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• • Changes a person’s behavior, cognition, motivation, and emotions; Most common psychiatric diagnosis: – 5% of people have mood disorder; – 25% of people with depression have a family member with mood disorder; – 50% of people with bipolar disorder have a family member with mood disorder; Two Diagnostic Categories: 1. Major Depressive Disorder (MDD) • A person experiences one or more episodes of depression with no manic or hypomanic manifestations; • Twice as many women than men; • Onset is usually early to mid 20’s; 2. Bipolar Disorders • A person experiences major depression with one or more manic or hypomanic episodes; • Female and male ratio is the same; • Onset is usually mid to late 20’s (late adolescence to early adulthood) • High prevalence among professionals and well-educated persons;
• • • Is one of the most prevalent mental health problem within the US; Depressive symptoms are experienced by 9-20% of adult persons, and half of these persons will develop clinical depression within a year; About 80% will eventually have recurrent episodes; In elderly, 6 – 12% have depression (MELANCHOLIC DEPRESSION) Children of parents who suffered from depression are at risk to develop the disorder; The onset of childhood depression predisposes a child to develop recurrent adult depression; Events that will predispose children and adolescent to depression: • Loss of parents • Death of very important persons • Death of a beloved pet • Move to another neighborhood or town • Academic problems or failures • Physical illness or injury THEORIES OF DEPRESSION: a. Biochemical Theory • Decreased norepinephrine and serotonin. • Alterations in the functions of the hypothalamic-pituitary-adrenal system may cause depression;
Reduced recognition and concentration. hypersomnia. DSM-IV Criteria for Major Depression: 1. social learning. c. Cognitive Theory Depression results when a person perceives all stressful situations as being negative. coping with individuals. Recurrent death or suicidal thoughts. and mstujrrnmdusrn . and hormonal secretions. leaden paralysis. life events. Sociological Theory Stated that depression is caused by abnormal medical. 5. Arise from negative experiences during childhood such as loss of loved ones. 8. Psychodynamic or Psychoanalytical Theory Depression occurs as a result of a person’s ego loss in relationship to early life occurrences. • Char by increased appetite. Interpersonal Theory Person’s difficulties. Anger inappropriately directed TO SELF often triggered by the loss of a loved one or object.2 • Alterations in the circadian rhythm (wake-sleep cycle) will cause problem with sleep patterns. social isolation. or divorce. Symptoms must persists for a minimum of 2 weeks. 7. Types of Depression: 1. • May involve other mental conditions such as schizophrenia. e. and life changes can be stressful and may lead to depression. Behavioral Theory Depression develops when one feels helpless and unworthy f. DEPRESSED MOOD 2. ANHEDONIA 3. and stress and response mechanism by an individual. Sleep disturbances 4. A person must have at least 5/9. arousal. Feelings of worthlessness or guilt. Reacts to all situations as if they are stressful and relate himself or others in a negative light. weight gain. one of which is a depressed mood or anhedonia. Fatigue or energy loss. activity. Role dispute. Unresolved grieving in the early stage of child-parent relationship. Possible weight loss or weight gain. prolonged grief reaction. b. leaving home. 6. Atypical Depression • Mood disturbance that occurs in younger populations. Psychomotor agitation – increase or decrease activities. 9. and role transition are major interpersonal themes. d.
3. 4. 9. Retarded Depression Depression manifested by decreased psychomotor activities. Melancholic or Endogenous Depression • Occurring most often in older persons (at least 40 years old) • Char by anhedonia and an inability to be cheered up.3 extreme sensitivity to interpersonal rejection. Diagnostic Examinations related to Depression: 1. mstujrrnmdusrn . • Duration is at least 2 years. 8. Psychotic Depression Manifests with signs of depression accompanied by delusions and hallucinations. 4. Growth Hormone determination • Some depressed children may have decreased secretion of GH during the day and increased secretion while asleep. Depression last longer than two years. Seasonal Affective Disorder (SAD) Depression occurring in relation to seasonal change most often beginning in fall or winter and remitting in spring. thyroid hormone secretions are decreased. 3. Drug-induced Depression Depression developed due to use of prescription. OTC. Chronic Depression About 10% of depressed patients will fall under this category. Postpartum Depression • Symptoms of depression occurs in the first 30 days postpartum but may last for one year. 5. Polysomnographic Patterns • In depressed adults. Paranoid Depression Patient have depressed symptoms with paranoid ideation. Dexamethasone Suppression Test (DST) • A positive result occurs when serum and urinary cortisol do not fall or not suppressed. or other types of drugs. the REM phase is shortened which result in frequent night and early morning awakening. 7. Thyrotropin-releasing Hormone Test • In depressed persons. 10. 6. 2. Dysthymic Disorder • Depressed mood with 3 other signs of depression. 2.
