Major Depressive Disorder

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Major Depressive Disorder

• Sadness
• Guilt
• Low Self-Esteem

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Symtoms

• Loss of interest or pleasure in almost all
  activities for at least 2 weeks in addition to at
  least four other depressive symptoms. These
  include
• Include appetite
• Weight or sleep changes
• A decrease in energy or activity
• Feeling of guilt or worthlessness
• Decreased concentration
• Suicidal thoughts or activities

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diagnosed

• When one or more of these episodes occures
  without a history of manic(or hypomanic)episodes.
• When these is a history of manic episodes,the
  diagnosis is bipolar disorder
• Durationvery widely
• Described as mild,moderate and severe(severe
  without psychotic features,or severe with
  psychotic features)

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Etiology

• in people with chronic or severe illnesses
• Neurochemical
• Hormonal
• Biological features
• As well as psychodynamic,cognitive and
  socail/behavioral influences

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Epidemiology

• 2-3 in men
• 5-9 in women
• Frequently occurs in clients-
• Client during withdrawal from alcohol or other
  substances
• Anorexia nervosa
• Phobias
• Schizophrenia
• A history of abuse
• Post traumatic behavior
• Poor social support

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General Interaction

• Knowledgeable about medication actions
• Timing of effectiveness
• Side effects
• Teaching the client and family
• Maintaining the client safety
• Decreasing psychotic symptoms
• Assisting the client in meeting physiologic need
  and hygine
• Promoting self-esteem
• Expression of feelings
• Socialization and leisure skills and identifying
  sources of support

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Nursing Diagnosis

• Ineffective coping
• Impaired social interaction
• Bathing/hygine self-care deficit
• Dressing/gooming self-care deficit
• Feeling self-care deficit
• Toileting self-care deficit
• Chronic low self-esteem

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Nursing Diagnosis

• Social isolation
• Disturbed thought process
• Risk for other-directed violence
• Risk for suicide
• Dysfunctional grieving
• Disturbed sleep pattern
• Hopelessness

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Ineffective Coping

• Assessment
• Suicide ideas or behavior
• Slow mental process
• Disordered thoughts
• Feeling of despair,hoplessness,and wortlessness
• Guity
• Anhedonia(in ability to experience pleasure)
• Disorientation
• Generalized restlessness or agitation

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Ineffective Coping

• Sleep disturbancesearlyawakening,
• insomnia,or exessive sleep
• Anger or hostility(may not be overt)
• Rumination
• Delusions,hallucinations or other psychotic
  symtoms
• Diminished interest in sexual activity
• Fear of intensity of feelings
• anxiety

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Expected Outcomes

• Immediate the client will
• Be free from self-inflicted harm
• Engage in reality-based interactions
• Be oriented to person,place,and time
• Express anger or hostility out wardly in safe
  maner

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Expected Outcomes

• Stabilization the client will
• Express feeling directly with congraent verbal
  and nonverbal messages
• Be free from psychotic symptoms
• Demonstrate functional level of psychomotor
  activity

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Expected Outcomes

• Community the client will
• Demonstrate compliance with and knowledge of
  medications,if any
• Demonstrate an increased ability to cope with
  anxiety,stress or frustration
• Verbalize or demonstrate acceptance of loss or
  change,if any
• Identity a support system in the community

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Implementation

• Provide a safe environment for the client
• Continually the clients potential for suicide
• Observe the client closely,after antidepressant
  medication begins to raise the client mood
• Re orient the client to person,place and time
• Spend time with the client
• Attenttion to the client

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Implementation

• Assign the same staff members to work with client
  whenever possible
• Use a moderate,level tone to voice,avoid being
  overly cheerful
• Use silence and active listendning(you are
  concerned a worthwhile person)
• At first,use simple,direct sentences
• Avoid asking the client many questions,especially
  questions that require only brief answers

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Implementation

• Be comfortable stitting with the client in
  silence
• Allow(and encourage)the client to cry
• Do not cut off interactions with cheerful remarks
  platitudes(no one really want to die,youll
  feel better soon)
• Encourage the client to ventilate feelings in
  whatever way is comfortable( let the client know
  you will listen and accept what is being
  expressed)

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Implementation

• Interact with the client on topics with which he
  or she is comfortable.do not probe for
  information
• Counseling the client about the problem solving
  process
• Provide positive feedback at each step of the
  process

