Pathophysiology
Depression is classified as an affective or mood disorder on the basis of characteristic disorganized emotions. It results
from decreased activity by the excitatory neurotransmitters, norepinephrine and serotonin, in the brain. The exact
mechanism has not yet been established.
(Gould, 2006, p. 589)
Clinical Manifestations
Major depression is indicated by a prolonged period, which lasts more than 2 months, of profound sadness
marked by hopelessness and an inability to find pleasure in any activity.
Feelings of despair and hopelessness
Feelings of irritability and agitation
Detachment from life and the people around you
Always feeling tired or having no energy
Crying for no apparent reason
Loss of libido
Not being able to concentrate or make decisions
Thoughts of suicide
A loss of appetite
A change in sleep patterns (insomnia, or excessive sleep)
Headaches or stomach upsets that occur frequently.
(Gould, 2006, p. 589)
(Health Canada, 2009)
Risk Factors
Many factors contribute to the development of major depression. An individual may be genetically predisposed to
depression, and his or her risk can be increased by several external factors. They include:
The death or illness of a spouse, friend or family member
Difficulties at work or with a personal relationship
Low self-esteem
Financial difficulties
Addictions
(Health Canada, 2009)
DSM IV – TR Criteria for Depression
In order to be diagnosed with depression a patient must have 5 or more of the following symptoms for 2 consecutive
weeks.
These symptoms are a change from the patients normal functioning and tend to throw off the patients daily routine,
home and work life. The depression is not specifically caused by medication side effects, recreational drug use, and
alcohol use. Also it is not a normal reaction to the death of a family member, friend or loved one.
In order to be diagnosed with depression a patient must have 5 or more of the following symptoms for 2 consecutive
weeks. The symptoms are as follows:
Depressed mood
Loss of interest and pleasure in activities
Changes in weight (loss or gain)
Sleep disturbances
Agitation or retardation in motor activity
Fatigue and loss of energy
Feelings of worthlessness or guilt
Trouble with thinking and concentration
Repeated thoughts of death
(All about depression, 2010)
Medication Indications Adverse Effects Nursing Interventions
Tranylcypromine Used in the treatment of Anxiety, irritability, anorexia, Limit amount of drug available to
10 mg B.I.D. depression. insomnia, tachycardia, hypertension suicidal patient.
Antidepressant or hypotension, increased Monitor BP carefully.
perspiration, muscle tremors, sexual Taper dosage gradually after
dysfunction. long-term therapy.
Clonazepam Used in the treatment of Bradycardia, tachycardia, CV Monitor addiction-prone patients
0.5 mg B.I.D. panic disorder. collapse, hypotension and carefully.
Antieleptic, hypertension, palpitations, edema, Monitor liver function & blood
Benzodiazepine visual & auditory disturbances, counts periodically in pts in long –
diplopia, anorexia, elevations of term therapy.
blood enzymes, dizziness, Taper dosage gradually after
depression, diaphoresis, muscular long-term therapy.
disturbances, drug dependence with Have pt. avoid alcohol, sleep-
withdrawal. inducing, or over-the-counter drugs.
(Karch, 2010)
Diagnostic Test Purposes Normal Levels Nursing Responsibilities
CBC Test: Used To identify people who may RBC’s: M=4.5-5.3 Post Care:
to evaluate the have an infection. F=4.1-5.1 Apply pressure to the bleeding
composition and To diagnose anemia. WBC’s: 4.5-11 site until the bleeding stops.
concentration of To identify acute and chronic Hmg: M=138-180 If the patient feels dizzy or faint
the cellular illness, bleeding tendencies, and F=120-160 after the blood has been drawn have
components of WBC disorders. Htc: M=0.37-0.49 them rest
blood. To monitor treatment for F=0.36-0.46 (Advameg, Inc., 2010)
anemia and other blood diseases.
ECG Test: A To determine baseline cardiac Regular sinus rhythm, Preparation:
graphic function. all important intervals Provide privacy.
representation of To help evaluate response to within normal ranges. Test Expose only the patient’s chest
the heart’s cardiac medication. is specifically looking for and arms.
electrical To help monitor recovery after abnormal results. Place patient in supine position.
activities, or an MI, or when a patient Instruct the pt to lie still without
conduction system. experiences chest discomfort. talking & to not cross legs.
To measure the size and Post Care:
position of the heart chambers. Disconnect leads and wipe off
paste from pt’s chest.
Document data about procedure.
(Perry, & Potter, 2010)
Thyroid Level To diagnose/screen adults for TSH: 0.4 - 4.0 mIU/L. Preparation:
Test (TSH): thyroid disorders. Ask the patient if they have had
Measures the To monitor thyroid replacement any radioactive materials or had X-
amount of thyroid therapy in people with rays that used iodine dye within the
stimulating hypothyroidism. last 4-6 weeks (this may taint the
hormone (TSH) in To monitor gland function in test results).
your blood. people with hyperthyroidism. Post Care:
To help evaluate the function of Apply pressure to the bleeding
the pituitary gland. site until bleeding stops.
