Nursing Care Plan (NCP) for Mood Disorders (Major Depressive Disorder, Bipolar Disorder)

Upon completion of this nursing care plan for Mood Disorders, focusing on Major Depressive Disorder and Bipolar Disorder, nursing students will be able to:

Understand the Spectrum of Mood Disorders:
- Develop a comprehensive understanding of mood disorders, encompassing Major Depressive Disorder (MDD) and Bipolar Disorder (BD), including the key characteristics, diagnostic criteria, and variations in mood states.
Differentiate Between MDD and BD:
- Differentiate between Major Depressive Disorder and Bipolar Disorder, recognizing the distinct features of depressive episodes, manic or hypomanic episodes, and the potential for mood cycling in individuals with Bipolar Disorder.
Implement Therapeutic Communication:
- Acquire proficiency in therapeutic communication strategies when interacting with individuals affected by mood disorders, fostering trust, empathy, and a supportive therapeutic relationship.
Facilitate Multidisciplinary Collaboration:
- Develop skills in collaborating with a multidisciplinary healthcare team, including psychiatrists, psychologists, social workers, and family members, to provide comprehensive care and support for individuals with mood disorders.
Educate Patients and Caregivers:
- Provide education to individuals with mood disorders and their caregivers on the nature of the conditions, treatment options, coping strategies, and the importance of medication adherence and regular follow-up.

Pathophysiology for Mood Disorders

Mood disorders are a category of mental illnesses that affect a person’s emotional state over a long period of time. Emotions, or moods, may fluctuate frequently and seemingly without any reason. The most common of these are Major Depressive Disorder and Bipolar Disorder. Depression may be a common feature of other mental illnesses but can occur independently as well. Clients with mood disorders are at higher risk for substance abuse and suicidal tendencies.

Research has shown that there is a high incidence of depression among clients who also have chronic medical conditions such as heart disease, cancer, Alzheimer’s disease, and hypertension. Treatment is geared toward managing symptoms through the use of medications and psychotherapy.

Etiology for Mood Disorders

Diagnostic Criteria:

Diagnoses do not include symptoms related to other medical conditions or substance use, does not meet the criteria for another mental illness or psychotic disorder.

Major Depressive Disorder (MDD):

Five or more of the following new symptoms present in the same 2-week period.
- Depressed mood, most days
- Loss of interest or pleasure in most activities
- Significant weight loss or weight gain
- Insomnia or hypersomnia, most days
- Slow or aggravated psychomotor function
- Fatigue or loss of energy, most days
- Feelings of worthlessness or inappropriate guilt, most days
- Inability to think or concentrate, indecisiveness, most days
- Recurrent thoughts of death, without a specific plan or attempt
Symptoms significantly affect social or occupational functioning
Never had a manic or hypomanic episode

Bipolar Disorder (BPD):

One or more manic episodes; or one hypomanic and one major depressive episode
A distinct period of abnormally elevated mood lasting more than 1 week
More than 3 of the following occur during mood disturbance
- Inflated self-esteem
- Decreased need for sleep
- Racing thoughts
- Easily distracted
- Increased activity
- Excess risky or pleasurable activity

Desired Outcome for Mood Disorders

Stabilization of Mood Episodes:
- Achieve stabilization of mood episodes, promoting a balance between depressive and manic/hypomanic states in individuals with Bipolar Disorder. For Major Depressive Disorder, the goal is the resolution of depressive symptoms.
Enhanced Quality of Life:
- Improve the overall quality of life for individuals with mood disorders by addressing symptoms, enhancing coping mechanisms, and promoting a sense of well-being and functionality in daily activities.
Prevention of Recurrence:
- Implement strategies and interventions to prevent the recurrence of mood episodes, minimizing the impact of depressive or manic/hypomanic relapses and enhancing long-term mental health.
Optimal Medication Management:
- Ensure optimal medication management, including appropriate dosages and adherence to prescribed medications. Monitor for side effects and adjust treatment plans as needed to maximize therapeutic benefits.
Empowerment and Coping Skills:
- Empower individuals and their support systems with effective coping skills, psychoeducation, and resources to manage the challenges associated with mood disorders. Foster resilience and self-efficacy in navigating the complexities of these conditions.

