A patient with moderate depression presents with persistent low mood, fatigue, and difficulty sleeping. Laboratory tests show mildly elevated cortisol levels and mild anemia. Given these findings, which nursing intervention is most appropriate to address the patient's current condition?

C) Initiate a sleep hygiene program to improve sleep quality

A) Encourage the patient to increase physical activity to improve energy levels

B) Educate the patient on the importance of a balanced diet to address anemia

C) Initiate a sleep hygiene program to improve sleep quality

D) Refer the patient for electroconvulsive therapy (ECT) to manage depression

A patient with moderate depression is experiencing persistent fatigue, insomnia, and weight loss. Her blood pressure is 140/90 mmHg, and her heart rate is 105 bpm. Laboratory tests indicate mild anemia and elevated cortisol levels, with normal thyroid function. Which nursing intervention is most appropriate to address both her physiological and psychological symptoms?

A) Encourage the patient to maintain a consistent sleep schedule and incorporate relaxation techniques before bedtime.

B) Advise the patient to increase dietary iron intake to address anemia and monitor blood pressure regularly.

C) Recommend engaging in daily physical activity to improve mood and cardiovascular health.

D) Suggest increasing fluid intake to manage potential dehydration and consult with a dietitian for meal planning.

A patient who recently started on a norepinephrine reuptake inhibitor reports experiencing palpitations and dizziness. The healthcare team suspects these symptoms may be a side effect of the medication. Which nursing intervention is the most appropriate to prioritize for this patient?

D) Monitor the patient's heart rate and blood pressure closely.

A) Educate the patient on the importance of maintaining hydration.

B) Encourage the patient to increase dietary potassium intake.

C) Advise the patient to take their medication at bedtime to reduce side effects.

D) Monitor the patient's heart rate and blood pressure closely.

A patient has recently started on a norepinephrine reuptake inhibitor for depression and reports palpitations and dizziness. The healthcare team found mild hypokalemia and made dietary recommendations along with medication adjustments. What is the most appropriate nursing intervention to prioritize for this patient?

B) Monitor the patient's vital signs and symptoms closely to detect any worsening of the condition.

A) Educate the patient on the importance of adhering to dietary modifications to manage hypokalemia.

B) Monitor the patient's vital signs and symptoms closely to detect any worsening of the condition.

C) Encourage the patient to increase physical activity to enhance mood and energy levels.

D) Schedule more frequent psychotherapy sessions to address depressive symptoms comprehensively.

A patient with a history of anemia and depressive symptoms has shown improvement in palpitations and dizziness after a medication adjustment but continues to experience fatigue and concentration difficulties. Her hemoglobin level is 11.2 g/dL. Which intervention should the nurse prioritize to address the patient's symptoms?

B) Encourage the intake of iron-rich foods and consider iron supplementation.

A) Increase the frequency of physical exercise to improve energy levels and appetite.

B) Encourage the intake of iron-rich foods and consider iron supplementation.

C) Schedule relaxation techniques to manage stress and improve concentration.

D) Administer a multivitamin supplement to address potential nutrient deficiencies.

A patient with stabilized blood pressure and heart rate after a medication adjustment reports persistent fatigue and difficulty concentrating. Laboratory results reveal normalized potassium levels but mild anemia with a hemoglobin level of 11.2 g/dL. What is the most appropriate nursing intervention to address the patient's current symptoms?

B) Encourage increased dietary intake of iron-rich foods and consider iron supplements.

A) Increase the dosage of her current medication to further stabilize her heart rate.

B) Encourage increased dietary intake of iron-rich foods and consider iron supplements.

C) Advise the patient to reduce physical activity to conserve energy.

D) Suggest the patient increase fluid intake to improve blood pressure stability.

A patient with a history of depression and newly diagnosed iron deficiency anemia is experiencing increased fatigue and occasional shortness of breath. After being started on oral iron supplementation, which nursing intervention is most important to ensure the effectiveness of the treatment?

C) Instruct the patient to take the iron supplement with vitamin C to improve absorption.

A) Encourage the patient to take the iron supplement with meals to enhance absorption.

B) Advise the patient to increase intake of calcium-rich foods to support overall health.

C) Instruct the patient to take the iron supplement with vitamin C to improve absorption.

D) Recommend the patient to take the iron supplement at bedtime to minimize gastrointestinal side effects.

A patient with iron deficiency anemia and depression is started on oral iron supplementation. Which nursing intervention is most appropriate to ensure effective absorption of the iron supplement?

B) Instruct the patient to take the iron supplement on an empty stomach with a glass of orange juice.

A) Administer the iron supplement with a glass of milk to enhance absorption.

B) Instruct the patient to take the iron supplement on an empty stomach with a glass of orange juice.

C) Advise the patient to take the iron supplement with meals to reduce gastrointestinal discomfort.

D) Suggest taking the iron supplement just before bedtime to ensure compliance.

A patient with anemia reports gastrointestinal side effects from oral iron supplementation, including constipation and nausea. What is the most appropriate nursing intervention to address these side effects while optimizing iron absorption?

