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Outline
Pathophysiology
Mood disorders are a category of mental illnesses that affect a person’s emotional state over a long period of time. Emotions, or moods, may fluctuate frequently and seemingly without any reason. The most common of these are Major Depressive Disorder and Bipolar Disorder. Depression may be a common feature of other mental illnesses, but can occur independently as well. Clients with mood disorders are at higher risk for substance abuse and suicidal tendencies. Research has shown that there is a high incidence of depression among clients that also have chronic medical conditions such as heart disease, cancer, Alzheimer’s disease and hypertension. Treatment is geared toward managing symptoms through the use of medications and psychotherapy.
Etiology
Diagnostic Criteria:
Diagnoses do not include symptoms related to other medical conditions or substance use, does not meet the criteria for another mental illness or psychotic disorder.
Major Depressive Disorder (MDD):
- Five or more of the following new symptoms present in the same 2-week period.
- Depressed mood, most days
- Loss of interest or pleasure in most activities
- Significant weight loss or weight gain
- Insomnia or hypersomnia, most days
- Slow or aggravated psychomotor function
- Fatigue or loss of energy, most days
- Feelings of worthlessness or inappropriate guilt, most days
- Inability to think or concentrate, indecisiveness, most days
- Recurrent thoughts of death, without a specific plan or attempt
- Symptoms significantly affect social or occupational functioning
- Never had a manic or hypomanic episode
Bipolar Disorder (BPD):
- One or more manic episodes; or one hypomanic and one major depressive episode
- Distinct period of abnormally elevated mood lasting more than 1 week
- More than 3 of the following occur during mood disturbance
- Inflated self-esteem
- Decreased need for sleep
- Racing thoughts
- Easily distracted
- Increased activity
- Excess risky or pleasurable activity
Desired Outcome
Client will remain safe. Client will not cause harm to self or others. Client will demonstrate coping techniques. Client will identify appropriate actions for managing emotions.
Mood Disorders (Major Depressive Disorder, Bipolar Disorder) Nursing Care Plan
Subjective Data:
- Prolonged sadness
- Change in appetite
- Change in sleep patterns
- Irritability
- Feelings of guilt
- Inability to concentrate
- Inability to feel pleasure in former interests
- Suicidal ideations
- Grandiose delusions
- Unexplained aches and pains
- Increased fatigue (MDD)
- Decreased need for rest (BPD)
- Significant mood swings
Objective Data:
- Pessimism
- Reckless behavior
- Easily distracted
- Racing speech
- Tearfulness
- Restlessness
Nursing Interventions and Rationales
- Assess for level of suicide precautions necessary
- Verbalizes desire to commit suicide
- Has a suicide plan
- Previous / recent suicide attempts
Determine if client is an active risk to self or others and what safety precautions need to be initiated. Always ask if there is a specific plan.
- Initiate suicide precautions as necessary per facility protocol
- Do not leave client unattended
- Remove unnecessary items from room that may be used as a weapon (sharp instruments, belts, etc.)
Provide for the safety of client and others. Follow your facility’s specific protocol regarding supervision and documentation.
- Implement a written “no-suicide” contract with client
Clients who agree to a written contract are often less likely to carry out a suicide plan. It shows the client that they have value.
- Obtain history from client or family members regarding any current or a history of substance abuse. Labs may be necessary.
Determine if client’s symptoms are caused by or exacerbated by use of drugs or alcohol.
- Remove client valuables and send home with trusted family member or lock in facility safe.
Clients experiencing suicidal behaviors or manic episodes may give away valuables or money indiscriminately and may become victims of theft.
- Encourage client to talk about feelings and emotions
Helps client verbalize and identify the cause of their actions. Builds trust and rapport.
- Provide activities that do not require concentration or competition (drawing, walking, exercise, music, etc.)
Clients who are depressed have difficulty concentrating. Allows client time to calm down. Competition (games) can cause aggression – no card games except solitaire.
- Provide calm, relaxing environment
Overstimulation during manic episodes may cause an exacerbation of symptoms
- Teach client visualization techniques that replace negative images with positive images
Help improve client’s self-image and confidence
- Minimize environmental stimuli
- Close blinds/curtains
- Keep door closed to reduce noise
- Limit visitors
- Cluster care
Reduce chance of overstimulation to minimize aggression or agitation.
- Observe for destructive or manipulative behaviors
Clients experiencing mania often have poor impulse control and may become hostile.
- Offer and arrange religious counseling as appropriate per client preference and facility protocol
Religious services may be offered, but are not required. Clients often have deep cultural or religious views and may benefit from these services.
- Encourage bedtime routine that may include warm bath, soothing music and lack of stimulation. Avoid caffeine.
Promote healthy sleep hygiene and encourages rest and relaxation which can decrease mania and improve mood.
- Assist with ADLs by giving short, one-step instructions
Promotes independence while minimizing the stress of complex instructions. Clients often have difficulty concentrating, so using one-step directions is important.
- Administer medications appropriately
Antidepressants and antimanic medications may be given to improve client functioning and effectiveness of interventions.
- Antidepressants – SSRI’s, SNRI’s, MAOI’s, TCA’s
- Anti-manic – Haloperidol, Benzodiazepines, Lithium
References
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