Mood Disorders (Major Depressive Disorder, Bipolar Disorder) Nursing Care Plan

Subjective Data:

Prolonged sadness
Change in appetite
Change in sleep patterns
Irritability
Feelings of guilt
Inability to concentrate
Inability to feel pleasure in former interests
Suicidal ideations
Grandiose delusions
Unexplained aches and pains
Increased fatigue (MDD)
Decreased need for rest (BPD)
Significant mood swings

Objective Data:

Pessimism
Reckless behavior
Easily distracted
Racing speech
Tearfulness
Restlessness

Nursing Assessment for Mood Disorders (Major Depressive Disorder, Bipolar Disorder):

Comprehensive Psychosocial Assessment:
- Conduct a comprehensive psychosocial assessment, including personal and family history, social support networks, living conditions, and any recent life events or stressors that may contribute to the development or exacerbation of mood disorders.
Mood and Affect Evaluation:
- Evaluate the individual’s current mood and affect, assessing for signs of depression, mania/hypomania, or mood fluctuations. Use standardized tools to quantify symptom severity and track changes over time.
Suicidality and Self-Harm Risk Assessment:
- Assess the risk of suicidality and self-harm by exploring thoughts, plans, and intent. Evaluate the presence of risk factors and protective factors. Implement appropriate interventions and safety measures based on the assessment.
Cognitive Function and Thought Content:
- Evaluate cognitive function, including concentration, memory, and thought content. Assess for the presence of cognitive distortions, negative thought patterns, and any psychotic features that may accompany mood disorders.
Sleep and Appetite Patterns:
- Explore sleep patterns, including insomnia or hypersomnia, and changes in appetite or weight. These factors can provide valuable insights into the severity and nature of mood disturbances.
Medication History and Adherence:
- Obtain a detailed medication history, including current and past psychiatric medications. Assess medication adherence, potential side effects, and the impact of medications on mood stabilization.
Functional Impairment:
- Evaluate the individual’s level of functional impairment in daily activities, work, and relationships. Identify areas where mood disorders may impact functionality and assess the need for additional support or interventions.

Nursing Interventions and Rationales for Mood Disorders

Assess for level of suicide precautions necessary
- Verbalizes desire to commit suicide
- Has a suicide plan
- Previous/recent suicide attempts

Determine if the client is an active risk to self or others and what safety precautions need to be initiated. Always ask if there is a specific plan.

Initiate suicide precautions as necessary per facility protocol
- Do not leave the client unattended
- Remove unnecessary items from the room that may be used as a weapon (sharp instruments, belts, etc.)

Provide for the safety of the client and others. Follow your facility’s specific protocol regarding supervision and documentation.

Implement a written “no-suicide” contract with the client

Clients who agree to a written contract are often less likely to carry out a suicide plan. It shows the client that they have value.

Obtain history from client or family members regarding any current or a history of substance abuse. Labs may be necessary.

Determine if the client’s symptoms are caused by or exacerbated by the use of drugs or alcohol.

Remove client valuables and send them home with a trusted family member or lock in the facility safe.

Clients experiencing suicidal behaviors or manic episodes may give away valuables or money indiscriminately and may become victims of theft.

Encourage client to talk about feelings and emotions using therapeutic communication techniques

Helps client verbalize and identify the cause of their actions. Builds trust and rapport.

Provide activities that do not require concentration or competition (drawing, walking, exercise, music, etc.)

Clients who are depressed have difficulty concentrating. Allows client time to calm down. Competition (games) can cause aggression – no card games except solitaire.

Provide a calm, relaxing environment

Overstimulation during manic episodes may cause an exacerbation of symptoms

Teach client visualization techniques that replace negative images with positive images

Help improve the client’s self-image and confidence

Minimize environmental stimuli
- Close blinds/curtains
- Keep the door closed to reduce noise
- Limit visitors
- Cluster care

Reduce the chance of overstimulation to minimize aggression or agitation.

Observe for destructive or manipulative behaviors

Clients experiencing mania often have poor impulse control and may become hostile.

Offer and arrange religious counseling as appropriate per client preference and facility protocol

Religious services may be offered, but are not required. Clients often have deep cultural or religious views and may benefit from these services.

Encourage a bedtime routine that may include a warm bath, soothing music, and lack of stimulation. Avoid caffeine.

Promote healthy sleep hygiene and encourage rest and relaxation which can decrease mania and improve mood.