Nurse Interventions • Assess px for signs of suicide. Psychotherapy Behavioral therapy Cognitive therapy Electroconvulsive therapy Pharmacotherapy 1. B. where they are. TCA – Imipramine 3. • Assess px for adverse drug reactions. Bipolar disorders are those in which individuals experience the extremes of mood polarity like he/she may feel very euphoric or very depressed. F. • • Characterized by episodes of mania and depression with periods of normal mood and activity in between.4 Management: A. MAOI – Phenelzine BIPOLAR DISORDERS • Also known as manic-depressive disorder. • Accept the patient who they are. • Reinforce decision making by patients. • Spend time with withdrawn patients. • • • THEORIES OF MANIA: 1. • Create a safe and structured environment. • Monitor px for cheeking or hoarding of drugs. • Assess for signs of toxicity. • Respond to anger therapeutically. • Involve px in activities in which they can experience success and increase in selfesteem. E. Bipolar disorders appear equally common among men and women. Biological Theory • Related to excessive levels of neurotransmitters such as norepinephrine. and focus on their strengths. In men. C. Psychodynamic Theory • Faulty family relationship and communication during early life are responsible for manic behaviors in later life. the first episode is usually of manic manifestations. D. 2. • Manic behaviors are defense against or massive denial of depression. • Make decisions for patients that are not yet ready to make decisions. mstujrrnmdusrn . In women. SSRI – Fluoxetine 2. • Never reinforce hallucinations or delusions. it is depressive symptoms that come first before the manic signs.
Encourage rest periods. Hypersexuality 13. o Provide clear and concise comments and directions. Distractibility 6. high-caloric “finger foods” Avoid stimulants like caffeine or cola. Pharmacotherapy – Antimanic Drugs mstujrrnmdusrn . Increase irritability 8. o Reinforce reality especially if the px have altered perception. o o High-protein. Nursing Management o Create a safe environment. ELEVATED MOOD 2.5 serotonin. Pleasurable activity involvement 12. Resistance to treatment 14. Loud and rapid speech 3. Flight of ideas 4. Insomnia 11. Anorexia 10. B. o Limit the patient’s participation in group activities. and dopamine. Depression and delusion 15. Anger 5. o Provide positive feedback for socially acceptable behaviors. Assist the px to focus on a single task. Grandiosity or inflated self-esteem 7. o Monitor sleeping and eating patterns. Labile mood and lack of illness awareness Types of Bipolar Disorders: • Bipolar I • • Bipolar II Cyclothymic Disorder Management: A. Hyperactivity 9. • High consideration is also given to genetic considerations (twins and with family history) Clinical Manifestations of Mania: 1. o Reduce environmental stimuli. o Provide physical exercise as a substitute for increased motor activity.
irritate and restless. After she gave birth she was noticed with behavioral oddities such as impaired sleep. unstable psychotic History of Present Illness: The patient has been mentally ill since 2004. She was tolerated at home. Goal Interaction To gain rapport of my patient. acceptance. Establish trust. December 2009 patient leave their house in Romblon. I.6 • • • – – Name Sex Age Address Civil Status Birth date Birthplace Religion Nationality Date Admitted Admitted Doctor Diagnosis General data : Lithium carbonate Carbamazepine Valproic acid Anxiolytics Antipsychotics : Patient X : Female : 25 y/o : Filvelle Subd. and open communication To understand the patient’s problems. she was found and take cared by a concerned citizen in Bulacan. According to the concerned citizen who takes care of her. She was noted to be laughing and talking to self. after she gave birth to his son. mstujrrnmdusrn . She was noted to be repeatedly taking a bath and wandering around their area. Sta. patient was assaultive as she hit children and she seen climbing on the wall which prompted consults hence admission. Cruz Guiguinto Bulacan : Married : March 12 1985 : N Andres Romblon : Catholic : Filipino : April 20 2010 : : Bipolar Affective Disorder Arrest episode manic with symptoms. To demonstrate genuine care and understanding.
To discuss the contract to my patient. She uses regression. To explore patient’s thoughts. feelings. Mood was irritable with constricted affect and poor eye contact. She admits hearing of vices “meron” but don’t elaborate Nurse-Patient Interaction (NPI) – Orientation Phase NPI N: Magandang hapon sa iyo P: Magandang hapon N: Ano po ba ang pangalan mo? P: Rose N: Ako nga pala po si Carelle May Casiano student nurse po ng Perpetual Help College of Manila Simula po ngayon Magkakasama po tayo at pag Uusapan natin ang inyong Talambuhay. Short-term Objectives To be able to introduce myself to my patient and getting to know one another. and actions III. General Objectives To distinguish the sickness of the client thru the observation done. To gain trust from my patient. hanggang sa Byernes po sa susunod na Inference Broad Opening Rationale To establish open-ended communication To establish open-ended communication To gain rapport and trust Giving Information Broad Opening mstujrrnmdusrn . She has no appropriate answers when questioned. Mental Status Examination Seen and examined as an adult female. To reduce the level of fear To observe and assess my patient’s personality. To reduce the anxiety felt by the client towards the nurse. evasion and acting-out as Defense Mechanism.7 To mutually formulate a contract with the patient II. thinly built in hospital gown. The patient has poor impulse control.
