Major Depression and Nursing Management

Major Depression and Nursing Management
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Introduction -

Depression is the common psychiatric disorder among the teenagers, adults and old age people. In this disorder patients feel sadness, fear, rejection, hopeless, lack of interest and try be isolate from the social community. Depressed patients need an immediate appointment with doctor or mental health professional.

What is depression?

Depression is a mood disorder which is characterized by sadness, hopelessness, lack of interest, fear, social isolation, feelings of guilty, lack of concentration and disturbed sleep.

Incidence -

Major depression disorder is more common among the age group 40-60 years.
Based on gender, this disorder is more prevalent among the females comparing to the males.

Causes -

There are several factors which are linked to depression. Some common causes are genetic factors, psychological factors, biological factors, pharmacological factors.

   • Genetic factors - You are at higher risk if your family member or blood relation has any history of depression or mood disorders. It can pass through genetically and more common for the people who has a family history of depression.

   • Psychological factors - Some events and psychological conditions cause depression, such as fear, stressful situations, failure in life, negligence from people.

   • Biological factors - Biological defects and abnormality can also cause depression. It includes abnormalities in basal ganglia, prefrontal cortex, cortisol levels, neuroendocrine and serotonin.

   • Pharmacological factors - Some prescribed drugs of psychiatric problems and other disorders can cause depression. Such as steriods, antiparkinsonian drug, antihypertensive drug etc.

   • Other factors - Hypothyroidism, Cushing's syndrome, decreased level of dopamine.

Pathophysiology -

( Based on Dopamine Hypothesis )

Due to any factor, neural circuits get constricted in CNS
Decreased dopamine production
Less dopamine in CNS

NOTE - Decreased level of Dopamine, Serotonin, Noradrenaline cause depression.

Clinical Manifestations -

The symptoms of major depressive disorder may vary in men, women and children.

1. Major depression symptoms in men -

   • Emotional - Feelings of hopelessness, helpless, sadness, loneliness.
   • Mood - Aggressiveness, anxious, irritability, fear, lack of interest.
   • Behaviour - Tiredness, thought of suicide, thought of decreased self worth, loss of pleasure in activities, doing high risk activities, excess alcohol consumption and drug abuse.
   • Cognitive function - lack of concentration, delay response, Decrease thinking capacity.
   • Sleeping patterns - Insomnia, excessive sleeping, alteration in sleeping time, sleeplessness in night.
   • Sexual interest - Lack of sexual interest, decreased sexual activities.
   • Physical function - Headache, tiredness, digestive problems, Alteration in nervous system.

2. Major depression symptoms in women -

   • Emotional - Hopeless, sadness, anxious, fear, loneliness, crying.
   • Mood - Irritability.
   • Behaviour - Social isolation, thoughts of suicide, lack of interest in working.
   • Cognitive function - Decreased thinking capacity, decreased conversation.
   • Sleeping patterns - sleeplessness throughout the night, waking too early, Sleeping for longer periods.
   • Sexual interest - Lack of sexual interest.
   • Physical function - Loss of appetite, headache, cramps, weight gain or loss, decreased energy, fatigue.

3. Major depression symptoms in children -

   • Emotional - Thoughts of failure, crying, sadness, loneliness.
   • Mood - Anger, irritability, fear.
   • Behaviour - Try to isolate from friends and siblings, Lack of interest for playing and activities, thoughts of self worthlessness, thoughts of suicide.
   • Cognitive function - Poor concentration, fearful and anxious speech.
   • Sleeping patterns - Short duration sleeping time, crying after or during sleeping, Insomnia or sleeping too much.
   • Physical function - Lack of activities, weight gain or loss, lack of appetite, digestive problems.

Assessment and diagnostic evaluation -

   • Beck Depression Inventory (BDI) - It is used to determine the duration, progression and severity of the depression.

   • Toxicology screening - If the depression is related to the drugs' side-effect, it is used to confirm that.

Medical management -

Various types of effective treatments are available for the major depression disorder. If a patient diagnose with major depression disorder, he/she should go for treatment as soon as possible.

   • Psychotherapy - Major depression disorder can be treated with psychotherapy. It has lot of therapeutic treatments such as problem solving therapy, self control therapy, cognitive therapy, behavioural therapy, interpersonal psychotherapy.

   • Electroconvulsive therapy (ECT) - It is most effective method for the major depression disorder. In this process an electrical current passes to the brain.

Pharmacological management -

   • Client should use antidepressant drugs which must be prescribed by a physician.
   • The client should the drug according to the physician drug combination and timing.
   • If the patient is too much of depressed, don't allow him to take medications by himself.

Nursing Management 

Nursing assessment -

   • Subjective data - Assess the client carefully during the history collection such as verbalization, coping skills, sleeping patterns, physical activity, drugs abuse, emotional tensions, diet pattern.

   • Objective data - The nurse should follow and record the client behaviour carefully such as lack of goal, problem management capabilities, social interaction, self worthlessness, self harmful behaviour, smoking, drug abuse.

Nursing diagnosis -

1. High risk of self directed violence related to depressed mood, feelings of worthlessness and anger directed  inward on self.

Objective - Patient will not harm self.

   • Create safe environment for the severe depressed patients. Remove all the potentially harmful objects from the patient. Supervise closely during the meals and medication administration.
   • Do not allow the patient to put the blot on his side of the door of bathroom or toilet.
   • Encourage the patient to the express his feelings including anger.

2. Dysfunctional grieving process related to perceived to real loss as evidenced by denial of loss, inability to perform daily activities.

Objective - Patient will be able to perform normal behaviour and communicate associated with grieving.

Intervention -
   • Assess the stage of fixation in grief process.
   • Spend time with the patient and accept him, show empathy, communicate in a positive way and give care.
   • Allow the patient to take decision regarding own care.
   • Provide simple activities which can be performed easily.

3. Altered communication process related to depressive cognitions as evidenced by being unable to communicate with others and expression of fear of failure.

Objective - Patient will communicate with staff and other patients.

Intervention -
   • Observe the patient's non-verbal communication very carefully. Sometimes patient may express that he is happy but his activities, facial expression and speech can determine the actual situation.
   • Ask the questions in such a way so that patient will have to answer in more than one words.
   • Maintain silence and don't express anxiety or discomfort to the patient.