Depression Case Study
The nurse completes a physical assessment. When asked what brought her to the hospital, Anna replies, “Things just aren’t right” and begins to cry. After further conversation, Anna describes her mood as “very sad now.” She rarely goes out or invites friends to visit. She admits that she feels like strangers are saying bad things about her. Sometimes she hears a man’s voice that is a “little bit scary.”
What question should the nurse ask as a priority nursing assessment?
The daughter, an only child who is visiting from out of town, offers additional information about Anna’s behaviors. The client’s clothes fit looser and weight loss is evident. Current alcohol use is suspected, and a breathalyzer is positive for alcohol use. Anna denies current suicidal ideation, but the nurse recognizes that the client has risk factors for suicide based on the SAD PERSONS scale.
S = Sex. Men kill themselves more often than women, although women make more attempts.
A = Age. High-risk groups include 19-years-old or younger; 45-years-old or older, especially the elderly of 65-years or older.
D = Depression. Many of those who attempt suicide manifest a depressive syndrome.
P = Previous attempts. Of those who commit suicide, many have made previous attempts.
E = ETOH. Alcohol use is associated with up to 65% of suicides.
R = Rational thinking loss. People with psychoses are more likely to commit suicide than those in the general population.
S = Social supports lacking. A suicidal person often lacks significant others, meaningful employment, and other supports. These areas should be assessed.
O = Organized plan. The presence of a specific plan (date, place, means) signifies a person at high risk.
N = No spouse. Persons who are widowed, separated, divorced, or single are at greater risk than those who are married.
S = Sickness. Severe illness is a significant risk factor.
How many risk factors does Anna have?
Six points on the SAD PERSONS scale:
Anna is assessed by the nurse, social worker, and healthcare provider. Based on their assessments, hospitalization is recommended for psychotic depression. Which behavior is inconsistent with depression?
If the client refuses treatment, which behavior justifies short-term involuntary treatment?
What classification of drugs is the antidepressant fluoxetine (Prozac)?
What is the major action of SSRI antidepressants?
The nurse understands that SSRIs are now more widely prescribed than tricyclics for antidepressant therapy. What is the rationale?
When the client receives fluoxetine (Prozac), the nurse must explain the purpose and when to expect therapeutic effectiveness. When should the client begin to feel less depressed?
Which side effects commonly occur in clients who are taking SSRI antidepressants?
The nurse must explain the purpose of Risperdal. Which explanation is best?
What role do thyroid levels play in depression?
When Anna awakens in the morning, she sits for periods of time at the edge of her bed. She does not initiate combing her hair, getting dressed, or going to breakfast. Which nursing intervention is important?
Since the client has decreased energy, which intervention is best?
As the nurse initially communicates with Anna, which communication technique is important?
According to the nursing progress notes, Anna demonstrates decreased social interaction, rarely talks, needs assistance to her room, appears confused, and only slept 30 minutes in the past 24 hours. The daily graphics indicate that she has slept an average of 2 hours in the past week. She is eating 50% of her meals. According to this data, what is the priority nursing problem?
Since Anna is eating 50% of her meals, which priority nursing intervention should be included on the treatment plan?
One morning the nurse takes Anna’s morning blood pressure, which is 141/108. After reviewing the progress notes, there were several days when it was elevated. The nurse wants to validate if she has hypertension. Which DSM-IV-TR axis would the nurse use to interpret for the presence of hypertension?
One morning the nurse is doing unit rounds and finds Anna sitting at the edge of her bed with a sheet around her neck. What is the first nursing action?
When Anna wants to change clothes and get ready for sleep at night, what should the staff do?
Anna is placed on constant observation for safety precautions, so the nurse must assign a staff member to remain with her at all times. Which staff member is best to assign to Anna?
One afternoon the nurse notices that a visitor brings some cans of Anna’s favorite soft drink. What should the nurse do?
After several days of constant observation, the nurse reassesses the need to maintain safety precautions. What will ensure that the client will be safe?
The nurse must teach the client about possible adverse effects from the ECT treatments. Which information should be included in the teaching plan?
When the nurse prepares a client for ECT, what should be expected?
When Anna awakens from the treatment, the nurse should be prepared to perform which nursing action?
What signs and symptoms should the nurse expect to assess if a client taking an MAO antidepressant ingests foods containing tyramine?