Pts diagnosis Depression 1) Causes a. biological differences b. Brain chemistry (neurotransmitters) c. Hormones (thyroid, menopause) d.

d. Inherited traits (genes) e. Life events (death of loved one, loss of job, etc.) 2) Complications a. Excess weight (leading to heart disease or DM) b. Alcohol or substance abuse c. Anxiety, panic disorder, social phobia d. Relationship difficulties e. Social isolation f. Suicidal feelings, suicide attempts g. Self-mutilation 3) Diagnosis Major, 5 or more of the following a. Depressed mood b. Anhedonia c. Significant weight loss or gain, or appetite d. Insomnia or desire to sleep e. Restlessness or slowed behavior f. Fatigue or loss of energy g. Feelings of worthlessness or guilt h. Trouble making decisions i. Recurrent thoughts of death or suicide 4) Treatment (for this patient) a. Clonazipam b. Group therapy c. Rec therapy d. Individual sessions with the doctor Assessment 1) Physical a. No remarkable findings, HR regular, 2+ peripheral pulses all extremities, lungs clear bilateraly, skin warm dry and intact, BS in all four quads, regular BM, no difficulties urinating, PERRLA 2) Psychosocial a. Flat affect, talks in a low voice and prefers to give one words answers, denies thoughts of suicide, agrees to tell nurse if she does At the time, I didnt realize we were supposed to fill out the forms, so, as a result, I didnt ask those questions.

Nursing Diagnosis: Risk for suicide r/t depression aeb previous suicide attempt Goal: Pt does not commit suicide

Nursing Diagnosis: Social isolation r/t depression aeb observed behaviors of patient Goal: pt participates in group activities and interacts with others I: pt attended group therapy session

Nursing Diagnosis: Risk for imbalanced nutrition, less than body requirements r/t decreased appetite and intake of food Goal: Pt will eat enough calories to maintain or increase her weight I: Monitor weight

Nursing Diagnosis: Risk for imbalanced fluid balance r/t decreased intake of fluids Goal: pt will drink >1000mL of fluid throughout the day I: monitor fluid intake

I: have a no suicide contract in place

O: pt acknowledges she will not attempt suicide I: teach/remind pt to tell a staff member if feeling suicidal O: pt verbalized understanding

O: pt was still very flat and did not communicate freely I: I sat and talked with her in her room

O: Aid weighed pt and found it to be decreasing I: encouraged food and snacks throughout the day O: pt would only take a couple bites but was not really interested in food I: Allowed pt to pick her own meals from menu O: At dinner, pt seemed pleased with what she had received and consumed more of it than she had in the past

O: care givers are better able to assess fluid balance I: encouraged glass of apple juice and held it for her O: pt drank full glass

O: pt was A LOT more communicative, less blunted, would make eye contact, and talked about her kids. I: Allowed visitors (parents) to come visit her O: Pt seemed less blunted and smiled when she met with parents

I: remove access to objects that could harm pt O: pt does not have access to such objects

I: Refreshed her water mug twice with ice and water O: the first time the ice melted with no fluid missing, the next there was 50 mL gone when I retrieved it for her during dinner

Evaluation/Revision: Pt did not commit suicide on my shift

Evaluation/Revision: Pts affect seemed brighter at dinner with the rest of the patients, she made eye contact and would occasionally spontaneously smile

Evaluation/Revision: Pts appetite seems to be coming back, may be due to social interventions in previous column

Evaluation/Revision: Pts desire for fluid seems to be returning, though I doubt she got 1000mL that day.