Depression Nursing Interventions PDF

Preview

Summary

Direct from NCLEX study guide: nursing interventions ...

Description

Nursing Interventions: DEPRESSION Goal: To assess for suicidal potential A. Recognition of suicidal intent. 1. Self-destructive behaviors are viewed as attempts to escape unbearable life situations. 2. Anxiety and hostility are overwhelmingly present. 3. There is a presence of ambivalence; living versus self-destructive impulses. 4. Depression, low self-esteem and feelings of hopelessness are critical to evaluate: suicide attempts are often made when the client feels like giving up. 5. Assess for indirect self-destructive behavior: any activity that is detrimental to the physical well being of the client in which the potential outcome is death. a. Eating disorders: anorexia nervosa, bulimia, obesity, overeating. b. Noncompliance with medical treatment (ex: diabetic who will not take insulin) c. Cigarette smoking, gambling, criminal and/or socially deviant activities. d. Alcohol and drug abuse. e. Participation in high-risk sports (eg. Auto racing, skydiving) *Nursing priority* Depression and suicidal behaviors may be viewed as anger turned inward on the self. If this anger can be verbalized in a nonthreatening environment, the client may be able to resolve these feelings, regardless of the discomfort involved. B. Suicide danger signs -- see Sad Persons Scale 1. The presence of a suicide plan: specifics relating to method, lethality, and likelihood for rescue. 2. Change in established patterns in routines (ex: giving away personal items, making a will, saying good-bye) 3. Anticipation of failure: loss of a job, preoccupation with physical disease, actual or anticipated loss of a significant other. 4. Change in behavior, presence of panic, agitation, or calmness; often as depression lifts, client has enough energy to act on suicidal feelings. 5. Hopelessness: feelings of impending doom, futility, or entrapment. 6. Withdrawal and rejection of help. C. Clients at risk 1. Adolescents and older adults; males more likely to complete the suicide act. 2. Clients experiencing recent stress of a maturational or situational crisis. 3. Clients with chronic or painful illnesses. 4. Clients with previous suicide attempts or suicidal behavior. 5. Withdrawn, depressed, or hallucinating clients. 6. Clients with sexual identity conflicts and those who abuse alcohol and drugs.

Goal: To provide for basic human needs of safety and protection of self-destruction. A. Remove all potentially harmful objects (ex: belts, sharp objects, matches, lighters, strings, etc.) B. Maintain a one-to-one relationship and close observation C. Have client make a written contract agreeing not to harm himself or herself; provide an alternative plan of coping. D. Administer lamotrigine (Lamictal), if ordered. *Nursing priority* Be aware of special times the client might be suicidal (when suddenly cheerful, when fewer staff members are available, upon arising in the morning, or during a busy routine day.) When drug therapy is started, client may feel better an act on suicidal ideations. Goal: To provide for physical needs of nutrition and rest/activity. A. Assess for changes in weight (weight loss may indicate deepening depression) B. Encourage increased bulk and roughage in diet along with sufficient fluids if client is constipated. C. Provide for adequate amount of exercise and rest; encourage client not to sleep during the day D. Assist with hygiene and personal appearance. *Nursing priority* Depressed clients are particularly vulnerable to constipation as a result of psychomotor retardation. Goal: To promote expression of feelings. A. Encourage expression of angry, guilty, or depressed feelings. B. Convey a kind, pleasant, interested approach to promote a sense of dignity and selfworth in the client. C. Support the client’s expression of feelings by allowing the client to respond in his or her own time. D. Seek out client; initiate frequent contact. E. Assist with decision making when depression is severe. Goal: To provide meaningful socialization activities. A. Encourage participation in activities (ex: plan a work assignment with client to do simple tasks: straightening game room, picking up magazines.) B. Assess hobbies, sports, or activities client enjoys and encourage client participation. C. Encourage client to participate in small-group conversation or activity: practice social skills through role-playing and psychodrama. D. Encourage activities that promote a sense of accomplishment and enhance self-esteem.

*Nursing priority* The depressed client often has impaired decision-making/problem-solving ability and needs structure in his or her life. The nurse must devise a plan of therapeutic activities and provide client with a written time schedule -

The client who is moderately depressed feels best early in the day, whereas later in the day is a better time for the severely depressed individual to participate in activities.

ADOLESCENT SUICIDE Characteristics - History of suicide ideation - Previous suicide attempt - Long-term use of drugs - Acting-out behaviors; delinquency, stealing, vandalism, academic failure, promiscuity, loss of boyfriend/girlfriend Family Characteristics - Unproductive, conflictual communication - Impaired problem-solving ability - Inconsistent positive reinforcements, plus a greater number of negative reinforcements - Unstable home environment...