Postpartum Depression Nursing Diagnosis and Nursing Care Plan

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Postpartum Depression Nursing Care Plans Diagnosis and Interventions

Postpartum Depression NCLEX Review and Nursing Care Plans

The birth of a child can elicit a range of strong emotions, from joy and excitement of meeting the newborn, to dread and anxiety about taking care of the infant, especially for a new mother. It can also lead to something unexpected, such as negative emotions like sadness.

After childbirth, most new mothers have postpartum “baby blues,” which include mood changes, crying bouts, anxiety, and problems sleeping. The baby blues usually start two to three days after delivery and can linger for up to two weeks.

However, some new mothers suffer from postpartum depression, which is a more severe and long-lasting form of depression. After giving birth, an intense mood disorder known as postpartum psychosis may also occur.

Postpartum depression (PPD) is a sensation of melancholy that may start as early as within 3 months following childbirth and may last longer than a year after.

PPD interferes with the mother’s regular functions. It may be because of the hormonal changes such as the estrogen, progesterone, and gonadotropin-releasing hormone levels rise and fall that happens during pregnancy and after childbirth.

If a woman suffers from postpartum depression, getting help as soon as possible will help the patient manage the symptoms and promote bonding with the baby.

There are three terminologies that are used to characterize the mood shifts that pregnant women may experience after giving birth:

  • Baby blues. In the days following childbirth, up to 70% of women experience the “baby blues.” The woman may have abrupt mood fluctuations, such as feeling extremely pleased and then extremely depressed, may cry for no apparent cause, and experience feelings of impatience, irritability, restlessness, anxiety, loneliness, and sadness. The baby blues can persist anywhere from a few hours up to two weeks following delivery. The baby blues usually do not require medical attention.
  • Postpartum depression (PPD). It happens in days, weeks, or even months after a baby is born. PPD can strike anyone following the birth of a child, not just the first. The woman can experience sensations comparable to the baby blues, such as grief, despair, anxiety, and loneliness, but they are much stronger. PPD frequently prevents the woman from doing the things needed to do on a daily basis. Consultation with a health care practitioner, such as your OB/GYN or primary care doctor if the capacity to function is impaired. The doctor can assess depression symptoms and devise a treatment plan. If the patient does not receive treatment for PPD, the symptoms may worsen. While PPD is a serious illness, it is treatable with medication and treatment.
  • Postpartum psychosis. It is a potentially fatal mental disease that can strike new mothers. This illness can strike swiftly, usually within the first three months following delivery. Women can experience auditory hallucinations (hearing things that aren’t actually happening, such as a person talking) and delusions, losing touch with reality (strongly believing things that are clearly irrational). Visual hallucinations (seeing things that aren’t there) are less prevalent than auditory hallucinations. Insomnia (inability to sleep), agitation and anger, pacing, restlessness, and unusual feelings and actions are some of the other symptoms. Women with postpartum psychosis require immediate care and almost invariably require medication. Women are sometimes admitted to hospitals because of the danger of harming themselves or others.
  • Postpartum Obsessive-Compulsive Condition (OCD). An anxiety-related mood disorder affects about 3% to 5% of new mothers. Intrusive and persistent thoughts are common symptoms of postpartum OCD. The majority of these thoughts involve injuring or even murdering the baby. Because moms with postpartum OCD are aware of and appalled by these thoughts, they are rarely acted upon. Compulsive routines, such as cleaning and changing the infant repeatedly, are other behavioral markers of postpartum OCD. Postpartum OCD frequently stays undiagnosed and untreated because moms feel embarrassed and ashamed of their thoughts and behaviors.
  • Postpartum Post-Traumatic Stress Disorder (PTSD). A type of postpartum depression that is distinct. Over 9% of postpartum mothers are affected. Postpartum PTSD symptoms, like general PTSD, are triggered by an actual or perceived threat to the mother. This hazard or trauma usually occurs during or immediately after childbirth.

Signs and Symptoms of Postpartum Depression

The symptoms of postpartum depression normally appear within the first several weeks after delivery, although the signs of clinical depression may appear earlier in pregnancy or up to a year after childbirth. These may include:

  • persistent sadness
  • extreme mood swings
  • crying excessively
  • difficulty bonding with the baby
  • withdrawing from friends and relatives
  • loss of appetite or eating significantly more than usual
  • inability to sleep or excessive sleeping
  • overwhelming exhaustion or lack of energy
  • reduced interest and enjoyment in previously enjoyed activities
  • anger and irritation
  • fear of not being a good mother
  • hopelessness
  • feelings of inadequacy, shame, remorse, or worthlessness
  • ability to think clearly, concentrate, or make decisions has deteriorated.
  • restlessness
  • panic attacks and severe anxiety
  • suspicion of harming the baby
  • suicide or death thoughts

Causes of postpartum depression

Postpartum depression has no single cause, but physical and emotional factors may play a role such as,

  • Physical transformations. A substantial decline in hormones (estrogen and progesterone) in the body after childbirth may lead to postpartum depression. Other hormones generated by the thyroid gland may also decline dramatically, leaving anxiety and sadness.
  • Emotional problems. When sleep-deprived and overloaded, even simple issues can be difficult to handle. It might be difficult to care for a newborn. It may feel like there is a loss of control.

