Nursing Care Plan (NCP) for Mood Disorders (Major Depressive Disorder, Bipolar Disorder)

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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

Writing a Nursing Care Plan (NCP) for Mood Disorders (Major Depressive Disorder, Bipolar Disorder)

A Nursing Care Plan (NCP) for Mood Disorders (Major Depressive Disorder, Bipolar Disorder) starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

In this care plan, we will explore mood disorders, including major depressive disorder and bipolar disorder. So, in this mood disorder care plan, we will cover the desired outcome, the subjective and objective data along with the nursing interventions and rationales. 

 

Now let’s look at our mood disorder care plan, starting with the subjective data. You may notice that the patient is experiencing some prolonged sadness, fatigue, or inability to concentrate, especially when they’re in a depressive episode. They may experience mood swings, where they kind of go from being super happy and energetic, to really sad and tired. This especially happens when the patient goes in between manic depressive episodes. They may experience a change in their sleep or appetite based on their mood. 

 

Now, let’s look at our objective data. You may notice that your patient is being very pessimistic or negative about things, or even really tearful when they’re talking about things, especially when they’re in a depressive episode. A patient that is bipolar might show some really reckless behavior. They might start doing things that they wouldn’t usually do like having unprotected sex with multiple people. They might become very restless and have a racing speech. This would all especially be when they’re in a manic episode. 

 

Now, let’s look at our nursing interventions. You will assess your patient for suicidal and homicidal thoughts and initiate precautions per protocol in your organization, or doctor orders. You want to do this to determine if there’s any danger to themselves or others. You want to always promote safety overall. Remove all their belongings if they’re suicidal, that way they don’t have any weapons available to use. You may want to have the patient sign a suicide contract just saying that they’re not going to commit suicide. This is just going to help make them feel more accountable for not doing this. 

 

Encourage communication about feelings and emotions. This will help you to build trust and rapport with your patient. You want to provide activities that don’t require a lot of concentration or competition. This is going to help them to relax, but also keep busy. Make sure you provide a calm, relaxing environment. You want to help minimize stimulations to help decrease the exacerbation of their symptoms observed for destructive behaviors. They could become hostile. So just keep an eye on them. If you notice, they’re starting to really scratch their arms a lot, or, pace the room, definitely be prepared for anything to happen. Take the precautions as necessary. 

 

You want to provide short, simple instructions. This helps to promote independence. This is going to help them to do what you need them to do, but you’re going to provide those instructions very simply and not make it very complicated for them. So lastly, you want to give medications as ordered by the doctor to help improve the patient’s functioning. You might give medications such as antidepressants or even antipsychotics to help improve that functioning. And you want to decrease symptoms. 

 

We love you guys. Now go out and be your best self today and as always, happy nursing!

 

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