thoughts and feelings of the patient regarding social isolation.
In the beginning of treatment / therapy, allow the patient to continue withdrawn attitude or ritualistic behavior without any judgment or verbalization of disapproval.The client may become more relaxed and open for discussion if he/she is allowed to precipitate the heightened anxiety by performing ritualistic behaviors or maintaining distance from the social group.
Initially, support the patient by meeting dependency needs if deemed necessary.The patient can become more confused, depressed or anxious if the avenues for dependency are suddenly and/or complete eliminated.
Encourage the patient to be independent and provide positive reinforcement for being able to do self-care and other independent behaviors.To enhance the patient’s self-esteem and encourage him/her to repeat desired behaviors.  
Discuss with the patient and significant other/s the available treatments for depression and anxiety.Depression and anxiety disorders are treatable. Psychotherapy involves speaking with a licensed therapist and going through how to gradually cope with the symptoms. Medications such as anxiolytics and antidepressants can help the patient cope with these disorders.
Support the patient’s efforts to verbalize and explore the meaning behind each ritualistic behavior or tendency to become withdrawn.The patient should first recognize and accept the presence of ritualistic behavior or tendency to become withdrawn before change can happen.
Provide a supportive approach when gradually limiting the time given for ritualistic behavior or withdrawn attitude.To encourage the patient to replace his/her ritualistic behaviors with adaptive behaviors.  
Encourage him/her to join social events gradually. Include his/her interests/previous hobbies in the activities of the social group.To provide chances for the patient to interact socially.
Encourage the patient to perform activities like crafts and games with one or more persons during the day and discourage sleeping during the day.Sleeping during the day can make the patient less sleepy at night, which can cause insomnia. Encouraging socialization can help the patient cope with depression.
Teach the patient to perform relaxation techniques such as deep breathing exercises, guided imagery, meditation, and progressive muscle relaxation.To promote relaxation and reduce stress levels.

Other possible nursing diagnosis:

  • Risk for Self-directed Violence
  • Chronic Low Self-esteem
  • Spiritual Distress
  • Powerlessness / Hopelessness
  • Self-care Deficit

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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