Risk Factors to Postpartum Depression

  • History of depression. If the woman was diagnosed with depression prior to the pregnancy, there is a probability that it will resurface after birth.
  • Low self-confidence. A woman with poor self-esteem may have insecurity when making decisions and may be reluctant to leave the baby alone.
  • Workplace and home stress. If the woman’s stress is not addressed, it will most likely lead to depression.
  • Lack of support system. Emotional support is crucial in a woman’s recovery from postpartum depression. The woman may sink deeper into depression when there’s no one to talk to or support her.

Diagnosis of Postpartum Depression

To distinguish between a short-term case of postpartum baby blues and a more serious type of depression, the doctor will usually consult with the patient about feelings, thoughts, and mental health. The patient must share the symptoms with the doctor so that an effective treatment plan will be developed. The doctor may do the following tests as part of the evaluation:

  • Assessment by questionnaire. Perform a depression screening, which may entail filling out a questionnaire.
  • Blood test. Blood testing is ordered to see if the signs and symptoms are being caused by an underactive thyroid.

Treatment for Postpartum Depression

  1. Management of “baby blues”. The baby blues normally dissipate within a few days to one to two weeks on their own. While waiting, the mother should do the following:
    • Get as much sleep as possible.
    • Accept the assistance of family and friends.
    • Make friends with other new mothers.
    • Avoid drinking and using recreational drugs, which can exacerbate mood fluctuations.
    • Get health counseling
  1. Psychotherapy. It may be beneficial to speak with a psychiatrist, psychologist, or another mental health expert about the anxiety. The patient can learn better ways to cope with emotions, solve problems, make realistic objectives, and respond to situations positively through therapy. Family or relationship counseling might also be beneficial.
  1. Antidepressants. An antidepressant may be prescribed by the healthcare provider. Any drugs taken while breastfeeding will pass via breast milk. Most antidepressants, on the other hand, can be taken during breastfeeding with little danger of negative effects for the infant. Consult with the healthcare provider to consider the dangers and advantages of various antidepressants.
  2. Management of postpartum psychosis. It necessitates rapid medical attention, which is generally in the hospital.To regulate the signs and symptoms, It may be advised to combine the medications, such as antipsychotics, mood stabilizers, and benzodiazepines.
  3. Electroconvulsive Therapy (ECT). If the postpartum depression is severe and there is trouble sleeping, ECT may be considered if the symptoms aren’t responding to medicine. ECT is a technique that involves passing tiny electrical currents through the brain to cause a short seizure. ECT appears to create changes in brain chemistry that can help with psychosis and depression symptoms, especially when other therapies have failed.

Prevention of Postpartum Depression

The pregnant mother will be monitored by the healthcare provider for signs and symptoms of depression while still pregnant. During and after the pregnancy, the healthcare provider may ask the patient to fill out a depression screening questionnaire. Mild depression can sometimes be treated with the help of support groups, counseling, or other therapies. Antidepressants may be prescribed for different conditions, including during pregnancy.

Here are some suggestions to help a patient cope with postpartum depression:

  • Find someone to talk to, whether it’s a therapist, a friend, a family member, or someone who will listen.
  • Join a new parent support group.
  • Make an effort to eat nutritious foods and schedule time for exercise.
  • Make rest a priority.
  • Spend time with friends or loved ones.
  • Make time for self and things usually enjoyed such as reading or other hobbies.
  • Get assistance with daily tasks or errands.

Postpartum Depression Nursing Diagnosis

Postpartum Depression Nursing Care Plan 1

Impaired Social Interaction

Nursing Diagnosis: Impaired Social Interaction related to altered thought process, lack of motivation and energy, lack of support from family members, fear, and feeling of worthlessness secondary to postpartum depression, as evidenced by dysfunctional interactions with the newborn, family and friends, a shift in communication style, withdrawal from other people and frequent expression of sadness and loneliness.

