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Mental Health Nursing, Mental Health professionalism, nursing, education, ethics, caring, school, essay, document, assignment, health, general nursing, wellness, Mental disease, disease, social stereotypes, suicide, depression,
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DOMINICA STATE COLLEGE
Faculty of Health Sciences
ASSOCIATE OF SCIENCE GENERAL NURSING
MENTAL HEALTH NUR224
Sorrowing Old Man; Vincent Van GoghINDIVIDUAL ASSIGNMENT ON MAJOR DEPRESSIVE DISORDER
Presented to
MRS. BEVERLY H. FONTAINE
by
REBEKAH ROBERTS
10BROR00498
6. 7. 2012
1
CONTENTS
ACKNOWLEDGEMENTS 3
INTRODUCTION 4
SCENARIO 5
CASE STUDY 6
ETIOLOGICAL BASIS OF DISORDER 8
CONCEPT MAPPING
o SUBJECTIVE AND OBJECTIVE ASSESSMENT 10
o NURSING DIAGNOSES 11
o NURSING GOALS 12
o NURSING INTERVENTIONS 13
o NURSING OUTCOMES 14
OUTLINE OF POSSIBLE SOLUTIONS 15
CONCLUSION 17
REFERENCES 18
2
ACKNOWLEDGEMENTS
The student wishes to express sincere and heartfelt gratitude to the individuals whose
assistance has made the project a successful and worthwhile endeavour.
"Although the world is full of suffering, it is also full of overcoming it."
Helen Keller
3
INTRODUCTION
The nursing process, as with all aspects of nursing is integral to provision of care in
mental health nursing. This project serves to test the critical thinking and application
skills of the student. This project allows the opportunity for creative thinking, gaining
new knowledge and application of said knowledge to mental health nursing practice.
Major depressive disorder is defined in the DSM IV TR, as a mood disorder that
manifests in a change from the person's normal mood; social, occupational, educational
or other important functioning that is negatively impaired by the change in mood. This
disease is a serious illness that severely impacts one’s life as thoughts, behaviours and
activities of daily living are affected.
This disease is characterized by a combination of symptoms that interfere with a
person's ability to work, sleep, study, eat, and enjoy once-pleasurable activities. Major
depression is disabling and prevents a person from functioning normally. Some people
may experience only a single episode within their lifetime, but more often a person may
have multiple episodes.
This disease is important to study as a nurse as the prevalence is as high as 6.7
percent in American adults with 3o% of these being severe depression, (National
Institute of Mental Health, 2012). This large number shows how important it is that such
a disease be treated and intercepted as the damages to the individual and society could
be devastating if untreated as self and social destructive behavior can be pursued.
4
This project will seek to elaborate on aspects of the Nursing process to illuminate what
is to be done for a hypothetical patient suffering from this disease from diagnosis to
treatment.
SCENARIO
A. P. is a 29 year old woman who was admitted to the psychiatric unit with severe
weight loss, though she stated that she was not dieting and had thoughts of death. Her
friends had persuaded her to come as they had become worried about her daily
depressed mood, fatigue, loss of interest in normal and pleasurable activities and a
diminished ability to concentrate. She claimed that these feelings began two months
ago after the termination of a three year long relationship with her boyfriend. She also
stated that her father and maternal uncle had suffered with depression in the past.
5
CASE STUDY
A. P. is a 29 year old woman who was admitted to the psychiatric unit with severe
weight loss, though she stated that she was not dieting and had thoughts of death. Her
friends had persuaded her to come as they had become worried about her daily
depressed mood, fatigue, loss of interest in normal and pleasurable activities and
diminished ability to concentrate. She claimed that these feelings began two months
ago after the termination of a three year long relationship with her boyfriend. She also
stated that her father and maternal uncle had suffered with depression in the past. She
was given the medical diagnosis of unipolar depression.
