During the initial assessment of Sad, which of the following non-pharmacological interventions would be most appropriate to include in her care plan to address her symptoms of early-stage depression?

A) Encouraging regular physical activity

B) Initiating a high-calorie diet

C) Recommending increased caffeine intake

D) Advising complete social isolation

What is the primary goal of non-pharmacological interventions in the initial management of Sad's depressive symptoms?

C) To promote engagement in activities that improve mood and energy levels

A) To completely eliminate all symptoms of depression

B) To prevent the development of psychotic symptoms

C) To promote engagement in activities that improve mood and energy levels

D) To increase food intake to prevent weight loss

Which of the following interventions is most important for the nurse to reinforce during Sad's follow-up visit to support her mental health improvement?

A) Encouraging Sad to maintain her morning walk routine

B) Advising Sad to increase her caffeine intake to boost energy

C) Suggesting Sad avoid social interactions to minimize feeling overwhelmed

D) Recommending Sudden changes in diet to improve mood

Which intervention is most likely to help Sad address her persistent low mood and negative thought patterns?

B) Engage in cognitive-behavioral therapy

A) Increase the frequency of her morning walks

B) Engage in cognitive-behavioral therapy

C) Join a high-intensity exercise class

D) Take nutritional supplements for energy

When a patient reports increased mood stability and slight weight gain during a follow-up visit, what nursing intervention is most appropriate to continue supporting the patient's mental health recovery?

B) Encourage the patient to maintain her current routine and integrate relaxation techniques

A) Discontinue therapy sessions as the patient shows improvement

B) Encourage the patient to maintain her current routine and integrate relaxation techniques

C) Suggest the patient reduce social activities to avoid feeling overwhelmed

D) Advise the patient to focus solely on physical exercise to enhance mood

What is the most appropriate nursing intervention to suggest for Sad to help manage her feelings of being overwhelmed in social settings?

B) Suggest deep breathing exercises

C) Recommend increased caffeine intake

D) Advise avoiding social interactions

During Sad's follow-up appointment, which observation indicates an improvement in her mental health status?

D) Her affect is more consistently bright with better eye contact.

A) She reports occasional struggles with larger decisions.

B) Her blood pressure is 114/76 mmHg.

D) Her affect is more consistently bright with better eye contact.

What is the primary benefit of cognitive-behavioral therapy (CBT) for patients like Sad who experience anxiety in social situations?

B) It helps patients identify and change negative thought patterns.

A) It provides immediate relief from anxiety through medication.

B) It helps patients identify and change negative thought patterns.

C) It teaches patients how to avoid social situations to reduce stress.

D) It focuses on improving physical health to indirectly reduce anxiety.

What key intervention did the nurse suggest to Sad to help manage her occasional headaches?

B) Monitor headaches and take regular breaks from screens

C) Reduce physical activity to avoid fatigue

D) Skip meals to avoid digestive issues

Sad - Nursing Case Study

Pathophysiology

• Primary mechanism: Dysregulation of neurotransmitters, mainly serotonin, norepinephrine, and dopamine, in the brain leads to mood imbalances and feelings of sadness or depression. These neurotransmitters are crucial for mood regulation, motivation, and pleasure.

• Secondary mechanism: Chronic stress and elevated cortisol levels can damage brain structures like the hippocampus and prefrontal cortex, impairing emotional regulation and cognitive function, further contributing to persistent sad feelings.

• Key complication: If unaddressed, these mechanisms can lead to decreased interest in daily activities, impaired functioning, and potential development of major depressive disorder, impacting overall quality of life and health.

