ALI GARH College of Nursing and

Post RN BSc Nursing 2nd Professional

Session 2022-2024

Portfolio
Subject: Psychiatric Mental Health Nursing
Principle: Madam Nazia Ahmad
Submitted to: Nayab Tasneem
Submitted by: Nargis Ashiq Ali
Roll No:
Student Cover Letter
Name of Student Nargis Ashiq Ali
Roll No
Class Post RN BSc Nursing 2nd Professional
Teacher Name Ma’am Nayab Tasneem

Respected Ma’am,
I would like to submit my portfolio for your kind and
expert guidance. I hope that you consider my little effort regarding
objectives, and lesson plans are understand. I look forward to my portfolio
with you.
Thank you for your parting special attention.

,Your Obediently
Post RN BSc of Nursing
Ali Garh College of Nursing
Allied Health Science, Lahore
 Acknowledgment
I bow my head before Allah Almighty in gratitude for giving me
the opportunity to make this case study and further for sustaining
interest, which many times did oscillate.

First and foremost my utmost gratitude to Madam Nazia,

Principal Ali Garh College of Nursing, Where sincerity and
encouragement I shall never forget who permitted me to take the
start of this activity.

Who deems it an honor to express our heartiest gratitude and

acknowledge the total support and standards of excellence
provided by Nayab Tasneem, Ali Garh College of Nursing I
would also like to thank my institution, faculty members, my
fellows, seniors and well-wishers. It would be unfair if I would not
say thanks to my patient and his family who helped me for
beautiful formatting of the document.
 Table of Content

Depression
Introduction
Definition
Depression
Etiology
Drugs that cause depression
Depression due to physical illness
Type of depression
Clinical Manifestations
Classification
 Introduction
Depression:
 Depression is a mood disorder that causes a persistent feeling of sadness and loss of
interest in things and activities you once enjoyed. It can also cause difficulty with
thinking, memory, eating, and sleeping.
 It’s normal to feel sad about or grieve over difficult life situations, such as losing your job
or a divorce. But depression is different in that it persists practically every day for at least
two weeks and involves symptoms other than sadness alone.
 Without treatment, depression can get worse and last longer. In severe cases, it can lead
to self-harm or death by suicide.

Definition:
 Depression is a common mental health condition that causes a persistent feeling of
sadness and changes in how you think, sleep, eat and act.

Etiology:
 Genetic causes
 Environmental factors
 Biochemical factors e.g. deficiency of neurotransmitters in certain areas of brain like
dopamine.
 Co-occurring disorders
 Dopaminergic activity :reduce in depression and increase in mania
 Endocrinal factors

Drugs that cause depression:

 Analgesics
  Antihypertensive
 Antidepressants
 Antipsychotics

Depression due to physical illness:

 Viral illness
 Carcinoma
 Thyroid diseases
 Neurological disorders

Types of depression:
 Major Depressive Disorder (MDD)
 When people use the term clinical depression, they are generally referring to major depressive disorder
(MDD). Major depressive disorder is a mood disorder characterized by a number of key features:
 Depressed mood
 Lack of interest in activities normally enjoyed
 Changes in weight
 Changes in sleep
 Fatigue
 Feelings of worthlessness and guilt
 ATYPICAL DEPRESSION
 POST PARTUM DEPRESSION
 PERSISTANT DEPRESSIVE DISORDER
 Bipolar disorder is a mood disorder characterized by periods of abnormally elevated mood known as mania.
These periods can be mild (hypomania).Mania can be so extreme as to cause marked impairment with a person's
life, require hospitalization, or affect a person's sense of reality.
 CATATONIC DEPRESSION
Seasonal Affective Disorder (SAD)
 If you experience depression, sleepiness, and weight gain during the winter months but feel perfectly fine in
spring, you may have a condition known as seasonal affective disorder (SAD)
  Melancholia is severe depression which often has physical symptoms. You might:
 Move more slowly
 Feel sad, down or miserable
 Be completely unable to enjoy anything.
 Psychotic depression:
Sometimes depression can include losing touch with reality or experiencing psychosis. Symptoms of psychotic
depression can include hallucinations, delusions and paranoia.
 Dysthymic disorder
Dysthymia is long-term depression which lasts at least 2 years. It has similar symptoms to major depression, but they’re
less severe.

