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Dx: Major Depression Disorder: A recurrent severely depressed mood that…

- - - - Significant weight loss.
        
        Nsg Dx: Risk of malnutrition.
        
        Nursing Action: Weigh the patient weekly, and observe eating patterns.
        
        Outcomes: Patient will comply with diet regimen and verbalize understanding by the second day of being admitted. Patient will avoid any more weight loss by the end of the week of being admitted.
        
        Nursing Action: Encourage small, high-calorie, high-protein snacks and fluids frequently throughout the day and evening.
    - - Nsg Dx: Impaired social functioning
        
        Nursing Action: Increase the patient’s contacts with others, first one, then eventually include group therapy.
        
        Outcomes: The patient will demonstrate progress in sustaining relationships with friends and family after a week of group therapy. Patient implements exercising at least twice a week into daily routine.
        
        Nursing Action: Promote expression of feelings, and refer both patient and family to self-help groups.
        
        Monoamine oxidase inhibitors MAOI's:
        LAST OPTION
        Blocks the destruction of serotonin, norepinephrine, dopamine, and tyramine.
        Side effects: Agitation, anxiety, decrease blood pressure, hypertensive crisis due to interactions with many other medication. Patient should be educated on the diet regimen (avoid tyramine foods!)
        Ex: Phenelzine: Oral tablet 15 mg
        Isocarboxazid: Oral tablet 10 mg
  - - - Mood of sadness, despair, emptiness, hopelessness.
        
        Nsg Dx: Risk of suicide.
        
        Nursing Action: Develop a safety plan with the patient for dealing with feelings of intense hopelessness and despair.
        
        Outcomes: The patient will be free of self-harm by second day of being admitted. Patient will acquire effective coping skills by discharge day.
        
        Nursing Action: Remove harmful objects. Depending on the level of suicidal ideation, patient will be monitor periodically or continually.
        
        Tricyclic antidepressants TCA's:
        -tryptline -ipramine
        inhibits serotonin and norepinephrine reuptake, inhibit alpha receptors.
        Side effects: Dry mouth, constipation, urinary retention, blurred vision, hypotension.
        Ex: Amitriptyline: 40 mg to 100 mg orally per day, maximum dose 150 mg/day
        Doxepin: Oral capsule 75 mg to 150 mg/day, maximum dose 150 mg/day
        Selective Serotonin reuptake inhibitors SSRI's:
        -tine, -line, -pram
        Inhibit the reuptake or serotonin back into the neuron, allowing more serotonin floating around in the brain which will help in approve mood.
        Side effects: Weight gain, insomnia, sexual dysfunction
        Ex: Ciralopram Oral solution (10 mg/5 mL), oral tablet (10 mg, 20 mg, 40 mg)
        Escitalopram Oral tablet 10 mg to 20 mg
    - - Nsg Dx: Impaired activities of daily living.
        
        Nursing Action: Refer patient to therapist to determine underlying cause.
        
        Outcomes: The patient will conduct optimal self-care activities based on personal abilities by the third day after being encourage and shown demonstration. Patient will identify a hobby that he/she is interested in by discharge day.
        
        Nursing Action: Encourage patient to use grooming items such as toothpaste, washcloth, soap, makeup, shaving, etc. To assist in temporarily raise self-esteem.