(A.D.A.M. Inc., 2010)
Individual Therapy
Individual therapy involves a series of counseling sessions, which may be short- or long-term. After working with the
patient to establish appropriate goals, the therapist mediates the patient's disturbed behaviour patterns to promote
personality growth and development.
Group Therapy
Guided by a psychotherapist, a group of people (ideally four to ten) experiencing similar emotional problems meets to
discuss their concerns. The duration of group therapy may vary from a few weeks for acute conditions requiring
hospitalization to several years for chronic conditions.
(Psychiatric nursing made, 2004)
Electroconvulsive Therapy
Electrical current is applied to the patient's brain through electrodes. Electrodes can be placed one of three ways:
Bilateral (Either side of head), Unilateral (One side of head) or Bifrontal (Frontal area of head). Bilateral is most
common and most effective. Patient is administered anesthetic and is not awake for the procedure. The patient also
receives a muscle relaxant to prevent injury during the seizure.
(Videbeck, 2008)
Nursing Process for dealing with the patient with a risk for suicide
Ask the patient if they have any thoughts of self harm. Assess for a plan, and create a contract with the patient
Develop a positive therapeutic relationship with the client. Avoid repeated discussion of the patient's suicide
history and orient the discussion to the present and future.
Observe, record, and report any changes in mood or behaviour that may signify increasing suicide risk.
Frequently check on patient's (Q15) and document the results of the regular surveillance checks.
Ensure that the patient has taken their medications as ordered.
Involve the patient in treatment planning and self-care management of psychiatric disorders.
Teach the patient effective coping strategies, and cognitive behavioural activities.
Nursing process for dealing with the patient with ADL self-care deficits
Assess the patient's ability to dress, groom, and bath themselves.
Assist patient in accepting necessary amount of dependence.
Set short term goals with the patient.
Use consistent routines and allow adequate time for patient to complete tasks.
Provide positive reinforcement for all activities attempted; Note partial achievements.
Maintain privacy during dressing and bathing.
Encourage the patient to participate in group activities that encourage the ADL's
Nursing process for dealing with the patient with ineffective role performance
When talking to the patient use therapeutic communication techniques.
Ask the client direct questions regarding new roles and how the health care system can help her continue in
roles.
Allow the patient to express their feelings towards the role change.
Reinforce the patient's strengths and values. Have the patient make a list of the strengths needed to fulfill their
new role.
Work with the patient to set goals so that they are able to reach their desired role.
Provide educational materials to family members regarding patient behaviour management, and caregiver
stress-coping management
(Ackley & Ladwig, 2008)
Health Teaching for the Client, Family & Significant Others
Encourage patient to interact with others
Encourage family members to help with household cleaning duties.
Patient must avoid alcohol and drugs for they can worsen depression.
If client is on medication make sure that they take all medications as per doctor’s orders.
Encourage client to participate in activities like exercising.
Teach client the importance of balanced nutrition.
Let family know that they can talk to the patient about their feelings with therapeutic techniques like active
listening and asking open ended questions.
(Kozier et al, 2010)
(White & Duncan, 2002)
References
Ackley, B. J., & Ladwig, G. B. (2008). Nursing Diagnosis Handbook (8th ed.). St. Louis: Mosby
Elsevier.
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[Link]
Advameg, Inc., Initials. (2010). Complete blood count. Retrieved from
[Link]
Bellafiore, D. (2010). What is group therapy?. Retrieved from
[Link]
Franklin, D. (2010). Psychological Treatment Sevices. Retrieved from
[Link]
Gould, B. (2006). Pathophysiology for the health professions. Philadelphia, PA: W B Saunders
Co.
Health Canada, . (2009, February). Mental health depression. Retrieved from [Link]
[Link]/hl-vs/iyh-vsv/diseases-maladies/[Link]
Karch, A. (2010). Lippincott’s nursing drug guide. Lippincott Williams & Wilkins.
Kozier, B., Erb, G., Berman, A., Buck, M., . . . Bouchal, S. (2010). Fundamentals of canadian
nursing: concepts, process, and practice, second canadian edition. Toronto: Pearson
Education Canada
Perry, A.G., & Potter, P.A. (2010). Clinical nursing skills & techniques. St. Louis, Missouri:
Mosby Inc.
Psychiatric nursing made incredibly easy. (2004). Ambler, PA: Lippincott Williams & Wilkins.
Videbeck, S. (2008). Psychiatric-mantal health nursing 5th edition. Philadelphia, PA: Lippincott
Williams & Wilkins.
White, L, & Duncan, G. (2002). Medical-surgical nursing: an integrated approach. Cengage
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