B) Suggest taking the iron supplement with orange juice to enhance absorption

A) Administer the iron supplement with meals to reduce nausea

B) Suggest taking the iron supplement with orange juice to enhance absorption

C) Recommend a lower dose of iron taken more frequently throughout the day

D) Advise discontinuing the iron supplement and focus solely on dietary sources of iron

A patient with iron deficiency anemia is experiencing gastrointestinal side effects from oral iron supplementation, affecting her compliance. Which nursing intervention would best address both her anemia and gastrointestinal discomfort while supporting her mental health needs?

C) Recommend taking iron supplements with food to reduce gastrointestinal upset and adding a stool softener to alleviate constipation.

A) Discontinue iron supplementation and recommend a high-iron diet to manage anemia.

B) Suggest switching to an intravenous iron therapy to bypass gastrointestinal side effects.

C) Recommend taking iron supplements with food to reduce gastrointestinal upset and adding a stool softener to alleviate constipation.

D) Advise taking iron supplements every other day to minimize side effects while exploring cognitive behavioral therapy for mental health support.

Depression - Nursing Case Study

Pathophysiology

• Primary mechanism: Neurotransmitter Imbalance - Depression is largely related to imbalances in neurotransmitters like serotonin, norepinephrine, and dopamine. These chemicals are crucial for mood regulation, and their disrupted levels can impair communication between neurons, leading to mood disturbances.

• Secondary mechanism: HPA Axis Dysregulation - The hypothalamic-pituitary-adrenal (HPA) axis becomes hyperactive in many individuals with depression, causing elevated cortisol levels. This stress hormone can negatively affect brain regions such as the hippocampus, which is involved in emotion and memory, further perpetuating depressive symptoms.

• Key complication: Neuroplasticity Impairment - Chronic stress and neurotransmitter imbalances can lead to reduced neuroplasticity, impacting the brain's ability to adapt and reorganize. This can result in persistent negative thought patterns and difficulty in recovering from depressive episodes.

Patient Profile

Demographics:

34-year-old female, social worker

History:

• Key past medical history: Diagnosed with depression 5 years ago, history of anxiety, occasional migraine

• Current medications: Sertraline 100 mg daily, occasional use of ibuprofen for migraines

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Persistent low mood and fatigue

• Key symptoms: Insomnia, decreased appetite, difficulty concentrating, feelings of worthlessness, occasional headaches

• Vital signs: Blood pressure 138/88 mmHg, heart rate 102 bpm, respiratory rate 18 breaths per minute, temperature 98.6°F, weight loss of 5 pounds in the last month

Section 1

Given the patient's persistent low mood and fatigue, her healthcare provider decided to conduct a comprehensive assessment to gather more information about her current condition. During the initial assessment, the patient was noted to have a flat affect and appeared visibly tired. She reported difficulty sleeping, only achieving about 3-4 hours of broken sleep each night, despite feeling exhausted. Her appetite had significantly decreased, corroborating the recent weight loss. A mental status examination revealed a score indicative of moderate depression, with particular difficulty in tasks requiring sustained attention or memory recall. The patient's blood pressure remained slightly elevated at 140/90 mmHg, and her heart rate was persistently tachycardic at 105 bpm, suggesting a physiological response to her heightened stress levels.

Laboratory tests were ordered to rule out any underlying medical conditions that could be contributing to her symptoms. Results showed a mildly elevated cortisol level, supporting the hypothesis of HPA axis dysregulation. Her thyroid function tests were within normal limits, ruling out hypothyroidism as a potential cause. A complete blood count revealed mild anemia, which could be contributing to her fatigue and lack of energy. The combination of these findings suggests that her current pharmacologic treatment may not be adequately addressing the underlying neurobiological mechanisms contributing to her depression, such as neurotransmitter imbalance and impaired neuroplasticity.

Considering the assessment findings and laboratory results, the healthcare team decided to adjust her treatment plan. The plan included a referral to a psychiatrist for possible medication adjustment, considering the addition of a medication targeting norepinephrine reuptake or an agent that could enhance neuroplasticity. Cognitive behavioral therapy was also recommended to help address negative thought patterns and improve coping strategies. The team emphasized the importance of regular follow-up appointments to monitor her response to these interventions and adjust the care plan as needed. This approach aims to alleviate her depressive symptoms and enhance her overall functioning, potentially reducing the risk of further complications.

Section 2

Following the adjustment in her treatment plan, the patient was scheduled for follow-up appointments to closely monitor her response to the interventions. During the first follow-up, approximately four weeks after initiating the new treatment strategy, the patient reported a slight improvement in her mood and a marginal increase in her energy levels. She noted that her sleep had improved modestly, achieving around 5-6 hours of sleep per night, although it remained fragmented. Despite these positive changes, her appetite continued to be poor, and she had not regained any weight. Her vital signs were reassessed, revealing a blood pressure of 135/85 mmHg and a heart rate of 98 bpm, indicating a slight improvement but still reflective of ongoing stress.

