Prep Assignment for simulation – #4

Assessment of:
The client with Postpartum Depression

Learning Objectives:
1. Assess a postpartum woman and differentiate normal vs abnormal findings.
2. Use therapeutic communication while caring for a postpartum client who is experiencing signs
and symptoms of postpartum depression.
3. Intervene effectively for the client who is experiencing signs and symptoms of postpartum
depression.
4. Evaluate the effectiveness of the interventions for the client experiencing signs and symptoms
of postpartum depression.

Simulation is a clinical experience. As with any clinical assignment, paperwork is to be

complete and provide enough detail to assist the student during the simulation experience.
All assignment must be completed in black ink or typed. Written assignments must be legible.

Due date for this assignment: Assignment must be submitted 24 hours before the student’s
scheduled simulation experience.

Simulation assignments must be submitted via Blackboard under the “Completed

Assignments” tab. Students are encouraged to keep a copy of their assignments as they will
not be returned.

Any student failing to submit the assignment on time via Blackboard will not be allowed to participate
in the experience. If the experience is missed, this will count as a clinical absence and the clinical
absence policy will be followed. The instructor will provide a make-up assignment which will need to
be submitted to the instructor on the date given per the instructor.

Assignments to be completed:

1. Please read Chapter 16 – Depressive Disorders – pages 378-413

2. Complete the depression scenario #7 (Mindy Wright) in the online textbook (Townsend 8 th
edition):
3. Please review the following medication as it pertains to breastfeeding women.
a. Zoloft
4. Read the article contained within the link listed below:

http://www.ppdil.org/symptoms-of-ppmds/?
gclid=EAIaIQobChMI2OW12vix1QIVAalpCh0vuwbNEAMYAyAAEgJOf_D_BwE

Video on “Baby Blues” vs. “Postpartum Depression”

https://www.youtube.com/watch?v=6kaCdrvNGZw

5. The video on the use of the EDPS tool has been linked. Please review to submit the required
information.

https://www.youtube.com/watch?v=Ey3M6hFo3Mw
The information below is to be submitted on Blackboard under the “Completed Assignment
tab” by the student:

1. Results from the assigned interactive (Mindy Wright) clinical scenario #7. The student
must achieve 80% total in order for the assignment to be considered passing.

2. Explain the purpose of the Edinburgh Postnatal Depression Scale (EPDS) tool and how
this information can be used by the nurse. This is a tool to help screen postpartum and
pregnant women for depression. We can use the score to determine whether or not the woman
needs further treatment for depression, such as group therapy or psychopharmacology.

3. In viewing the EPDS assessment tool, identify two (2) assessment questions in which
the nurse should focus on.

a. Focusing on the 10th question would be most pertinent – assessing thoughts of self-
harm or violence.
b. The 6th question asks about things getting on top of the patient – is the patient able to
cope efficiently or does she need help?

4. What medication teaching would you provide your patient for Zoloft?
 Report any new or worsening symptoms to your doctor, such as mood or behavior
changes, anxiety, panic attacks, trouble sleeping, feeling impulsive, agitated, hostile,
hyperactive, or feeling more depressed and having suicidal thoughts.
 Contact doctor immediately if you have a seizure, blurred vision, eye pain or swelling,
signs of low levels of sodium in the body (headache, confusion, memory problems,
severe weakness, feeling unsteady), or any signs of a manic episode.
 Symptoms of serotonin syndrome: agitation, hallucinations, fever, sweating, shivering,
tachycardia, muscle stiffness, twitching, loss of coordination, nausea/vomiting, or
diarrhea.
 Common side effects: drowsiness, tiredness, anxiety/agitation, indigestion, loss of
appetite, sweating, tremors/shaking, sleep problems, decreased sex drive.
 Zoloft is the safest medication to take while breastfeeding. The drug is either
undetectable in the infants blood or is present in insignificant amounts. Very small
amounts of the drug is passed into the breastmilk, so most published reports say that
there are no harmful effects on the nursing infant. Blood tests can be given to the infant
several hours after taking the medication if the mother is worried.

5. What is postpartum depression? 20 % of new moms have a PPMD (postpartum mood disorder) and
80% experience baby blues. After several weeks, a routine is established and the baby blues diminish,
but with PP depression, this becomes a medical problem. Symptoms include insomnia or sleeping too
much, loss of appetite or overeating, nausea, lack of interest in activities, inability to concentrate,
severe mood swings, lethargy or hyperactivity, feelings of helplessness, anxiety, panic attacks,
obsessions, disorientation and confusion, excessive crying, intrusive or repeating thoughts,
hopelessness or lack of control, and inability to care of yourself or baby. Dad can often be the first line
of defense in recognizing the symptoms are lasting longer than they should. Discussing this before the
birth can make it easier for him to take action and reach out if needed.
6. What is the cause of postpartum depression? The rapid fluctuation in sex and stress hormones as
well as thyroid hormones may contribute. Lower levels of the hormone allopregnanolone in the second
trimester were associated with an increased chance of developing PP depression in women already
known to be at risk for the disorder. Other factors include physical changes from the pregnancy,
changes in relationships or work, worries about parenting, and lack of sleep.
 7. Who is at risk to experience postpartum depression? Any new mother can experience these
symptoms of depression or other mood disorders. Women are increased risk during or after pregnancy
if they previously experienced depression or other mood disorders, if they are experiencing very
stressful life events in addition to the pregnancy, or if they do not have the support of family and friends.

Questions to ask:

 Is there anything on the screening tool you completed (EPDS) that you would like to discuss further?
 In the past two weeks, how often have you felt down, depressed, or hopeless?
 Have you had any thought of harming yourself?
 How is your sleep – are you able to sleep when baby sleeps?
 How is your energy?
 How is your appetite?
 Are you having any thoughts that are scaring you?
 Are you able to rest/relax when your baby is being cared for by someone else?
 Are you worried about the way you are feeling or thinking?
 Has anyone talked to you about postpartum depression or anxiety?
 Do you feel you have adequate support at home?
 Is there anything else you would like to tell me about the way you are feeling or the thoughts you are
having?

These feelings can be upsetting, but they are normal. Treatments can include medications, talk therapy, group
therapy, support groups, and in severe cases, ECT or hospitalization.