Assist with ADLs by giving short, one-step instructions

Promotes independence while minimizing the stress of complex instructions. Clients often have difficulty concentrating, so using one-step directions is important.

Administer medications appropriately

Antidepressants and antimanic medications may be given to improve client functioning and the effectiveness of interventions.

Antidepressants – SSRI’s, SNRI’s, MAOI’s, TCA’s
Anti-manic – Haloperidol, Benzodiazepines, Lithium

Educate patient on the use of psychiatric medications

Advise patient that a new antidepressant may take up to 4 weeks to show signs of improvement.
Do not suddenly stop taking any antidepressants or mood-stabilizing medications, as adverse effects can occur.
Drinking or using substances is not recommended with most psychiatric medications
Advise patient what to do if a dose is missed (dependent on the medication)
Notify provider or seek immediate medical attention if symptoms worsen or if experiencing suicidal thoughts

Evaluation for Mood Disorders (Major Depressive Disorder, Bipolar Disorder) Care Management:

Symptom Monitoring and Severity Assessment:
- Regularly monitor mood symptoms and assess their severity using standardized tools. Compare current assessments to baseline measures to evaluate the effectiveness of interventions and the progression of symptom management.
Medication Adherence and Side Effects:
- Evaluate medication adherence and monitor for potential side effects. Adjust medication regimens as needed to optimize therapeutic benefits while minimizing adverse effects.
Functionality and Quality of Life Improvement:
- Assess improvements in functionality and overall quality of life. Determine the impact of care interventions on the individual’s ability to engage in daily activities, work, and maintain positive relationships.
Prevention of Recurrence:
- Monitor for the prevention of mood episode recurrence. Evaluate the effectiveness of preventive strategies and interventions in minimizing the frequency and severity of depressive or manic/hypomanic episodes.
Patient Empowerment and Coping Skills:
- Evaluate the individual’s ability to apply coping skills and psychoeducation in managing mood disorder challenges. Assess the level of empowerment and self-efficacy in navigating the complexities of their mental health.

References

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Transcript

In this care plan, we will explore mood disorders, including major depressive disorder and bipolar disorder. So, in this mood disorder care plan, we will cover the desired outcome, the subjective and objective data along with the nursing interventions and rationales.

Now let’s look at our mood disorder care plan, starting with the subjective data. You may notice that the patient is experiencing some prolonged sadness, fatigue, or inability to concentrate, especially when they’re in a depressive episode. They may experience mood swings, where they kind of go from being super happy and energetic, to really sad and tired. This especially happens when the patient goes in between manic depressive episodes. They may experience a change in their sleep or appetite based on their mood.

Now, let’s look at our objective data. You may notice that your patient is being very pessimistic or negative about things, or even really tearful when they’re talking about things, especially when they’re in a depressive episode. A patient that is bipolar might show some really reckless behavior. They might start doing things that they wouldn’t usually do like having unprotected sex with multiple people. They might become very restless and have a racing speech. This would all especially be when they’re in a manic episode.

Now, let’s look at our nursing interventions. You will assess your patient for suicidal and homicidal thoughts and initiate precautions per protocol in your organization, or doctor orders. You want to do this to determine if there’s any danger to themselves or others. You want to always promote safety overall. Remove all their belongings if they’re suicidal, that way they don’t have any weapons available to use. You may want to have the patient sign a suicide contract just saying that they’re not going to commit suicide. This is just going to help make them feel more accountable for not doing this.

Encourage communication about feelings and emotions. This will help you to build trust and rapport with your patient. You want to provide activities that don’t require a lot of concentration or competition. This is going to help them to relax, but also keep busy. Make sure you provide a calm, relaxing environment. You want to help minimize stimulations to help decrease the exacerbation of their symptoms observed for destructive behaviors. They could become hostile. So just keep an eye on them. If you notice, they’re starting to really scratch their arms a lot, or, pace the room, definitely be prepared for anything to happen. Take the precautions as necessary.

You want to provide short, simple instructions. This helps to promote independence. This is going to help them to do what you need them to do, but you’re going to provide those instructions very simply and not make it very complicated for them. So lastly, you want to give medications as ordered by the doctor to help improve the patient’s functioning. You might give medications such as antidepressants or even antipsychotics to help improve that functioning. And you want to decrease symptoms.

We love you guys. Now go out and be your best self today and as always, happy nursing!