By: MALLARE, MICHELLE GLISELLE G.

GROUP 3

MAJOR
DEPRESSIVE
DISORDER
DEFINITION OF
DEPRESSION.
Depression is a mood disorder that causes a
persistent feeling of sadness and loss of interest.
Also called major depressive disorder or clinical
depression, it affects how you feel, think and
behave and can lead to a variety of emotional and
physical problems. You may have trouble doing
normal day-to-day activities, and sometimes you
may feel as if life isn't worth living.
MENTAL STATUS
EXAM
(ATOMIC)
APPEARANCE AND
BEHAVIOR
Client is a 51-year-old filipino woman of average
height but appears to be underweight. On
appearance she has long black hair, untrimmed nails,
dry lips and darkened eyebags. No visual marks such
as tattoos or scars and no signs of tremors or
abnormal movements were noted. At the time of
examination, she was poorly groomed and dressed
mildly unkept. She was not confined to bed. She
was unfocused throughout the interview with poor
eye contact.
 She articulates herself softly throughout the
conversation, particularly when mentioning past
unhappiness. Although she has trouble staying
THINKING focused, she answered questions slowly with
minimal responses.

She has feelings of depersonalization and

derealization (extreme feelings of detachment
from the self or the environment), hopelessness
and loss of interest in life.

No hallucinations or illusions were noted but extreme

guilt and suicidal ideations were recognized when
she was convinced that she had made a mistake and
stated “I feel like killing myself”.

 ORIENTATION
IShe was alert and oriented to person, place and time.
She was able to answer questions and recall her past.
 MEMORY
The client was able to recall distant and
recent events. Her thought stream was
decreased. It was also disturbed and her
speech slowed down when mentioning past
unhappiness. She did experience thought
block when exploring sensitivities in her past.
A lot of negative thought disorder was
detected.
INTELLECTUAL FUNCTIONING
The client shows educational level
information. But has trouble
focusing on one topic at a time.
Client has the ability to interpret
and associate situations, proverbs
and comments.
 COGNITIVE
FUNCTIONING
When questioned about her
condition, client accepted the fact
that she is ill and requires treatment.
She has cooperated with doctors and
nurses and is compliant with
management.

 ACTIVITIES FOR THE PATIENT:

EXERCISE
Regular morning exercise has the greatest
impact on depression. Being physically active
prompts the release of brain chemicals such as
neurotransmitters and endorphins, which can
boost mood and ease depression symptoms.
Some exercises can include: Walking, jogging,
swimming, dancing, biking or even hiking.
 YOGA AND
MEDITATION
There has been increasing evidence that
mindfulness meditation or the ability to pay
attention to one's body, thoughts and emotions
in a nonjudgmental way can have an
antidepressant effect. Even simple yoga or
meditation techniques can improve a negative
mood and reduce stress.
 GARDENING
Like cognitive behaviorial therapy, which helps
people redirect thinking, engaging your mind in
something else, particularly something creative,
like gardening, can be helpful and uplifting. With
gardening, the added benefit of being in sunshine
weather permitting can improve outcomes.

 READING
Engrossing yourself in the character in a book’s
story can help shift your mood and move your
thoughts in a new and better direction. For
people who have mild depression, reading a
self-help book or other motivational book
between therapy sessions can be helpful and
might even accelerate recovery.
NURSING CARE PLAN:

RISK FOR SELF-DIRECTED

VIOLENCE
RELATED TO DEPRESSION AS EVIDENCED BY THOUGHTS OF SUICIDE
ASSESSMENT DIAGNOSIS PLANNING
SUBJECTIVE DATA: SHORT TERM GOAL:
Risk for self-directed After 2 days of nursing interventions the
"I feel like killing violence related patient will be able to :
to depression Express her feelings about why she wants
myself" as verbalized
to harm herself.
by the patient. as evidenced by
Verbalize ways on how to recognize levels
thoughts of suicide. of impending self-harm
OBJECTIVE DATA:
Verbalize understanding that self-harm is
Depressed mood a choice
Loss of interest or Assist in identifying thoughts, feelings, and
pleasure behavior that lead up to her wanting to
Weight loss commit suicide
Insomnia Verbalize techniques of coping skills
Restlessness LONG TERM GOAL:
Extreme guilt After 1 week of nursing interventions the
Trouble staying focused patient will be able to :
Thoughts of suicide Demonstrate self-control as evidenced by
relaxed posture and nonviolent behavior
 INTERVENTION
1. Identify the level of suicide precautions.
2. Encourage clients to express feelings (anger,
sadness, guilt) and come up with alternative
ways to handle feelings of anger and
frustration.
3. Encourage and listen to the patient about the
reasons why she wants to harm herself.
4. Facilitate discussion of factors or events that
precipitated the suicidal thoughts.
5. Remove dangerous items from the client's
environment.
6.
RATIONALE
1. A client with a high-risk will require a
constant supervision and a safe
environment.
2. Clients can learn alternative ways of dealing
with overwhelming emotions and gain a sense of
control over her life.
3. To make it easier to communicate with patient
and reduce harm.
4. To discover the cause of behavior to give
optimal care and intervention.
5. To prevent provocation and implementation
of suicide tendencies.
 INTERVENTION
6. Place cliengt in a room with protective
window coverings, as appropriate.
7. Instructed client and significant other in signs
and symptoms, and basic physiology of
depression.
RATIONALE
6. To prevent tendencies of injuring self.
7. To equip client and significant other with
knowledge on what it is and how will it be
managed.
 EVALUATION
SHORT TERM GOAL:
After 2 days of nursing intervention the patient:
Expressed her
feelings about why she wants to harm herself.
Verbalized ways on how to recognize levels of impending self-harm
Verbalized understanding that self-harm is a choice
Assisted in identifying thoughts, feelings, and behavior that lead up to her wanting to
commit suicide
Verbalized techniques of coping skills
GOAL WAS MET

LONG TERM GOAL:

After 1 week of nursing intervention the patient:
Demonstrated self-control as evidenced by relaxed posture and nonviolent behavior
GOAL WAS MET