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Suicidal behavior

• Depressed clients many certainly be suicidal,but
  many suicidal client are not depressed
• The risk of suicide is increased when

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The risk of suicide is increased when

• A plan is formulated
• The client has ability to carry out the plan
• Family history of suicide
• Become more painful,more violence,or lethal
• White,male,adolesent,or older than 55 years
• Divorced,widowed,separated,or living without
  family
• Terminally ill,addicted,or psychotic
• An early stage of treatment with antidepressant
  medications
• The client mood and activity level suddenly
  changes

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Etiology

• Suicide may be from the client
• anger
• psychological state or life situation
• Asking for help
• Seeking attention or attempting to manipulate
  someone with suicidal behavior

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Epimiology

• 15-24 years in USA
• Men more often than woman
• Over 65 years
• Client with depression,bipolar,schizophrenia,and
  substance abuse
• Close Obsevation of the Client
• To protect a client from suicidal attempts will
  very with each clients need

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Nursing Diagnoses

• Risk for Suicide
• Ineffective Coping
• Chronic Low Self-esteem
• Hopelessness
• Powerlessness
• Impaired Social Interaction

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Risk for SuicideExpected Outcomes
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Risk for SuicideExpected Outcomes

• Immediate the client will
• Not harm himself or other
• Identify alternative ways of dealing with stress
  and emotional problems

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Risk for SuicideExpected Outcomes

• Stabilization the client will
• Not harm himself or herself or others
• Demonstrate use of alternative ways of dealing
  with stress and emotional problems
• Verbalize knowledge of self-destructive behavior,
  other psychriatric problems,and safe use of
  medication,if

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Risk for SuicideExpected Outcomes

• Community the client will
• Develop a plan of community support to use if
  crisis situations arise in the future

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Nursing Interventions

• 1.Determine the appropriate level of suicide
  precautions
• Special attention/one to one supervision OF THE
  CLIENT AT ALL THE TIMES,but the client may attend
  activities off the unit.
• 2.assess/evaluate the level of suicide
  precautions at least daily.
• 3.Ask how detailed and feasible the plan FOR
  SUICIDE is.
• 4.KNOW THE WHEREABOUT s the client at all times.
• 5.Be especially alert to sharp objects/other
  dangerous/explain.
• 6.Make sure that the client cannot open windows.
• 7.Physical safety of the client is a priority.

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Nursing Interventions

• 8.Stay with the client whenbathing,sharving,and
  cutting nails.
• 9.Observe,record,and report any changes in the
  clients mood.
• 10.Be aware of the relationships/willing/life
  sitiation/worthwhile human.
• 11.Do not joke about deathevery body really
  want to live
• 12.Do not make moral judgment about suicide or
  reinfoce the clients feelling of guit or sin.
• 13.Interact/Activities/You will retern at a
  specific time.
• 14.Encourage and support the clients expression
  of anger.

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Bipolar DisorderManic Episode

• abnormally and persistently elevated,expansive,or
  irritable mood
• Clients who exhibit manic behavior may
• Be agitated
• Have no regard for eating,drinking,hygine,grooming
  ,,or sleeping
• Have extremely poor judgment
• Exhibit seductive or aggressive behavior
• Have psychotic symptoms such as hallucinations or
  delusion
• Be at in creased risk for injury

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Bipolar DisorderManic Episode

• Nursing Diagnoses
• Risk for Other-Directed violence
• Defensive coping
• Disturbed Thought Process
• Bathing/Hygine Self-Care Deficit
• Dressing/grooming Self-Care Deficit
• Feeding Self-Care Deficit
• Toileting Self-Care Deficit

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Bipolar DisorderManic Episode

• Nursing diagnoses
• Deficient Knowledge
• Risk for injury
• Disturbed Sensory Perception
• Chronic Low self-Esteem
• Ineffective therapeutic Regimen Management
• Impaired Social Interaction
• Imbalanced Nutrition
• Disturbed Sleep Pattern

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Bipolar DisorderManic Episode

• Nursing DiagnosesRisk for Other Directed
  Violence
• Risk factor
• Restlessness
• Hyperactivity
• Agitation
• Hostile Behavior
• Threatened or actual aggression toward self or
  others
• Low self-esteem

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Thank you