Patient Profile

Demographics:

35-year-old female, elementary school teacher

History:

• Key past medical history: No significant past medical history

• Current medications: None

• Allergies: None

Current Presentation:

• Chief complaint: Feeling persistently sad and low energy for the past month

• Key symptoms: Depressed mood, fatigue, decreased interest in daily activities

• Vital signs: Blood pressure 120/80 mmHg, heart rate 72 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F

Section 1

Initial Assessment Findings:

During the initial nursing assessment, Sad presents as a 35-year-old female who appears appropriately groomed but exhibits a flat affect. Her speech is soft and she maintains minimal eye contact. When asked about her mood, Sad describes feeling persistently "down" and "tired," and reports difficulty in finding joy in activities she used to enjoy, such as teaching and socializing with friends. Her appetite has slightly decreased, although she reports no significant weight change. Sad denies any suicidal ideation or thoughts of self-harm, and there is no evidence of psychotic symptoms.

Physical examination reveals no acute distress, and her vital signs remain within normal limits with a blood pressure of 120/80 mmHg, heart rate of 72 bpm, respiratory rate of 16 breaths per minute, and temperature of 98.6°F. A mental status examination shows intact orientation to person, place, and time, but Sad exhibits slowed psychomotor activity. Cognitive testing reveals mild difficulties with concentration and decision-making, which she attributes to her low energy levels and feelings of sadness. These findings suggest early-stage depression, requiring careful monitoring and potential intervention to prevent further decline in her mental health and overall functioning.

The nurse collaborates with Sad to establish a care plan focused on initial non-pharmacological interventions, such as incorporating regular physical activity, engaging in pleasurable activities, and ensuring adequate rest. Sad is receptive to these suggestions, expressing a willingness to try lifestyle modifications to improve her mood and energy levels. The nurse also discusses the potential for cognitive-behavioral therapy and highlights the importance of follow-up appointments to monitor Sad's progress and response to these interventions. These initial steps set the stage for further assessment and potential adjustment of the care plan based on Sad's evolving needs.

Section 2

Response to Interventions:

After two weeks of consistent effort, Sad returns for a follow-up appointment with the nurse. She reports having started a routine of daily morning walks, which she finds mildly refreshing, although she notes some difficulty in maintaining motivation on certain days. She has also reconnected with a small group of friends for weekly coffee meet-ups, which she describes as "nice, but a bit overwhelming at times." Despite these efforts, Sad continues to experience persistent low mood and fatigue, though she acknowledges slight improvements in her energy levels on days when she is more active.

During the follow-up assessment, Sad's vital signs remain stable, with a blood pressure of 118/76 mmHg, heart rate of 70 bpm, respiratory rate of 16 breaths per minute, and temperature of 98.4°F. However, she still exhibits a flat affect and reports ongoing challenges with concentration, particularly at work where decision-making is required. The nurse notes that while there is no significant change in her weight, Sad's appetite remains somewhat reduced.

Given these observations, the nurse discusses with Sad the possibility of incorporating cognitive-behavioral therapy more actively into her care plan, emphasizing its potential benefits in addressing her negative thought patterns and enhancing coping strategies. Sad is open to exploring this option and agrees to a referral for therapy sessions. The nurse reinforces the importance of continuing lifestyle modifications and schedules another follow-up to monitor progress, ensuring Sad understands the gradual nature of improvement with these interventions. This approach aims to support Sad's ongoing recovery and prevent any potential progression of her depressive symptoms.

Section 3

Two weeks after Sad's referral to cognitive-behavioral therapy, she returns for another follow-up visit with the nurse. Sad reports that she has attended her first two therapy sessions, which she describes as insightful yet emotionally taxing. Despite the initial challenges, she expresses a cautious optimism about the potential benefits of therapy. Sad continues her routine of morning walks, noticing a gradual increase in her stamina and a slight uplift in her mood on days she remains active. She also mentions that her weekly coffee meet-ups with friends are becoming more enjoyable, although she still occasionally feels overwhelmed in social settings.

