Overview
This lecture covers nursing care plans for major depressive disorder (MDD), including assessment, nursing diagnoses, interventions, goals, patient education, and medication management.
Understanding Major Depression
- Major depression is a mood disorder marked by persistent low mood, anhedonia, and functional impairment.
- Diagnosis requires at least five DSM-5 symptoms, including depressed mood or anhedonia.
- Other depressive disorders include dysthymia, PMDD, and depressive disorder due to medical conditions.
- Prevalence is higher in women and increases with age and comorbid illness.
Key Nursing Care Plan Priorities
- Evaluate suicide risk and ensure safety.
- Monitor mood, behavior changes, and medication adherence.
- Facilitate psychotherapy and provide education on depression management.
Assessment and Diagnosis
- Assess for subjective (sadness, guilt, hopelessness) and objective (sleep/appetite changes, psychomotor changes) symptoms.
- Formulate individualized nursing diagnoses based on clinical judgment.
Nursing Goals
- Client will seek help and not harm self/others.
- Client identifies support systems and develops future-oriented plans.
- Improved self-care, social interaction, and compliance with therapy.
Core Nursing Interventions
- Promote safety through suicide risk assessment, safe environment, and crisis planning.
- Foster therapeutic relationships and social support.
- Encourage gradual re-engagement in self-care and daily activities.
- Refer to CBT, support groups, and spirituality as appropriate.
- Administer and monitor medications (SSRIs, SNRIs, TCAs, MAOIs, atypical antidepressants).
Promoting Health and Self-Esteem
- Offer emotional support, validate feelings, and reinforce strengths.
- Support reestablishment of routines, independence in self-care, and positive feedback.
- Teach cognitive and behavioral strategies to reframe negative thoughts.
Patient and Family Education
- Educate about depression symptoms, treatment options, medication adherence, and relapse prevention.
- Discuss ECT and diet precautions with MAOIs.
- Involve family in care planning and support.
Medication Management
- First-line medications are SSRIs; SNRIs, TCAs, MAOIs, and atypical antidepressants used as indicated.
- Monitor for side effects, especially with polypharmacy or in pediatric/elderly clients.
Key Terms & Definitions
- Anhedonia — loss of interest or pleasure in most activities.
- DSM-5 — Diagnostic and Statistical Manual of Mental Disorders, 5th edition.
- CBT (Cognitive Behavioral Therapy) — therapy targeting negative thoughts and behaviors.
- Self-care — activities performed to maintain health and well-being.
- SSRI — selective serotonin reuptake inhibitor, a class of antidepressants.
Action Items / Next Steps
- Review major depression symptoms and DSM-5 criteria.
- Practice constructing nursing diagnoses for depression cases.
- Read about antidepressant classes and associated nursing considerations.
- Familiarize with resources for patient/family education and support groups.