Major Depressive Disorder Nursing Diagnosis and Nursing Care Plan

Major Depressive Disorder Nursing Care Plans Diagnosis and Interventions

Major Depressive Disorder Nursing Care Plans Diagnosis and Interventions

Depression is a mood condition characterized by a constant feeling of sadness and lack of interest. It influences how a person feels, thinks, and behaves and may cause many emotional and physical issues.

It is commonly known as major depressive disorder or clinical depression. The patient could struggle to do routine daily duties and occasionally question the purpose of life.

Causes of Major Depressive Disorder

• Neurotransmitters. Clinical and preclinical studies suggest that depletion in the central nervous system’s serotonin activity is a significant factor in Major depressive disorder and is also associated with reduced dopaminergic function. The possibility of developing Major depressive disorder is common in people with inactive D1 dopamine receptors or with a malfunction in the mesolimbic dopamine pathway based on some theories. Other neurotransmitters related to the development of Major depressive disorder (DA) are glutamate, brain-derived neurotrophic factor, norepinephrine (NE), and dopamine.
• Brain structures. Depression may occur in certain people due to brain abnormalities that impact mood. Studies on functional neuroimaging supported the theory that there is a connection between depression and decreased metabolic activity from the neocortical to limbic regions.
• Aging. Depression is a diagnosable and controllable medical disorder, not a natural component of the aging process. However, depression is more likely to occur in older people. According to studies, endocrine changes accompany depression throughout the lifetime, some of which are specific to aging. Additionally, low testosterone contributes to depression in older men. Women with a history of depression are more likely to experience it following menopause, even though estrogen replacement therapy does not alleviate the condition.
• Hormones. Depression may result from changes in the body’s hormone balance. Pregnancy, the postpartum period (the weeks and months following delivery), thyroid issues, menopause, and several other diseases can all cause changes in hormone levels.
• Inherited traits. Depression is more common among patients whose biological relatives suffer from it than those who are not. Researchers continuously investigate the link between the development of depression and genes.

Types of Major Depressive Disorder

Healthcare practitioners classify depression based on its symptoms and causes. These occurrences frequently have no evident cause. For no identifiable reason, they can remain far longer in some patients than in others.

• Bipolar depression. Patients with Bipolar depression experience alternate episodes of depressed mood and excessively high energy (manic). Patients might experience sadness, despair, or lack of energy during the depressed period.
• Perinatal depression. Perinatal generally means around birth. Perinatal depression can happen throughout pregnancy and until one year after giving birth. Symptoms extend beyond “baby blues,” which produce little sadness, anxiety, or pressure.
• Persistent depressive disorder. Dysthymia is another term for persistent depressive disorder. The symptoms of persistent depressive disorder are relatively mild than those of major depression. However, some patients might have PDD symptoms for up to two years.
• Premenstrual dysphoric disorder. Premenstrual dysphoric disorder (PMDD) is premenstrual disorder (PMS). However, the symptoms are more severe than those of PMS and include intense depression, anger, and anxiety. Symptoms primarily affect women in the days or weeks before their menstrual cycle.
• Psychotic depression. Severe depressive symptoms and hallucinations or delusions characterize psychotic depression. Delusions are unrealistic beliefs in things, whereas hallucinations include seeing, hearing, or being touched by objects that aren’t truly there.
• Seasonal affective disorder. Seasonal depression, a seasonal affective disorder, typically begins in late fall or early winter. It frequently disappears in the spring and summer.

Signs and Symptoms of Major Depressive Disorder

• sadness, weeping, loneliness, or despair
• irrational behavior, irritation, or frustration, even about simple matters
• loss of enjoyment or enthusiasm in most everyday activities, including sex, hobbies, and sports
• sleep disorders, such as insomnia or excessive sleeping
• feeling worn out and feeling tired makes even minor chores more challenging.
• weight loss and decreased appetite, or weight gain and increased desire for food
• a feeling of uneasiness, anxiety, or fear
• sluggish speech, posture, or other body movements
• thoughts of failures from the past or self-blame, along with feelings of worthlessness or regret
• having difficulty thinking, concentrating, making judgments, and remembering things
• suicidal ideation, suicide attempts, or other suicidal behavior frequently or repeatedly
• undiagnosed physical complaints like headaches or back pain

Complications of Major Depressive Disorder

Depression is a severe condition that can have a damaging effect on the patient and their family. Depression, if left untreated, often worsens, resulting in emotional, behavioral, and physiological issues that affect every aspect of life.

Some examples of depression-related complications are:

• Obesity or excess weight can result in cardiovascular disease and diabetes. It’s no surprise that patients turn to food for relief during depressive periods. Some refer to this behavior as emotional eating. A major depressive condition can also disrupt appetite hormones, causing a person to consume far more than usual.
• Physical ailment or pain. Physical discomfort and depression are closely linked. They share some neurotransmitters that serve as communicators between nerves. They also share parts of the same spinal cord and brain nerve pathways. A patient with depression may become more receptive to pain, and ongoing discomfort may exacerbate depression.
• Abuse of alcohol or drugs. Both alcohol and drugs can influence how the minds and bodies function. A person is more prone to develop other mental health disorders, such as anxiety, when they misuse substances. The likelihood that they will commit suicide is higher if they have suicidal thoughts.
• Issues on family, marriage, school, and work-related. A person with a major depressive disorder could struggle to concentrate or recall a word or someone’s name, which may occur between episodes of severe depression. Additionally, it may make it more challenging to carry out daily activities like job, study, and maintaining personal connections.
• Suicidal ideations and attempts. During severe MDD symptoms, the patient may experience suicide ideation. The patient might try to slash or burn their skin, rip out the hair, or pick at scabs to cope with unpleasant emotions. The use of drugs and alcohol concurrently may increase the likelihood of a severe injury.
• Medical disorders that cause premature mortality. Most people with major depressive disorder also have one or more chronic illnesses. Many of these conditions are manageable, even though no treatment exists. However, depression makes them more challenging to treat and manage.