Desired Outcomes:

  • The patient will be able to recognize the emotions that lead to poor social interactions.
  • Family, friends , or peers will be able to initiate an interaction with the patient.
  • The patient will take part in certain social events in the community such as leisure activities and church activities
  • The patient will be able to complete at least one activity by the end of the day.
  • The patient will be able to identify alternative methods when the patient feels the desire to withdraw from other people.
Nursing Interventions for Postpartum DepressionRationale
Provide tasks to the patient that demand little concentration at first including drawing or playing simple board games.Depressed people have trouble concentrating and remembering things. Activities with no “right or wrong” or “winner or loser” reduce the chances of the patient putting self-down.
Encourage the patient to engage in gross motor activities that need minimal concentration such as walking.These activities will help to relieve tension and may even improve mood.  
Involve the patient in one-on-one activities when they are the most depressed.This increases the likelihood of interactions while lowering anxiety levels.
Involve the patient in group activities including group discussions, art therapy or dance therapy.Isolation is reduced through socialization. Genuine concern for others can boost one’s self-esteem.
Help the patient to eventually, maximize the networking opportunities to first one other, then two others, and so on.Contact with others helps the patient to forget about self.  
Refer the patient and the family to local self-help organizations.  People sharing their stories can provide significant support and insight to the patient and family.
Assess the patient’s family patterns and social interactions.      Within the context of the family, the patient learns social interaction behaviors. As a result, whenever the nurse notices ineffective social patterns, the nurse can implement change interventions.
Encourage the patient to share feelings and thoughts about her problems.  The nurse can then identify and clarify the various causes of difficulty in social interaction. For example, feelings of being unloved or unlovable, as well as sexual insecurity.
Empower the patient’s coping mechanisms and boost the patient’s self-esteem.  A caregiver can aid the patient in the development of coping skills. Encourage the patient to perform ADLs independently as one strategy to instill coping mechanisms. The feeling of independence decreases as the patient gains the capacity to execute most of these activities without assistance. Another proven technique to boost the patient’s self-esteem and inspiration is to focus on the patient’s strengths and praise them for the tasks they have achieved.

Postpartum Depression Nursing Care Plan 2

Deficient Knowledge

Nursing Diagnosis: Deficient Knowledge related to unawareness of the causes, symptoms, and treatment options for the illness secondary to postpartum depression, as evidenced by expressions of inaccurate information on how to be a mother, difficulty in following instructions, display of inappropriate behaviors while taking care of the baby.

Desired Outcomes: 

  • The patient and significant other will be able to express understanding about the possible causes of depression, can give three-four of the signs and symptoms of depression, and understand the correct use of medications, purpose psychotherapy, and electroconvulsive therapy as treatment if needed.
  • The patient will be able to take care of the newborn with minimal help from significant others.
Nursing Interventions for Postpartum DepressionRationale
Assess the patient’s current knowledge on taking care of the newborn.    A baseline of the patient’s knowledge is a great technique to build a teaching plan that is not overwhelming to the patient. This allows the nurse to quickly identify which topics should be addressed first.
Examine the patient’s willingness to learn new knowledge regarding new tasks as a mother.  The ability to absorb and digest information is impacted by sudden changes in a person’s health and hospitalization. In the teaching process, it is critical to consider timing and adjust to the patient’s situation and perception.
Assess the patient and significant other’s understanding of depression and its causes.    Depression is a mood condition brought on by a combination of recurrent stressful experiences, heredity, and brain chemical imbalances.
Explain the major symptoms of depression to the patient and significant others.  Consistent sadness, loss of interest in normal activities, decreased energy, feelings of guilt, hopelessness or worthlessness, sleep disturbances, changes in appetite, trouble thinking or making decisions, and frequent thoughts of death or suicide attempts are typical symptoms of a major depressive episode that needs to be addressed.
Adapt the pace and teaching methods to the learning style of the patient.        If the patient does not respond well to the education plan or teaching methods, it should be adjusted and tailored. When knowledge is presented in the patient’s preferred learning style, it will be easier for the patient to retain information. The patient will be better able to process knowledge and remain motivated.
Provide encouragement and praise to the patient during learning sessions.While the patient is performing the skills during the teaching sessions, it is important to provide positive feedback. Feedback that is consistent and encouraging keeps patients motivated and shows them that they are progressing.
Advice the patient to talk to people with similar experiences, most importantly to a mother who has experience in taking care of a newborn.A sense of community provides the patient` a degree of optimism in that they are not alone in dealing with the new responsibility, a mother can encourage the patient and teach strategies on how to properly perform daily activities with the newborn.

Postpartum Depression Nursing Care Plan 3

Chronic Low Self-esteem

Nursing Diagnosis: Chronic Low Self-esteem related to neurophysiological imbalances, feelings of shame due to repeated failure, and impaired self-encouragement secondary to postpartum depression, as evidenced by an inability to accept own achievement, feeling of negativity when taking care of the newborn, role rejection and expression of worthlessness as a mother.

