Major Depressive Disorder

Symptoms of anxiety, Sullivan’s interpersonal model focuses on anxiety as the point of intervention.
Using the Sullivan model during the initial assessment, the nurse should focus on which area?

Tell me more about your anxiety, this statement encourages the client to talk openly about her anxiety.
what should the nurse say to elicit the most subjective information from the client?

The nurse recognizes this is as severe, the individual with severe anxiety can only focus on a narrowed area of concern.
Joan is having an extreme amount of stress at work, she has filed multiple harassment complaints against her boss. she states she has to “hold” herself to “higher set of standards” because her boss uses a stricter set of standards for her performance.

Theory of Social Interaction,
the nurse will use the theory of Social interaction because Joan has identified that difficulties with social interaction have contributed to her anxiety.
Which model or theory is likely to produce the most effective results when treating Joan’s anxiety?

Tell me more about your chest pain. It is important for the nurse to understand the clients perception of the problems before making further recommendations.
Joan tells the nurse she sweats all the time and occasionally has chest pain, she also complains about numbness in her arms and hands.

Infective coping related to interpersonal conflicts. From the subjective data presented the clients difficulty with peers is the only anxiety related diagnosis that the nurse can impact.
Which nursing diagnosis for the client’s anxiety should the nurse record?

Stating the sources for present anxiety. The nurse must understand the client’s perception of the sources of her anxiety in order to help the client.
Joan says her boss is out to get her because she is 52 years old, which behavior should the nurse illicit from the client?

This nursing diagnosis should be added Anxiety related to maturational crisis. Joan appears to be having significant anxiety as a result of her age (level of maturation) and its effect at her job. This perception is the only ideology the nurse can help Joan to overcome.
Joan is worried she is being singled out because of her age and everyone thinks she should be doing better.

What does being 52 years old mean to you? This question encourages Joan to explore the relation between her age and her level of anxiety.
Which question or statement by the nurse will most likely encourage Joan to talk about the issues that are contributing to her anxiety

Measure your anxiety on a scale, then decide when to use Xanax, but do not exceed twice a day. Self monitoring tools promote independence and teach the client to track symptoms.
Joan is prescribed Xanax PRN how should the nurse answer Joan’s question on how to take her medication?

Anxiety level may increase. clients who suffer from anxiety may experience increased anxiety when taking an antidepressant.
What information should the nurse discuss with Joan about Wellbutrin XL

anorexia or bulimia, and seizures. Anorexia and bulimia are both contradictions for Wellbutrin XL because of a higher incidence of seizures experiences by clients treated for bulimia. Clients with a history of seizures are higher risk for seizures when taking this medication.
Before receiving a prescription for Wellburtin the nurse should ensure joan doesn’t have

Do not consume alcohol while taking the medication. Alcohol should not be consumed when taking this medication because it may increase the risk of seizures.
The nurse is teaching about Wellbutrin and Joan asks if it is ok to drink alcohol .

0.5
0.25 mg ordered 0.5 available. take?

The headaches usually go away with a few days. Headaches can happen early in treatment and clients must often be encourages to continue taking their medication.
Several days after starting Wellbutrin Joan says it is giving her headaches.

Have you had any suicide thoughts since starting Wellbutrin? Assessment for dangerousness to oneself or others is always the first priority when assessing the depressed client.
What is the most important question for the nurse to ask once she has started this medication?

How do you plan to hurt yourself? when assessing for suicidal ideation, the nurse must first determine if the client has a means to harm themselves, then the true desire to do self-harm. The second phase of suicide prevention involves making a no-self harm plan. Lastly, the presence/absence of a support system is useful information.
After 4 weeks of therapy Joan calls the clinic crying and says “she has nothing to live for” what question should the nurse ask 1st?

Go to the hospital now because this is a serious situation. At this point, the client should be assessed for possible hospital admission.
Joan states she has thought about taking an overdose of her two prescriptions because she knows this could be lethal. How should the nurse respond to Joan?

The things that happen at work don’t bother me so much. This statement suggests that the clients initial complaints have been resolved.
Joan is admitted to the hospital and is now on 10mg Lexapro at bedtime and 150mg Wellbutrin in the morning what suggests her medication combo is working?

Most clients do better by taking the medicine for a year. Continunung the medication for a minimum of 1 year decreases the chance for future episodes of depression.
6 months after her initial presentation while waiting to be seen by the ANRP she states she wants to stop taking her medication. The nurse should respond

I just tell the boss that nothing she does will upset me. This is reaction formation, a type of defense mechanism that occurs when clients turn their feeling or impulse into their opposites such as Joan’ statement about her boss.
It has now been 1 year since Joan’s initial presentation to the clinic. The nurse is listening to Joan describe her work and recognizes that the client is using reaction formation as a defense mechanism. Which statement by the client is the nurse basing this assessment on?

How do you feel when your boss says something that upsets you? The nurse is encouraging the client to focus on her feelings so she will be able to recognize when stressful events occur and deals with the feelings.
The nurse knows Joan is still easily upset by her boss’ behavior how should the nurse respond?

Assessment
The nurse is concerned about Joan’s apparent continuing difficulties with her boss which standard of the ANA Psychiatric – Mental health Nursing care should the Nurse apply?