During this visit, Sad's vital signs remain stable: blood pressure is 116/74 mmHg, heart rate is 72 bpm, respiratory rate is 16 breaths per minute, and her temperature is 98.6°F. The nurse observes a slight improvement in Sad's affect, noting that she smiles briefly when discussing her walks and therapy sessions. Sad admits to experiencing fewer difficulties with concentration, although she still struggles with decision-making at work. Her appetite has slightly improved, and there is a modest weight gain of 1.5 pounds, indicating a stabilization in her nutritional status.

The nurse discusses with Sad the importance of continuing her current interventions and encourages her to set small, achievable goals to maintain motivation. Additionally, the nurse suggests integrating relaxation techniques, such as deep breathing exercises or mindfulness, to help manage feelings of overwhelm. Sad agrees to try these new strategies and expresses a desire to continue her progress. The nurse schedules another follow-up appointment in four weeks to reassess Sad's condition and further evaluate her response to the combined interventions. This approach aims to support Sad's continued recovery and reinforce her commitment to her mental health journey.

Section 4

Four weeks later, Sad returns for her scheduled follow-up appointment with the nurse. During the visit, Sad reports that she has been consistently attending her cognitive-behavioral therapy sessions and practicing the relaxation techniques recommended by the nurse. She describes these exercises as particularly helpful in managing her feelings of overwhelm, especially in social situations. As a result, Sad feels more comfortable during her coffee meet-ups with friends and notes that she is beginning to enjoy them more consistently. Her concentration at work has seen further improvement, though she still occasionally struggles with larger decisions.

The nurse conducts a thorough assessment and observes that Sad's affect is more consistently bright, with Sad smiling more frequently and maintaining better eye contact throughout the conversation. Her vital signs remain within normal limits: blood pressure is 114/76 mmHg, heart rate is 70 bpm, respiratory rate is 16 breaths per minute, and her temperature is 98.4°F. Sad's weight has increased by another 1.5 pounds, indicating continued improvement in her nutritional status. She also reports sleeping better, with fewer interruptions throughout the night, which she attributes to the relaxation techniques and increased physical activity.

Encouraged by Sad's progress, the nurse discusses the importance of maintaining her current routine and exploring additional strategies to support her recovery. The nurse suggests incorporating a balanced diet to further enhance her mood and energy levels. Sad expresses a willingness to work on this aspect of her health and agrees to meet with a nutritionist. The nurse emphasizes the need for ongoing monitoring and support, scheduling another follow-up appointment in four weeks to evaluate Sad's continued progress and address any new concerns that may arise as she navigates her mental health journey.

Section 5

Four weeks later, Sad returns for her follow-up appointment, appearing well-groomed and showing a relaxed demeanor. During the initial assessment, the nurse notes that Sad's affect remains bright and her interactions are positive. Sad reports that she has maintained her regular therapy sessions and has also begun incorporating a balanced diet with the guidance of a nutritionist. She feels that these dietary changes have contributed to her increased energy levels and overall well-being. Sad's vital signs are stable: her blood pressure is 112/74 mmHg, heart rate is 68 bpm, respiratory rate is 16 breaths per minute, and her temperature is 98.2°F. She has gained an additional pound, suggesting continued nutritional improvement.

Sad shares that she has started a gentle exercise routine, including yoga and walking, which she finds beneficial in managing stress and enhancing her mood. She notes that the combination of therapy, diet, and exercise has made her feel more resilient and capable of handling daily challenges. However, she mentions experiencing occasional headaches, which she attributes to increased screen time at work. The nurse advises Sad to monitor these headaches and suggests taking regular breaks from screens, ensuring adequate hydration, and maintaining good posture to alleviate symptoms.

Encouraged by Sad's progress, the nurse highlights the importance of maintaining an integrated approach to her mental health, encompassing therapy, nutrition, and physical activity. They agree to continue monitoring her headaches and overall progress, with another follow-up scheduled in four weeks. The nurse also suggests keeping a headache diary to track potential triggers and patterns, which could provide valuable insights for further discussions. This proactive approach aims to ensure Sad's continued improvement and address any minor complications that may arise, reinforcing the holistic management of her mental health.