Diagnosis of Major Depressive Disorder

• Physical examination. The doctor may perform a physical exam and give health-related questions to the patient. Depression may be associated with an existing physical health condition in some circumstances.
• Laboratory testing. For instance, the doctor might check the thyroid to see if it’s functioning properly or perform a complete blood count.
• Psychiatric assessment. The mental health specialist will examine the signs, thoughts, and behavior patterns. The patient may be requested to answer a questionnaire to help the doctor make a proper diagnosis.
• Imaging. Neuroimaging can shed light on the characteristics of a neurologic condition that may manifest as psychiatric symptoms. The doctor may recommend imaging procedures such as a CT scan and MRI of the brain if the differential diagnosis includes organic brain disease or hypopituitarism.
• DSM-5. The mental health provider may obtain The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) issued by the American Psychiatric Association to determine whether the patient meets the criteria for depression

Treatment for Major Depressive Disorder

There are numerous efficient treatments for major depressive disorder. Here is a closer analysis of the available depression treatments:

• Medications. There are numerous varieties of antidepressants available, including those listed below. Discuss any potentially severe side effects with the doctor or pharmacist.
  • Selective serotonin reuptake inhibitors (SSRIs) are the commonly prescribed medication for depression. They can lessen the symptoms of moderate to severe depression, are generally safe, and have fewer adverse effects. SSRIs manage depression by elevating serotonin levels in the brain. Serotonin is one of the neurotransmitters, or chemical messengers, that connect brain nerve cells (neurons).
  • Atypical antidepressant. Atypical antidepressants work by changing chemical messengers (neurotransmitters) for brain cells to work and communicate with one another. Atypical antidepressants, like most antidepressants, treat depression by ultimately affecting changes in brain chemistry and interaction in brain circuitry known to control mood and assist in relieving depression.
  • Tricyclic and tetracyclic antidepressants. Commonly known as cyclic antidepressants, they were among the first produced antidepressant. They are practical, although antidepressants have mostly replaced them with lesser adverse effects. Cyclical antidepressants, on the other hand, may be a good alternative for some patients. In some situations, they treat depression when different medications are not effective.
  • Monoamine Oxidase Inhibitors. MAOIs are a potent class of antidepressants that manage depression by blocking the breakdown of the brain neurotransmitters serotonin, dopamine, and norepinephrine and facilitating their ability to control their mood.
  • Adapt to a crisis or other ongoing difficulties.
  • Find unhealthy, constructive ideas and behaviors and change them with healthy and optimistic thoughts.
  • Examine relationships and interactions, and establish beneficial ties with people.

  Major Depressive Disorder Nursing Diagnosis

  Nursing Care Plan for Major Depressive Disorder 1

  Impaired Social Interaction

  Nursing Diagnosis: Impaired Social Interaction related to changes in cognitive processes secondary to major depressive disorder as evidenced by dysfunctional interaction with family, friends, and others, expressed uneasiness in social settings, avoiding interaction with others, and making no eye contact.

  Desired Outcomes:

  • The patient will state that they enjoy communicating with others in activities and one-on-one conversations to the same amount as before being depressed.
  • The patient will recognize the emotions that cause unsatisfactory social relationships.
  • The patient will communicate with friends, family, and friends.
  • The patient will take part in certain community social events.

  Nursing Care Plan for Major Depressive Disorder 2

  Nursing Diagnosis: Low Self-Esteem related to neurophysiological imbalances secondary to major depressive disorder as evidenced by the inability to deal with events and hostile response to a positive review.

  Desired Outcomes:

  • The patient will have a positive outlook on life and the capacity to enjoy the moment.
  • The patient will list two areas they wish to improve and four positive characteristics honestly and nonjudgmentally.

  Nursing Care Plan for Major Depressive Disorder 3

  Nursing Diagnosis: Disturbed thought processes related to traumatic life experiences secondary to major depressive disorder as evidenced by incorrect assessment of the surroundings, memory issues/deficits, and reduced problem-solving abilities.

  Desired Outcomes:

  • The patient will analyze the facts and make sound decisions.
  • The patient will correctly recall current and distant information.
  • The patient will demonstrate a well-organized thought process.

  Nursing Care Plan for Major Depressive Disorder 4

  Risk for Self-directed Violence related to social isolation secondary to major depressive disorder.

  • The patient will ask for assistance if they feel the urge to hurt themselves.
  • The patient will exhibit behavioral manifestations of absent depression.
  • The patient will feel content with their current social situation and progress toward their personal goals.

  Nursing Care Plan for Major Depressive Disorder 5

  Grieving related to anticipated loss secondary to major depressive disorder as evidenced by anger, alterations in the activity and immunological function, depression, disassociation, lack of coordination, and sleep disruption.

  • The patient will perform self-care routines at their or her own pace.
  • The patient will show progress in navigating the stages of grief on their timeline.
  • The patient will verbally express a feeling of improvement toward the resolution of hope and despair the next time.

  Nursing References

  Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon

  Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

  Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon

  Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon

  Disclaimer:

  Please follow your facilities guidelines, policies, and procedures.

  The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

  This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

  Anna Curran. RN-BC, BSN, PHN, CMSRN I am a Critical Care ER nurse. I have been in this field for over 30 years. I also began teaching BSN and LVN students and found that by writing additional study guides helped their knowledge base, especially when it was time to take the NCLEX examinations.