Major Depressive Disorder

Description
  • A mood disorder may include symptoms of depressed mood, feelings or hopelessness and helplessness, decreased interest in usual activities, disinterest in relationship with others or cycles of depression and mania.
  • Depression is often concurrent with other psychiatric diagnoses. Almost have of clients with major depressive disorders have histories of non-mood psychiatric disorders.
  • A high incidence exists for persons with chronic illness or prolonges hospitalization or institutional care.
Risk Factors
  1. Biological factors – brainchemicals
  2. Family genetics – parent with depression, child 10-13% risk of depression.
  3. Gender – higher rate for women
  4. Age – often less than 40 when begins
  5. Marital status – more frequently single, widowed
  6. Season of year – Seasonal Affective Disorder (SAD) occurs when client experiences recurrent depression that occurs annually at the same time.
  7. Psychological influences – low self-esteem, unresolved grief.
  8. Environmental factors – lack of social support, stressful life events.
  9. Medical co-morbidity – clients with chronic or terminal illness, postpartum, and current substance abuse are especially prone to becoming depresses.
Signs and Symptoms
  1. Sexual disinterest
  2. Suicidal and homicidal ideations
  3. Decrease in personal hygiene
  4. Tearfulness, crying, and melancholy
  5. Altered thought process; difficulty concentrating, self-destructive behavior.
  6. Loss of energy or restlessness
  7. Anhedonia or loss of pleasure
  8. Gain or loss of weight
  9. Anger, self-directed
  10. Psychomotor retardation or agitation
  11. Insomnia or hypersomnia
  12. Feelings of hopelessness, worthlessness, and helplessness.
Nursing Diagnoses
  • Risk for violence, self-directed or directed at others
  • Impaired verbal communication
  • Decisional conflict
  • Altered role performance
  • Hopelessness
  • Deficit in diversional activity
  • Fatigue
  • Sel-care deficit
  • Altered thought processes
  • Self-esteem
  • Anxiety
Therapeutic Nursing Management
  1. Safe environment
  2. Psychological treatment
    • Individual psychotherapy – long –term therapeutic approach or short term solution-oriented, may focus on in-depth exploration, specific stress situations, or problem solving.
    • Behavioral therapy – modifying behavior to assist in reducing depressive symptoms and increasing coping skills.
    • Behavioral contacts – focus on specific client problems and need to help the client resolve them.
  3. Social treatment
    • Milieu therapy – incorporates day to day living experiences in a therapeutic environment to expect changes in perception and behavior.
    • Family therapy – aimed at assisting the family cope with the client’s illness and supporting the client in therapeutic ways.
    • Group therapy – focuses on assisting clients with interpersonal communication, coping, and problem-solving skills.
  4. Psychopharmacologic and Somatic treatments
    • Administer antidepressant medications
    • Continued assessment by monitoring client’s mental health status is critical, particularly interms of agitation and suicidal ideation.
    • Electroconvulsive therapy
Nursing Interventions
  1. Priority for care is always the client’s safety.
  2. Use of behavioral contacts. Use this technique to meet outcomes relating to “no self-harm” or no suicidal ideation or plan.
  3. Assess regularly for suicidal ideation or plan.
  4. Observe client for distorted, negative thinking.
  5. Assist client to learn and use problem solving and stress management skills.
  6. Avoid doing too much for the client, as this will only increase client’s dependence and decrease self-esteem.
  7. The nurse’s role in the physical care of the client experiencing major depressive disorder is to provide assessment and interventions related to appropriate nutrition, fluids, sleep, exercise, and hygieme, and to provide health education.
  8. Explore meaningful losses in the client’s life.
  9. Help the client and family to identify the internal and external indicators of major depressive disorder.

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