According to DSM IV TR, this disorder manifests and is diagnosed if the individual
presents with at least five of these signs and symptoms; depressed mood, diminished
interest, significant weight loss, insomnia, hypersomnia, and fatigue, feelings of
worthlessness and thoughts of death, psychomotor agitation and decreased ability to
think or concentrate. These symptoms must present nearly every day and hypersomnia
can present instead of insomnia and excessive and inappropriate guilt can present with
feelings of worthlessness. The thoughts of death reoccur with suicidal ideation, it may
not involve planning out a suicidal attempt or attempting to commit suicide.
Any individual suffering with major depressive disorder like A. P, can be effectively
treated with a mix of medication therapy and psychotherapy. The nurse’s responsibility,
in A. P’s, case would be to firstly establish a therapeutic relationship with the client
based on mutual trust and respect which forms the basis for a successful treatment
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regime. The nurse would assist in recovery and illness management by facilitating
adherence to medication regime, open rapport and communication with patient,
relatives and other members of the health team to promote a team approach.
Psychotherapy is a beautiful method which produces great results and no physiological
side effects to the patient. Interpersonal and cognitive behavioural therapy would be
ideal in this case, to assist her to solve problems in relationships that may have caused
the problem and to understand and eventually eliminate negative and unrealistic
thoughts about herself that contributes to depression.
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ETIOLOGICAL BASIS OF DISORDER
Major depressive disorder or unipolar depression is a medical illness that causes a
persistent feeling of sadness and loss of interest, it can cause result in physical
symptoms that can persist for weeks or more and can increase in strength gradually.
These symptoms can interfere with daily functioning and cause distress for both the
person with the disorder and those who care about him or her.
According to DSM IV TR, major depressive disorder can stem from genetic, biological,
psychological and environmental factors. According to ADAM Medical Encyclopaedia,
(2012) many researchers believe major depression is caused by chemical changes in
the brain. This may be due to a problem with your genes, or triggered by certain
stressful events. More likely, it's a combination of both. Studies show that first degree
relatives of people with depression have a higher incidence of the illness. Situational
and environmental factors can exacerbate a depressive disorder in significant ways.
These factors can include lack of support system, stress, problems in relationships
illness in self or loved one, legal difficulties, financial struggles, and job problems.
According to the National Institute of Mental Health, 2012; longstanding theories about
depression suggest that important neurotransmitters are out of balance in depression,
but it has been difficult to prove this. Magnetic resonance imaging (MRI), have shown
that the brains of people who have depression look different than those of people
without depression. The parts of the brain involved in mood, thinking, sleep, appetite,
8
and behaviour appear different. But these images do not reveal why the depression has
occurred.
This causes manifests in A.P, who has an immediate family history of the disorder. A
break up of a serious relationship acted as a trigger along with her genetic factors and
brought about the major depressive episode.
9
CONCEPT MAPPING
SUBJECTIVE AND OBJECTIVE ASSESSMENT
10
SUBJECTIVE
ASSESSMENT
OBJECTIVE
ASSESSMENT
Family history and health
history
Psychological assessment,
patient’s thoughts on self
Information on Present
illness using COLDSPA
Interview with family
and friends
Laboratory tests to eliminate
other disorders
Rorshach, sentence
completion or other
psychological test for
diagnosis
Possible stressors in life
Drug/ alcohol and
medication use
Lifestyle factors; diet, exercise,
coping level
NURSING DIAGNOSES
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FIRST SECOND THIRD
Imbalanced nutrition:
less than body
requirements
Related to disinterest in
self care
As evidenced by
severe weight loss
Secondary to
unipolar
depression
Related to cognitive
impairment
Ineffective coping
As evidenced by
patient’s behaviour
Risk for violence, self
directed
As evidenced by
patient’s
verbalisation
Related to impaired
cognitive function
Secondary to depressed mood
NURSING GOALS
12
first diagn
osis
Client will gain 2 pounds per week for the next 3 weeks.Client will exhibit no signs or symptoms of malnutrition by time of discharge from treatment
second
diagnosis
that patient will exhibit postive mood displays 48 hours after commencement of treatment regime.that during hospitalization patient will identify coping strategies to manage illness.