susunduin na ba ako? Asan yung sundo ko? N: Sino po sa tingin nyo susundo sayo? P: Yung ate ko Restating Exploring Clarification Encourage client to make idea more understandable Validation Confirms a statement Encourage client to express feelings or ideas. N: Anong Course mo sa Collge Rose? P: Pang Kalahatan. Broad Opening To establish open-ended communication N: Anung araw ngayon? P: di ko alam N: San ka po nakatira? P: Sa Romblon N: Ilang taon kana? P: 23 N: Kailan ang birthday mo? P: March 12 1985 N: Bali ilang taon ka na nga ulit? P: 24 N: Nakapag aral kaba? P: Oo. N: Anong pangkalahatan yon Rose. maari mo bang ipaliwanag? P: Ewan N: Hanggang ilang taon ka sa College? P: 1ST Year N: Anong dahilan at hanggang 1st Year lang ang tinapos mo? P: Ewan ko N: Kamusta ka ngayong araw? P: OK lang. Encourage the client to continue mstujrrnmdusrn .8 linggo P: (no response) N: Kamusta ka naman Rose? P: ok lang . College.
9 N: Nasaan po ang ate nyo? P: Nasa Romblon yata Presenting Reality N: Naku ate wala pong susundo Ngayon sa inyo kasi po. bali April…May… June… July… mga 3 buwan na Focusing N: Sabi mo buntis ka. Kelan ba ang huling regla mo? P: april yun e. Encourage client to introduce the topic. may bumaGabag ba saiyo? P: wala Broad Opening N: Anung gusto mong pag usapan Natin Rose? P: Buntis ako. baka hangin lang to. (ngiti) Broad Opening N: May asawa ka ba? P:Oo N: Nasaan sya? P: Nasa Romblon N: Kailan kayo huling nagkita? P: Ewan N: Ano naalala mo? P: Yung mga anak ko N: Nasaan sila Rose? P: Nandon sa Romblon N: Ilang anak meron ka? P: 2 N: Ilang taon na sila? P: 7 at 3 Encouraging the client to stay focus on the topic Encourage client to express feelings or ideas. Exploring N: Ano ang nasa isip mo at nasabi mong buntis ka? P: Wala. P: ok Making Observations N: Mukang tulala ka. or start a conversation Encourage client to express feelings or ideas. pinalabas po Kayo para po makausap po naming kayo. To promote easy understanding on the problem Verbalizing what the nurse perceives To establish open-ended communication mstujrrnmdusrn . Exploring N: Sa palagay mo ilang buwan na Yang pinag bubuntis mo? P: July ngaun.
10 N: Anong pangalan ng mga anak Mo? P: “silence” N: P: N: Naalala mo pa ba kung ilang Buwan kana dito? P: Oo. bago lang ako dito nung April 10 2010 lang. may Nag bigay sakin ng pagkain. bali mga 3 Buwan na ako dito N: Pano ka nakapunta dito? P: May pumuntang DSWD samin Kinuha ako. N:Anong trabaho naman yun Rose? P: silence N: San ka nagtrabaho Rose? P: Sa Bulacan N: Maari ko bang malaman kung Anong trabaho meron ka nun Sa Bulacan? P: Kumakain lang. N: Anong pagkain ang binigay nya Sayo? P: Basta masarap N: Ok Rose nagkaroon ka ba ng Trabaho? P: Oo. N:Mayron ka bang amo sa Bulacan? P: Oo N: Mababait ba sila? mstujrrnmdusrn . N: Sino yung nag bigay sayo ng Pagkain? P: yung babae. N: Ano sa tingin mo ang dahilan at Kinuha ka nila? P:Kumakain kasi ako nun.
nakatulala Ka na naman P: (mabgal na titingin ng bahagya) N: Salamat po sa iyong tiwala sa paglahad ng mga bagaybagay. N: Ano nag papasaya sayo sa pag tira mo ditto? N: May libreng pagkain dito.11 P: Oo N: Rose ano nga ulit yung trabaho Mo sa Bulacan? P: Naghuhugas.. mstujrrnmdusrn . sinigang na baboy. at naglalaba. N: ahhh Rose Masaya ka ba ditto? P: Oo.. Maari bang magkwentuhan ulit Tayo bukas? P: Sige. N: Bali pumasok ka bilang Katulong? P: Oo N: Pinapasweldo ka ban g ayos Ng mga amo mo? P: Oo N: Pinapakain ka ba nila? P: Oo N: Anong madalas nilang ipakain Sayo? P: Kanin. N: Minsan ba nalulungkot ka? P:Hindi N: May mga bumabagabag sayo Rose? P: Wala N: Rose tingin ka skin. bukas nandito ulit ako. P: (silence) N: Papasok ka na ulit sa loob Rose.at natutulog lang ako ditto.
12 – mstujrrnmdusrn .
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