Clinical Manifestations:
 Persistent sad, anxious, or “empty” mood
 Feelings of hopelessness
 Feelings of guilt, worthlessness, or helplessness
 Loss of interest or pleasure in hobbies and activities
 Decreased energy, fatigue
 Difficulty concentrating
 Difficulty sleeping, waking early in the morning, or oversleeping
 Changes in appetite or unplanned weight changes
 Physical aches or pains, headaches, cramps, or digestive problems.
 Thoughts of death or suicide or suicide attempts

Classification:
 Depression may be classified as:
 mild
 moderate
 severe, also called “major”
 MILD: mild depression involves more than just feeling blue temporarily. Your symptoms can go on for days and
are noticeable enough to interfere with your usual activities.
 Mild depression may cause:
  irritability or anger
 hopelessness

Moderate:
 Is the next level up from mild cases. Moderate and mild depression share similar symptoms. Additionally,
moderate depression may cause:
 problems with self-esteem
 reduced productivity
 feelings of worthlessness
 increased sensitivities
 excessive worrying

Severe:
 Severe (major) depression is classified as having the symptoms of mild to moderate depression, but the symptoms
are severe and noticeable, even to your loved ones.
 Episodes of major depression last an average of six months or longer. Sometimes severe depression can go away
after a while, but it can also be recurrent for some people.
 delusions
 hallucinations
 suicidal thoughts or behaviors

Treatment Measures for Depression:

NON PHARMACOLOGICAL THERAPY:
Lifestyle changes:
Stress reduction
Sleep
Social support
Psychotherapy:
Cognitive behavioral therapy
Interpersonal therapy
Psychodynamic therapy
 Electroconvulsive therapy

Pharmacological Treatment:
 Several drug classes and drugs can be used to treat depression:
 Selective serotonin reuptake inhibitors (SSRIs)
 Serotonin modulators
 Serotonin-norepinephrine reuptake inhibitors
 Norepinephrine-dopamine reuptake inhibitor
Nursing Interventions:
 Provide for patients’ physical needs.
 Assume active role in initiating communication.
 Educate patient about depression.
 Ask patient whether he thinks about death or suicide
 Provide a routine and schedule.
 Encourage and coach
 Provide nutritious snacks, meals, and fluids.
 Build a trusting relationship.
 Help the patient recognize their control.
 Promote safety.
 Administer medications
 Continually re-evaluate suicide risk.
 Build a trusting relationship.
 Help the patient recognize their control.
 Promote safety.
 Administer medications
 Continually re-evaluate suicide risk.
 Nursing Process
Nursing Health History
Demographic data
Name: MR.Y
Age: 41 years’ old
Sex: Male
Marital Status: Unmarried
Nationality: Pakistani
Religion: Islam
Occupation: Jobless
Admission Date: 09April 2019– 6pm
Date of Discharge: --------------------------- Pm
Admitting Impression: less sleep, odd behavior, patient is mute, self-talk
Diagnosis: Schizophrenia
Case scenario and Chief complaint:
This is a case of 41-year-old male patient received on 09 APRIL2019 from psychiatric OPD to PSYCHIATRIC
WARD of Punjab institute of Mental Hospital Lahore in with chief complaints of disoriented condition
 Odd behavior 10 years
 Self-talk 10 years
 Less sleep
  Pt is mute
History of present illness
H/O Odd behave and remain quit
Past medical history:
There is no significant past medical history .
Past Surgical History:
There is no surgical history.
Family history:
FATHER MOTHER
DIABETES ( -) (-)
HYPERTENSION (-) (-)
ASTHMA (-) (-)
Pulmonary TB (-) (-)

Social and Personal History:

Patient belongs to a Middle class family.
Parameters:
IV line
Cardiac Monitor
Vital Signe 6hrly
Input and Output Chart
Management of nursing.
Management of patient with schizophrenia
 clinical assessment
 Regular vital sign monitoring and level of consciousness.
 promote safety of the client and others
 Establishing therapeutic relationship
 using therapeutic communication

Physical Examination
 General appearance of client:
 An ill looking young client sit on chair in sitting position, , there is disorganized speech,
appeared to be cleaned and hygienic. There is no observable physical deformity or abnormality.
 Physique:
 Normal
 Consciousness:
 GCS of 15/15.
 Skin:
 General color Brown
Texture Smooth
Turgor Normal
Temperature Warm
Moisture Dry

 Nails:
Pallor -ve
Cyanosis -ve
Clubbing -ve

 Eyes:
Lids Symmetrical
Conjunctiva normal
Sclera Normal
Reaction to light R- brisk
L - brisk

 Nose:
Mucosa Pink
Patency Both nostrils patent
Smell Normal
Sinuses Not tender
 Mouth:
Mucosa Pink
Teeth
Gums pink

