Depression Nursing Care Plans Diagnosis and Interventions
Depression NCLEX Review and Nursing Care Plans
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- May appear withdrawn, avoids socializations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:
- 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 patient’s 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.
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:
- 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:
- Selective serotonin reuptake inhibitors (SSRI)
- Serotonin-norepinephrine reuptake inhibitors (SNRI)
- Atypical depressants
- Tricyclic depressants
- Monoamine Oxidase Inhibitors (MAOI)
2. 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.
3. 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.
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:
4. 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.
5. 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 Diagnosis for Depression
Nursing Care Plan for Depression 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.
|Nursing Interventions for Depression||Rationales|
|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 for Depression 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.
|Nursing Interventions for Depression||Rationale|
|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.|
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 (ideation, attempts, plan and available means), previous attempts of violence, having a suicidal plan that is clear and specific (lethal method and available means), having the energy to carry out the suicidal plan when depression begins to lift.
- 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.
|Nursing Interventions for Depression||Rationale|
|Determine the level of suicide precautions needed. Evaluate the patient’s suicidal intent, from a scale of 1 to 10, by directly asking if the patient is thinking of killing himself/herself, has a plan, means, and so on.||A high-risk patient will need consistent monitoring and a protective environment. Guidelines for necessity and urgency of interventions must be provided. Direct questioning is most beneficial when done in a caring, concerned manner.|
|Check to see if the needed quantity of drugs is available.||The pharmaceutical supply of a suicidal patient should usually be limited to 3-5 days.|
|Encourage the patient to talk about their feelings (anger, sadness, guilt) and come up with solutions to deal with their frustration and anger.||Clients might achieve a sense of self – control by trying out new methods of dealing with overwhelming emotions.|
|Establish contact with the family and make plans for crisis counseling. Activate self-help group linkages.||Clients require a support system to alleviate feelings of powerlessness, unworthiness, and isolation.|
|If the patient is admitted in a hospital, adhere to the unit’s standards.||In the hospital, clinic, or community, there are several measures for suicidal patients.|
|Create a written no-suicide commitment.||Reminds the patient of the steps he or she can take when they are having suicidal ideations.|
|Keep your composure and set firm guidelines for the patient’s behavior. Be honest and nonjudgmental in your responses.||Recognize that powerlessness and fear are at the root of this behavior. aids in the selection of an appropriate reaction|
|For instance, watch out for suicidal ideations or anxious sentiments while working with the client; expressed thoughts “It really doesn’t matter, I’d be better off dead,” the client says, or warns; mood changes, setting affairs in order, and history Suicide attempt in the past||Indicators suggesting the need for additional assessment and psychiatric treatment.|
|Provide environmental protection, such as constant but randomly timed surveillance. Inspection and removal of potentially harmful materials that can cause self-injury.||More structured environment may be required to retain control until internal control of oneself is achieved.|
|Assume that the client is in charge and accountable for his or her own actions, and behaviors.||Allows the individual to have more control.|
|Recognize the possibility of suicide as an option. Discuss the repercussions of the client’s actions if he or she pursues through the intention of committing suicide. Discuss about how it will assist the client in resolving his or her issues.||Suicide may be the client’s “only” option, and this approach provides an opportunity to examine and discuss other alternatives.|
Nursing Care Plan for Depression 4
Chronic Low Self-Esteem
Nursing Diagnosis: Chronic Low Self-Esteem related to feelings of shame and guilt, biochemical or neurophysiological imbalances, impaired cognitive self-appraisal, unrealistic expectation of self, and repeated past failure secondary to depression as possibly evidenced by inability to recognize one’s own achievement, negative view of self and abilities, repeated expression of worthlessness, rejection of a positive feedback, verbalization of self-negating statements, and evaluation of oneself as unable to deal with events.
- The patient will express belief in himself/herself.
- The patient will maintain his/her self-esteem.
- The patient will show a zeal for life and the ability to enjoy the current moment.
- By the end of the day, the patient will have identified one or two strengths.
- The patient will have identified two unreasonable self-expectations and will have reformulated more realistic life objectives with the nurse by the end of the day.
- The patient will select 3 judgmental adjectives that he/she uses to describe himself/herself (e.g., “I am lazy”) and replace them with objective terms (e.g., “I do not feel inspired to”).
- The patient will keep a daily load and rate his/her feelings of guilt, humiliation, and self-hatred on a scale of 1 to 10 (1 being the lowest, 10 being the highest).
- On a scale of 1 to 10, the patient will report diminished feelings of guilt, shame, and self-hatred (1 being the lowest, 10 being the highest).
- The patient will show that he or she can change unrealistic self-expectations.