However, during this visit, the patient disclosed experiencing occasional palpitations and episodes of dizziness, which had become more frequent over the past week. Considering these new symptoms and the recent addition of a norepinephrine reuptake inhibitor, the healthcare team suspected a possible side effect of the medication or an imbalance in her autonomic nervous system response. A repeat ECG was ordered, and laboratory tests were conducted to evaluate electrolyte levels, given that disturbances could contribute to her symptoms. The laboratory results showed a mild hypokalemia, which was promptly addressed with dietary modifications and supplementation. The ECG revealed no significant arrhythmias, but the team decided to adjust her medication dosage to mitigate any potential side effects.

The healthcare team emphasized the importance of continued engagement in cognitive behavioral therapy to further address her depressive symptoms and improve her coping mechanisms. The patient was encouraged to maintain a balanced diet to help correct her anemia and electrolyte imbalances. Regular monitoring of her vital signs and symptoms was planned to ensure her safety and provide timely interventions if needed. This comprehensive approach aimed to stabilize her condition, enhance her quality of life, and prevent escalation into more severe complications.

Section 3

Two weeks after the medication adjustment, the patient returned for another follow-up appointment. She reported a significant decrease in the frequency of palpitations and dizziness, suggesting a positive response to the revised medication dosage. However, she still experienced intermittent fatigue and found it challenging to concentrate on daily tasks, which continued to affect her work performance. The healthcare team conducted a thorough physical assessment and noted that her blood pressure had stabilized at 130/80 mmHg, and her heart rate had decreased to 88 bpm, indicating improved autonomic regulation. Despite these improvements, her weight remained unchanged, and she continued to report a lack of appetite.

The team reviewed her laboratory results, which now showed normalized potassium levels, but a hemoglobin level of 11.2 g/dL, indicating persistent mild anemia. Given this information, the team decided to enhance her dietary plan with additional iron-rich foods and consider iron supplementation if necessary. Her cognitive behavioral therapy sessions were increased in frequency to provide further support in managing her depressive symptoms and to work on strategies to improve focus and energy levels.

The healthcare team remained vigilant for any new symptoms or complications, as her overall progress was still fragile. They emphasized the importance of adherence to her treatment plan, regular exercise to boost appetite and energy, and maintaining hydration to aid in electrolyte balance. The patient was scheduled for another follow-up in four weeks, with instructions to report any significant changes in symptoms immediately. This proactive approach aimed to prevent potential complications and optimize her overall recovery.

Section 4

Four weeks later, the patient returned for her follow-up appointment with mixed results. Although she reported a slight improvement in her ability to concentrate and a modest increase in energy levels following the intensified cognitive behavioral therapy sessions, she now mentioned experiencing occasional shortness of breath and increased fatigue, particularly during physical activity. Her vital signs remained stable, with a blood pressure of 128/78 mmHg and a heart rate of 84 bpm. However, her physical assessment revealed pallor and mild tachypnea upon exertion, prompting further investigation.

The healthcare team ordered additional laboratory tests to explore the cause of these new symptoms. The results indicated that her hemoglobin levels had dropped further to 10.5 g/dL, suggesting worsening anemia despite dietary modifications. Additionally, her ferritin levels were low, confirming iron deficiency anemia as a contributing factor to her symptoms. Given these findings, the team decided to initiate oral iron supplementation to address her anemia more aggressively while continuing her current therapeutic regimen for depression.

The patient's case now presented a more complex scenario requiring careful monitoring of her response to the new intervention. The healthcare team emphasized the importance of compliance with iron supplementation and scheduled a follow-up appointment in two weeks to reassess her hematological status and overall well-being. This approach aimed to address the anemia effectively, thereby alleviating her fatigue and enhancing her recovery from depression, while remaining vigilant for any further complications that could arise.

Section 5

Two weeks later, the patient returned for her follow-up appointment. During the visit, she reported feeling slightly more energetic but still experienced significant fatigue and shortness of breath upon exertion. Her compliance with the iron supplementation was confirmed, but she admitted finding it challenging to maintain due to gastrointestinal side effects, including occasional constipation and nausea. Despite these issues, she expressed a determination to continue the regimen in hopes of further improvement.

On examination, her vital signs were stable: blood pressure was 130/80 mmHg and heart rate was 86 bpm. However, the physical assessment revealed persistent pallor and tachypnea with mild exertion. Repeat laboratory tests were conducted to evaluate her response to the iron supplementation. Her hemoglobin had increased marginally to 11.0 g/dL, and ferritin levels showed a slight improvement, indicating some response to the treatment. However, her overall clinical picture suggested that further optimization was needed to effectively manage her anemia and its impact on her depressive symptoms.

The healthcare team decided to address her gastrointestinal side effects by adjusting her iron supplementation regimen, considering options such as a different formulation or adding a stool softener to improve tolerance. Additionally, they discussed potential dietary adjustments to enhance iron absorption. The team also emphasized the need for continued cognitive behavioral therapy and regular monitoring of her mental health status. A multidisciplinary approach involving a dietitian and a mental health specialist was proposed to support her recovery holistically, aiming to alleviate her physical symptoms and promote a more robust response to depression treatment. The plan was to reassess her condition in another two weeks, focusing on both hematological improvements and mental health progress.