third diagn
osis
that the patient will not harm herself during hospitalisation
NURSING INTERVENTIONS
13
Keep strict documentation of patient's intake, output, and calorie count.
encourage intake of regular healthy meals and foods high in fiber
Weigh patient daily.
encourage patient to engage in diversional therapy and instruct on coping mechanisms
therapeutic relationship will be utilized to carry out interpersonal psychotherapy with patient to focus on strengths and positive traits
increase and mobilize support systems by carrying out group therapy
medication will be administered to patient as prescribed
monitor client for risk of harming self and others and intervene as necessary
document, report and record patient's status regularly
14
NURSING OUTCOMES
15
patient has gained 2 pounds per week in the last threeweeks.Client exhibits no signs or symptoms of malnutrition by time of discharge from treatment
fi rs t d ia g n o s is
patient exhibits postive mood displays 48 hours after commencement of treatment regime.during hospitalization patient identifies coping strategies to manage illness.
s e c o n d d ia g n o s is
the patient has not harmed herself during hospitalisation
th ird d ia g n o s is
OUTLINE OF POSSIBLE SOLUTIONS
Medical and nursing management of a patient with major depressive disorder must
include both pharmacotherapy and psychotherapy.
According to Encarta Encyclopaedia, 2008; antidepressant medications appear to work
by altering the levels of serotonin, norepinephrine, and other neurotransmitters in the
brain and they generally take at least two to three weeks to become effective.
Monoamine oxidase inhibitors, selective serotonin reuptake inhibitors and tricyclics are
usually used in treatment plans.
Tricyclics, named for their three-ring chemical structure, include amitriptyline (Elavil),
imipramine (Tofanil) and desipramine (Norpramin). Side effects of tricyclics may include
drowsiness, dizziness upon standing, blurred vision, nausea, insomnia, constipation,
and dry mouth.
MAOI’S include isocarboxazid (Marplan), phenelzine (Nardil), and tranylcypromine
(Parnate) and include much the same side effects as tricyclics.
SSRI’S include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil). These
drugs generally produce fewer and milder side effects than do other types of
antidepressants, although SSRIs may cause anxiety, insomnia, drowsiness, headaches,
and sexual dysfunction.
As major depression is more severe than other types longer term psychotherapy is
necessary for treatment. The most effective are cognitive-behavioural therapy,
interpersonal therapy and psychodynamic therapy. Cognitive –behavioural therapy
assumes that depression stems from unhealthy, negative and irrational thoughts about
16
one’s self and future and thus seeks to improve one’s outlook of self by teaching
understanding and elimination of negative thoughts about self.
In Interpersonal therapy the therapist or counselor helps a person resolve problems in
their relationships with others that may have caused the depression. The subsequent
improvement in social relationships and support helps alleviate the depression.
Psychodynamic therapy views depression as the result of internal unconscious conflicts
and thus the therapist focuses on past experiences and the resolution of childhood
conflicts. Psychoanalysis is an example of this.
Electro Convulsive therapy, though not used in Dominica is used to treat severe
depression in persons not responding to pharmaceutical and psychological treatment.
17
CONCLUSION
Mood disorders especially major depressive disorder severely affects the lives of the
persons suffering from it as well as their loved ones. Treatment of this disease is
intensive and requires proper planning and participation of all members of the health
team. Completing this project has given me the information necessary to care for a
patient with such a disorder. This project has given me insight into mood disorders and
treatment modalities for such which will undoubtedly enhance my clinical and practical
experience and practice.
18
REFERNECES
All Psych Online. (2012). DSM IV TR; Unipolar Depression. (2011). Retrieved from
http://allpsych.com/disorders/mood/majordepression.html
Encarta Encyclopaedia. (2008). Depression (Psychology). Microsoft Corporation
(2008).
PubMed Health. (2012). ADAM Encyclopaedia, Depressive Disorder, 2012.
Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001941/
National Institute of Mental Health, (2012). Depression, 2012. Retrieved from
http://www.nimh.nih.gov/health/publications/depression/what-are-the-different-
forms-of-depression.shtml
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