- Patient will describe four positive attributes in a factual and nonjudgmental manner, as well as two areas in which he or she wishes to improve.
|Nursing Interventions for Depression||Rationale|
|Determine the level of self-esteem of the patient.||Withdrawal from social contacts, feelings of inadequacy, lack of personal cleanliness and dress, and rejection of self are all signs of poor self-esteem and may suggest a negative thought pattern.|
|Allow the patient to perform activities of daily living.||Taking care of one’s appearance is the first step toward developing a healthy self-image.|
|After a task is completed, provide positive feedback.||The importance of positive reinforcement in the development of self-esteem are also important.|
|Allow the patient to participate in simple recreational activities in a group setting before progressing to more complicated ones.||When participating in a group setting, a patient may feel overwhelmed at first.|
|Teach visualization techniques to assist the patient in displacing negative self-images and thoughts with more positive images and thoughts.||It helps the patient choose more positive ideas and activities in order to build a healthier and more realistic self-image.|
|Encourage the patient to join a group therapy session where other people are going through similar situations/feelings.||To reduce feelings of loneliness by creating an environment that encourages positive feedback and a more realistic assessment of oneself. This also provides an opportunity to verbalize the patient’s feelings and carry out new behaviors.|
|Assess the patient’s need for assertiveness training tools in order to pursue the things in life that he or she wants or needs. Arrange for training through community-based programs, individual therapy, and literature, among other options.||Individuals with low self-esteem frequently feel unworthy and have difficulties identifying their needs and desires.|
|Assertiveness should be modeled.||Clients can learn from role models.|
|Use problem-solving skills to involve the patient in activities that he or she wants to improve. Examine and assess the need for extra instruction in this subject.||Low self-esteem can obstruct your ability to solve problems normally.|
|Assist the patient in identifying cognitive distortions that lead to a negative self-perception. Consider the following scenarios:|
-Neglecting positive characteristics
-Reading people’s minds
|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. (“He’s always,” “I’m never,” etc.) 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.|
Nursing Care Plan for Depression 5
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 one’s own existence, refusion to interact with families, friends or religious leaders and searching for a spiritual source of strength.
- The patient will feel a sense of belongingness as he/she shares their thoughts, feelings, and beliefs with others.
- The patient will experience a sense of inner self-connection.
- The patient will take part in spiritual rites and rites of passage.
- Within three days, the patient will share with the nurse two items that have given meaning to his or her life in the past.
- Within three days, the patient will speak with a nurse or a spiritual leader about spiritual problems and concerns.
- For one week, the patient will keep a journal of his or her thoughts and feelings.
- The patient will express that he or she feels forgiven.
- The patient will express a desire to return to previous creative endeavors.
- The patient will verbalize that previous spiritual practices provided solace to him/her.
|Nursing Interventions for Depression||Rationale|
|Evaluate the patient’s spiritual orientation, present involvement, and presence of conflicts. Assess which spiritual practices have provided comfort and significance to the patient’s life when he or she is not sick.||This provides a baseline for planning and acquiring suitable resources. Assess aspects of a person’s life that have been neglected and, if regained, could provide consolation and meaning during a difficult depression.|
|Encourage the patient to keep a daily journal in which he or she can put down their ideas and reflections.||This will aid in the identification of crucial personal difficulties as well as one’s thoughts and sentiments towards spiritual matters. Writing a journal is an excellent approach to delve deeper into life’s meanings.|
|Provide a tape recorder if the patient is unable to write.||Speaking aloud frequently aids in the clarification of thoughts and the exploration of concerns.|
|Discuss with the patient what has brought him or her comfort and purpose in the past.||Clients who are depressed often have a difficult time finding meaning in life and reasons to keep going when they are hopeless and despondent.|
|Suggest that the patient be contacted by the facility’s spiritual leader.||Spiritual leaders are experienced in dealing with spiritual difficulties and can offer the patient relief.|
|When necessary, provide referrals for religious or spiritual information (e.g., readings, programs, tapes, community resources). Promote participation in support groups.||When a patient is in the hospital, spiritual recordings and readings can be beneficial; however, when the patient is out in the community, the patient may state other needs. Specific assistance to help alleviate life stressors are pivotal to facilitate the recovery process. Discussion of concerns and questions with other people can aid in resolving the patient’s feelings.|
|Distinguish the difference between grief and guilt, and assist the client to recognize and address each one. Make a list of the consequences of activities motivated by a sense of guilt||As the client becomes more aware of the effects of their choices, they can be discussed, and the desire to change can help to improve new coping abilities. Avoid acting out of a false sense of guilt, and allow the client to return to work favored religious pursuits.|
|Reflective and therapeutic communication skills should be used, and also active listening.||Acceptance is communicated, and the client is given the opportunity to discover his or her own solutions to problems.|
|Ensure privacy for meditating, praying, or doing rituals.||Allows the client to engage in spiritual activities in his or her own unique way without the Fear of being interrupted or being judged by others.|
Other possible nursing diagnosis:
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. (2022). 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
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