Desired Outcomes:

  • Patient will be able to express belief in self and the role as a mother.
  • The patient will be able to demonstrate the ability to take care of and enjoy being with the newborn.
  • Patient will be able to identify one or two strengths by the end of the day.
  • Patient will verbalize decreased feelings of guilt, shame , and self-hate.
Nursing Interventions for Postpartum DepressionRationale
Determine the patient’s level of self-esteem and knowledge about being a new mother.Withdrawal from social contacts, feelings of inadequacy, neglect of personal hygiene and dress, and rejection of one’s own self or the newborn are all signs of a negative thought pattern.
Allow the patient to take care of self first.Taking care of one’s appearance is the first step toward developing a healthy self-image.
Provide favorable feedback to the patient after completing an assigned task.Building self-esteem relies heavily on positive reinforcement.
Allow the patient to participate in easy recreational activities before progressing to more difficult activities in a group setting.When a patient first begins to participate in a group environment, the patient may feel overwhelmed.  
Teach visualization techniques to help the patient place negative self-images and thoughts with more positive ones.Helping 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 or mothers have had similar experiences or sentiments.To reduce feelings of loneliness by creating an environment that encourages positive feedback and a more accurate assessment of oneself.
Assess the patient’s demand for assertiveness training techniques in order to achieve goals and desires in life. 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.  

Postpartum Depression Nursing Care Plan 4

Hopelessness

Nursing Diagnosis: Hopelessness related to a stressful environment, lack of support, and deficient knowledge secondary to postpartum disorder, as evidenced by impaired decision making, loss of life interest , and negative ruminations.

Desired Outcomes:

  • The patient will be able to express feelings and accept life occurrences that are beyond control.
  • The patient will use independent problem-solving skills to regain control of her life and new role as a mother.
Nursing Interventions for Postpartum DepressionRationale
Assess the patient’s signs of hopelessness and the possible reason for it.This helps to concentrate attention on specific parts of individual needs. Social disengagement, decreased physical activity, and patient statements expressing despair and pessimism are examples of these indicators.
Examine the patient’s negative behaviors such as withdrawal, avoidance, and substance addiction as ways to cope with feelings.The patient may have attempted to cope with hopelessness by engaging in hazardous and inefficient habits. It is possible to change these habits by acknowledging them.
Allow the patient to share her thoughts and feelings about the role as a mother.Patients can begin to take control of their lives by acknowledging the sentiments that underpin and drive their behaviors.
Give the patient hope by making realistic comments about the strengths and resources.Patients may feel hopeless, but hearing encouraging feedback from others can help.
Assist the patient in determining which aspects of life are within control.  Problem solving may be hampered by an individual’s emotional condition. Support may be required to identify areas under self-control and to be confident in control alternatives.
Allow the patient to take on more self-care and newborn care responsibilities, such as setting realistic objectives, planning activities, and making independent decisions.Assisting patients in setting realistic goals promotes feelings of control and happiness when goals are met, reducing feelings of hopelessness.

Postpartum Depression Nursing Care Plan 5

Grieving

Nursing Diagnosis: Grieving related to perceived loss secondary to postpartum depression, as evidenced by changes in activity level, emotional distress, and detachment from the newborn.

Desired Outcomes:

  • The patient will be able to engage in self-care and newborn care tasks at her own pace.
  • The patient will show improvement in dealing with the stages of grieving.
  • The patient will express a sense of improvement toward the resolution of hope and grief.
Nursing Interventions for Postpartum DepressionRationale
Discuss the patient’s perspective of loss and determine if there are any losses that have occurred in the past.        The significance of a loss is often overlooked by people. The patient may refuse to admit or discuss the suffering, and everything appears to be well. Physical and psychic energies usually lead to denial. When patients are depressed, they are most frequently physically and emotionally exhausted.
Examine the patient’s religious and cultural views in light of how to deal with earlier losses.Religious beliefs and cultural customs have an impact on how people express and accept grief.
Discuss and educate the patient about the stages of grief and how to accept the reality of feelings like guilt, rage, and powerlessness.This allows the patient to acknowledge natural sensations while also removing some of the guilt associated with them.  
Assist the patient in identifying the problem, recognizing the need for a different approach, and thoroughly describing all aspects of the situation.Pregnant patients may require clarity about the situation before they can acknowledge the change in their lives following childbirth..    
Provide the patient with alternative strategies for identifying and dealing with underlying sentiments of anger, hurt, and rejection.This llows the patient to consider more options for dealing with grief.  

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

Nursing Stat Facts
Nursing Stat Facts

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. (2020). 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, 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 intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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