Care plan

CARE PLAN ON DEPRESSION

1. Self-Care Deficit
Nursing Diagnosis
 Self-Care Deficit
May be related to
 Anergia (Decreased or lack of motivation).
 Perceptual or cognitive impairment.
 Severe anxiety.
 Severe preoccupation.
Possibly evidenced by
 Awakening earlier or later than desired.
 Body odor/hair unwashed and unkempt.
 Constipation related to lack of exercise, roughage in diet, and poor fluid intake.
 Consuming insufficient food or nutrients to meet minimum daily requirements.
 Decreased ability to function secondary to sleep deprivation.
 Inability to organize simple steps in hygiene and grooming.
 Persistent insomnia or hypersomnia.
 Weight loss.
Desired Outcomes
 Patient will groom and dress appropriately with help from a nursing staff and/ or
family.
 Patient will regain more normal elimination pattern with aid of foods high in
roughage, increased fluid intake, and exercise daily (also with the aid of medications).
 Patient will sleep between 4 to 6 hours with aid of nursing measures and/or
medications.
 Patient will gain 1 pound a week with encouragement from family, significant others,
and/or staff if significant weight loss is noted.
 Patient will demonstrate progress in the maintenance of adequate hygiene and be
appropriately groomed and dressed (shave/makeup, clothes clean and neat).
 Patient will experience normal elimination with the aid of diet, fluids, and exercise
within 3 weeks.
 Patient will sleep between 6 to 8 hours per night within one month.

2.  Patient will gradually return to weight consistent for height and age or baseline
before illness.
Nursing Interventions Rationale
Bathing and/or Hygiene Self-Care Deficit:
 Encourage the use of soap, washcloth, toothbrush,
shaving equipment, make-up etc.
Being clean and well groomed can
temporarily increase self-esteem.
 Give step-by-step reminders such as “Brush the
teeth “Clean the outer surfaces of your upper teeth,
then your lower teeth. . .”
Slowed thinking and difficulty
concentrating make organizing simple
tasks difficult.
Constipation
 Monitor intake and output, especially the bowel
movements.
Most of the depressed clients are
constipated. If this problem is not
addressed, it can lead to fecal impaction.
 Encourage the intake of nonalcoholic and
noncaffeinated fluids, 6 to 8 glasses a day.
Fluids can help prevent constipation.
 Offer fiber-rich foods and periods of exercise.
Roughage and exercise
stimulate peristalsis and help evacuation
of fecal material.
 Evaluate the need for laxatives and enemas.
These prevent the occurrence of fecal
impaction.
Disturbed Sleep Pattern
 Provide rest periods after activities.
Fatigue can intensify feelings of
depression.
 Encourage relaxation measures in the evening (e.g.,
drinking warm milk, back rub, or tepid bath).
These measures induce sleep and
relaxation.
 Encourage the client to get up and dress and to stay
out of bed during the day.
Minimize sleep during the day increases
the likelihood of sleep at night.
 Reduce environmental and physical stimulants in
the evening; Provide decaffeinated coffee, soft
music, soft lights and quiet activities.
Decreasing caffeine
and epinephrine levels increases the
possibility of sleep.
Imbalanced Nutrition
 Weight the client weekly and observe the eating
patterns of the client.
Give the information needed for revising
the intervention.
 Encourage eating with others.
Increases socialization, decrease focus
on the food.
 Serve foods or drinks the client likes.
Clients are more likely to eat foods they
like.

3.  Encourage small, high-calorie, and high-protein
snacks and fluids frequently throughout the day and
evening if weight loss is noted.
Minimize weight loss, constipation,
and dehydration.






Chronic Low Self-Esteem
Nursing Diagnosis
 Chronic Low Self-Esteem
May be related to
 Biochemical/neurophysiological imbalances.
 Feelings of shame and guilt.
 Impaired cognitive self-appraisal.
 Repeated past failure.
 Unrealistic expectation of self.
Possibly evidenced by
 Evaluates self as unable to deal with events.
 Inability to recognize own achievement.
 Negative view of self and abilities.
 Repeated expression of worthlessness.
 Rejection of a positive feedback.
 Self-negating verbalizations.
Desired Outcomes
 Patient will express belief in self.
 Patient will maintain self-esteem.
 Patient will demonstrate a zest for life and ability to enjoy the present.
 Patient will identify one or two strengths by the end of the day.
 Patient will identify two unrealistic self-expectations and reformulate more realistic life goals
with nurse by the end of the day.

4.  Patient will identify three judgemental terms (e.g., “I am lazy”) client uses to describe self and
identify objective terms to replace them (e.g., ” I do not feel motivated to).
 Patient will keep a daily load and identify on a scale of 1 to 10 (1 being the lowest, 10 being
the highest) feelings of guilt, shame, self-hate.
 Patient will report decreased feelings of guilt, shame and self-hate by using a scale of 1 to 10
(1 being the lowest, 10 being the highest).
 Patient will demonstrate the ability to modify unrealistic self-expectations.
 Patient will give an accurate and nonj udgm ental account of four positive qualities as well as identify two areas he or she wishes
to improve.
Nursing Interventions Rationale
Nursing Assessment
Assess the self-esteem level of the patient.
Signs of a low self-esteem includes withdrawal from
social relationships, feeling of inadequacy, neglect of
personal hygiene and dress, and rejecting self which
all may indicate a negative thought pattern.
Therapeutic Interventions
Allow the patient to perform personal care activities.
Paying attention to grooming serves as a first step
towards achieving positive self-image.
Give positive feedback after a task is achieved.
Positive reinforcement has a big part in building self-
esteem.
Allow the patient to engage in simple recreational
activities, advancing to a more complex activities in a
group environment.
Patient may feel overwhelmed at the start when
participating in a group setting.
Teach visualization techniques that can help the client
replace negative self-images with more positive images
and thought.
To promote a healthier and more realistic self-image
by helping the client choose more positive thoughts
and actions.

5. Encourage the client to participate in a group therapy
where the members share the same situations/feelings
that they have.
To minimize the feelings of isolation and provide an
atmosphere where positive feedback and a more
realistic appraisal of self are available.
Evaluate client’s need for assertiveness training tools to
pursue things he or she wants or needs in life. Arrange for
training through community-based programs, personal
counseling, literature etc.
Low self-esteem individuals often have feelings of
unworthiness and have difficulty determining their
needs and wants.
Role model assertiveness. Clients can follow examples/role models.
Involve the client in activities that he or she wants to
improve by using problem-solving skills. Assess and
evaluate the need for more teaching in this area.
Feelings of low self-esteem can interfere with usual
problem-solving abilities.
Work with the client to identify cognitive distortions that
encourage negative self-appraisal. For example:
1. Discounting positive attributes.
2. Mind reading.
3. Overgeneralizations.
4. Self-blame.
Cognitive distortions reinforce negative, inaccurate
perception of self and the world.
1. Focus on negative qualities.
2. Assuming others “do not like me”. for
example, without any real evidence that
assumptions are correct.
3. Taking one fact or event and making a
general rule out of it. (“He always”, I
never”).
4. Consistent self-blame for everything
perceived as negative.