Psychiatric Mental Health Nursing by Videbeck

348 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS

to explore anger, dependence, guilt, hopelessness,

helplessness, object loss, interpersonal issues, and ir-

rational beliefs. The goal is to reverse negative views

of the future, improve self-image, and help clients

gain competence and self-mastery. The nurse can

help clients to find a therapist through mental health

centers in specific communities.

Support group participation also helps some

clients and their families. Clients can receive support

and encouragement from others who struggle with

depression, while family members offer support to

one another. The National Alliance for the Mentally

Ill (NAMI) is an organization that can help clients

and families connect with local support groups.

fatal in overdose, but cyclic and MAOI antidepres-
sants are potentially fatal. Prescriptions may need
to be limited to only a 1-week supply at a time if con-
cerns linger about overdose.
An important component of client care is man-
agement of side effects. The nurse must make careful
observations and ask clients pertinent questions to
determine how they are tolerating medications.
Tables 15-1 through 15-4 give specific interventions to
manage side effects of antidepressant medications.
Clients and family must learn how to manage
the medication regimen because clients may need
to take these medications for months, years, or even
a lifetime. Education promotes compliance. Clients
should know how often they need to return for mon-
itoring and diagnostic tests.

PROVIDING CLIENT AND FAMILY TEACHING

Teaching clients and family about depression is im-
portant. They must understand that depression is an
illness not a lack of willpower or motivation. Learn-
ing about the beginning symptoms of relapse may
assist clients to seek treatment early and avoid a
lengthy recurrence.
Clients and family should know that treatment
outcomes are best when psychotherapy and antide-
pressants are combined. Psychotherapy helps clients

◗ CLIENT ANDFAMILYTEACHING

FORDEPRESSION

• Teach about the illness of depression.


• Discuss the importance of support groups and
  assist in locating resources.


• Teach the client and family about the benefits
  of therapy and follow-up appointments.


• Teach the action, side effects, and special
  instructions regarding medications.

NURSING CARE PLAN DEPRESSION

Nursing Diagnosis

➤Ineffective Coping

Inability to form a valid appraisal of the stressors, inadequate choices of practiced

responses, and/or inability to use available resources

ASSESSMENTDATA

• Suicidal ideas or behavior


• Slowed mental processes


• Disordered thoughts


• Feelings of despair, hopelessness, and
  worthlessness


• Guilt


• Anhedonia (inability to experience
  pleasure)


• Disorientation


• Generalized restlessness or agitation

continued on page 349

EXPECTEDOUTCOMES

Immediate

The client will

• Be free from self-inflicted harm


• Engage in reality-based interactions


• Be oriented to person, place, and time


• Express anger or hostility outwardly
  in a safe manner