Nursing Care for Adult Mental Health

Definition of Depression

Depression is a mood disorder characterized by profound sadness accompanied by intense feelings of frustration, hopelessness, and despair.

Types of Depression

1. Reactive Depression
Also known as Neurotic Depression.
This type of depression develops in response to a stressful life event such as the loss of a loved one, loss of employment, financial loss, or similar circumstances.

2. Psychotic Depression
A type of depression accompanied by delusions, hallucinations, and impaired contact with reality.

3. Manic-Depressive Psychosis (Bipolar Disorder)
The patient experiences episodes of depression alternating with episodes of mania. In some cases, only depressive episodes occur, accompanied by agitation, hallucinations, and delusions.

Problems Experienced by Patients with Depression

• Sleep disturbances: early morning awakening, insomnia, or excessive sleeping.
• Appetite disturbances: changes in eating patterns resulting in weight gain or weight loss.
• Constipation.
• Problems related to personal hygiene.
• Reduced activity and physical movement.
• Slowed thinking.
• Low self-confidence.
• Sadness and anger.
• Suicidal tendencies.
• Delusions or hallucinations in some types of depression.

Nursing Care

1. Maintaining Adequate Nutrition, Fluid Intake, and Elimination

• Observe the patient's food and fluid intake and identify any abnormalities.
• Determine the patient's preferred foods and attempt to provide them along with fruit juices.
• If the patient eats excessively, establish a meal schedule and serve appropriate portions at designated meal times.
• Monitor bowel elimination and manage any problems such as constipation.
• Encourage the patient to consume adequate amounts of fluids.

2. Maintaining an Appropriate Balance Between Sleep, Rest, and Activity

• If the patient spends most of the time in bed, regulate sleeping hours and assist the patient in waking up at the scheduled time.

If the patient is unable to sleep:

1.    Establish regular sleep and rest hours.

2.    Promote sleep by using measures such as a warm bath before bedtime and warm milk.

3.    A brief conversation before bedtime may reduce anxiety and provide reassurance.

4.    Limit daytime sleeping.

5.    Maintain a quiet environment at night and minimize excessive noise.

6.    Administer medications if necessary.

3. Protecting the Patient from Self-Harm

• Maintain a safe environment for the patient.
• Closely observe the patient, particularly during shift changes, holidays, the early stages of antidepressant therapy, sudden behavioral changes, and night shifts.
• Assess the patient for suicidal ideation or suicidal tendencies.

4. Assisting the Patient in Regaining Self-Confidence

• Maintain the patient's personal appearance through daily bathing and proper oral hygiene, facial care, nail care, clean clothing, and overall personal hygiene.
• Encourage participation in simple activities that can be completed easily within a short period, involving a small number of patients and without competition or comparison with others, according to the patient's abilities and interests.
• Praise the patient and provide material or emotional support upon successful completion of activities.

5. Reducing Feelings of Depression

• Encourage the patient to express feelings, listen attentively, and demonstrate acceptance.
• Spend time sitting with the patient, even if silent, allowing the patient to feel comfortable with your presence, and encourage talking or crying.
• Assist the patient in problem-solving, decision-making, behavior modification, and developing effective coping strategies for managing daily stress.