 Vital Signs:
Temperature 98.6 F
Blood Pressure 110/80mmHg
Pulse Rate 82beats per min
Respiratory Rate 16 breath per min
 Cardiovascular System:
Heart Rate 90 beats per min
Heart sound Regular rhythm, absent
murmurs
Peripheral pulses Regular
Capillary refill 2 sec brisk.
Blood pressure 90/60 mmHg
 Respiratory System:
Respiratory rate 12 breath per min
Breathing pattern Shortness of Breathing
Type of respiration Kussmaul Breathing
 Shape of chest Elliptical
Position of trachea Midline
Lung expansion Symmetrical
Percussion sound Resonant
Adventitious breath Absent
sounds
 Abdomen:
Shape Normal
Scar Absent
Bowel sounds Norm active

 Extremities:
Deformity Absent
Range of motion Normal
Muscular tone and Weak
strength
Gait Coordinated
 Neurological assessment:
Communication Disorganized speech
Level of consciousness conscious
GCS 15/15
Behavior anxious

 Complete Blood Examination:

Component Reference Unit 30nov2020 3nov2020 06nov202
value
Hemoglobin 13.0-16.5 G/dl 14.7 12.9 12.9
WBC 4.0-11.0 *10.e 3/uL 8.6 6.0 5.1
Platelet 150-400 *10.e 3/uL 215 244 270
 Renal Profile:

Component Reference Unit 30nov2020 03nov202 06nov2020
value
Urea 15-40 mg/dl 21 -- 22
Creatinine 0.4-1.3 mg/dl 1.0 -- 0.6
 Serum Electrolytes:

Component Reference Unit 30nov2020 03nov2020 06/08/2019
value
Sodium 135-155 mmol/L 142 143 151
Potassium 3.5-5.1 mmol/L 4.5 3.6 3.9
 Chloride 98-107 mmol/L 102 106 100
Magnesium 1.3-2.3 mg/dl 2.0 1.2 2.05
 Liver Function Test:

Component Reference value Unit Patient Value
Bilirubin Total 0.2-1.0 Mg/dl 0.8
Bilirubin Direct 0.3-1.2 Mg/dl --
Bilirubin indirect 0.2-0.8 Mg/dl --
Alkaline 42.308 U/L 245
phosphatase
SGPT Upto40 U/L 19
SGOT 4-5 U/L 29
Albumin 3.4-5.4 G/dl 4.0

DISCHARGE PLAN

Medication:
Risperidone 2-6mg HS

Kempro 5mg OD

Rivotril.5mgBd

Teaching about medications

 Advised patient to take medications regularly with healthy meals
 Drink sugar free fluids and eat sugar free hard candy to ease the anticholinergic effects of dry mouth
 Eat fruits and vegetables
 Advised patient for follow up

NURSING NURSING NURSING NURSING NURSING

ASSESMENT DIAGNOSIS PLANING INTERVENTION EVALUATION

Subjective data: Disturbed Promoting Promoting safety Goal was met

Pt name: Zahid Ali thought safety of client. of client and the client stay
s/o Nasir Ali process Decreased others and right to in reality.
Age/ sex related to anxiety level. privacy and
41yrs/male insomnia as Sustain dignity. Goal was met
Ward: evidence by attention and Therapeutic client
Rehabilitation less concentration to communication demonstrate
center D-Block sleep ,irritabi task and when speech and willingness to
lity ,confuse activity. thought are socialized with
H/o patient d Therapeutic disorganized or others
documented in file communication confused.
odd behavior self- . Used simple
talk and less sleep concrete
Objective data: explanation
Hight:5.5 feet Used destructing
Weight: 60k.g technique.
B.p:110/80mmhg
Temp:98.4f

References:
 References and Sources

 Depression (major depressive disorder) – Symptoms and causes. (2018, February 3). Mayo Clinic. Retrieved
March 17, 2022, from https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-
20356007

 Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurse’s Pocket Guide Diagnoses, Prioritized
Interventions, and Rationales (11th ed.). F. A. Davis Company.

 Mufson, L., Bufka, L., & Wright, C. V. (2016, October 1). Overcoming depression: How psychologists help with
depressive disorders. American Psychological Association. Retrieved March 17, 2022,
from https://www.apa.org/topics/depression/overcoming

 Smith, M., Robinson, L., & Segal, J. (2021, October). Coping with Depression. HelpGuide.org. Retrieved March 17,
2022, from https://www.helpguide.org/articles/depression/coping-with-depression.htm