University of Pangasinan

COLLEGE OF ALLIED HEALTH SCIENCES

A.Y. 2020 – 2021

CASE STUDY: MAJOR DEPRESSION

A partial fulfillment for the requirements in NUR 199: Care of Clients with Maladaptive
Patterns of Behavior, Acute, and Chronic
Level III, Summer Class

Submitted to:

PROF. CARLO EMMANUEL E. UMALI

Submitted by:

Alcantara, Jade D.

Alejo, Kristian Joshua

Ang, Ma. Fatima Joy J.

Aquino, Christine Meryl

Bañaga, Trisha Marie C.

Balilia, Janine B.

Ballesteros, Richelle Ann N.

Bartolome, Sherwin Caezar S.

Bautista, CJ C.

Biason, Lorraine L.

Bito, Danielle Carla R.

Cabrera, Samantha S.

Cacho, Luther Carl G.

16 June 2021

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 CASE SCENARIO

Maya, a 19-year-old woman, youngest in a family of 5, has been admitted to a local

acute mental health ward; this is her first admission. Maya was being treated for major

depressive disorder by her psychiatrist. Prior to her admission, Maya stays in her room

most of the day for the last two weeks and attempted to kill herself by cutting her wrists.

Her parents decided to take her to a psychiatric facility for evaluation. In the Psychiatric

ER, after speaking about the circumstances leading up to her suicide attempt Maya

became increasingly tearful and distressed, and started demanding to see her

boyfriend. After being told that her boyfriend was on his way and would arrive in about

10 minutes, Maya became angry demanding medication to calm her down. She then

proceeded to run towards the ward's doors shouting that she wanted to go home. At

that moment her boyfriend arrived on the ward and Maya also immediately calmed

down. During the assessment process Maya disclosed that being angry if she did not

get her way was not unusual for her. She also mentioned that she felt awful after these

bouts of anger. She described herself as a "terrible person who was out of control" and

she just wanted to die. The psychiatrist ordered 20 mg Fluoxetine OD and Olanzapine

20 mg, OD.

ii
 TABLE OF CONTENTS

Title Page ………………………………………………………………. i

Case Scenario ………………………………………………………. ii
Table of Contents ……………………………………………………… iii
I. Introduction ……………………………………………………… 1
II. Patient’s Profile and History ……...……………………………… 3
III. Mental Status Examination ……………………………………… 4
IV. Psychopathology ……………………………………………… 6
V. Process Recording ……………………………………………… 8
VI. Nursing Care Plans ……………………………………………… 11
VII. Drug Studies ……………………………………………………… 17
VIII. References …………………………………….………………... 21

iii
 I. INTRODUCTION

A. Overview

Sadness is a natural part of human experience. People may feel sad or depressed
when a loved one passes away or when they’re going through a life challenge, such as
a divorce or serious illness. These feelings are normally short-lived. When someone
experiences persistent and intense feelings of sadness for extended periods of time,
then they may have a mood disorder such as major depressive disorder (MDD). MDD,
also referred to as clinical depression, is a significant medical condition that can affect
many areas of an individual’s life. It impacts mood and behavior as well as
various physical functions, such as appetite and sleep. Some people have clinical
depression only once on their life, while others have it several times in a lifetime. Major
depression can sometimes occur from one generation to the next in families, but often it
may affect people with no family history of the illness. A health professional – such as
primary doctors or a psychiatrist can make a diagnosis of major depressive disorder
based on the symptoms, feelings and behavior of an individual.

To be diagnosed with major depressive disorder, there is a symptom criterion to

meet listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition
(DSM 5). This manual helps medical professionals diagnose mental health conditions.
According to the criteria; an individual must experience a change in previous
functioning, symptoms must occur for a period of 2 or more weeks, and at least one
symptom is either (1) depressed mood, or (2) loss of interest and pleasure. Depending
on the number and severity of symptoms, a depressive episode can be categorized as
mild, moderate, or severe. In Maya’s case, these symptoms are present within 2 weeks
prior to her admission to the psychiatric facility:

• Depressed mood most of the day as she appears tearful and distressed as
observed by others. (Adolescents are more prone to irritable mood.)
• Feelings of worthlessness as evidenced by the patient describing herself as a
“terrible person who was out of control.”

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 • Feelings of guilt as the patient disclosed being angry if she didn’t get something on
her way was not unusual for her, then feel awful afterwards.

• Markedly diminished interest or pleasure in almost all activities every day, called
anhedonia as manifested by social isolation and disinterest in interaction as Maya
stayed in her room most of the time for 2 weeks.

• Recurring thoughts of death as Maya always think that she is a terrible person and
just wanted to die.

• Suicidal thoughts which lead to suicide attempts as manifested by cuts on her wrists.

The exact cause of MDD is unknown. However, there are several factors that can
increase your risk of developing the condition. A combination of genes and stress can
affect brain chemistry and reduce the ability to maintain mood stability. Changes in the
balance of hormones might also contribute to the development of MDD. Although
depression can and does affect people of all ages, from all walks of life, the risk of
becoming depressed is increased by poverty, unemployment, life events such as the
death of a loved one or a relationship break-up, physical illness and problems caused
by alcohol and drug use. At a global level, over 300 million people are estimated to
suffer from depression, equivalent to 4.4% of the world’s population. The number of
persons with common mental disorders globally is going up, particularly in lower-income
countries, because the population is growing and more people are living to the age
when depression and anxiety most commonly occurs. Depression is more common
among females (5.1%) than males (3.6%). Prevalence varies by WHO Region, from a
low of 2.6% among males in the Western Pacific Region to 5.9% among females in the
African Region. Prevalence rates vary by age, peaking in older adulthood (above 7.5%
among females aged 55-74 years, and above 5.5% among males). Depression also
occurs in children and adolescents below the age of 15 years, but at a lower level than
older age groups. This reflects the overall growth of the global population, as well as a
proportionate increase in the age groups at which depression is more prevalent.

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 II. PATIENT’S PROFILE AND HISTORY

Patient’s Demographic Profile

Maya is a 19-year-old female adolescent and is the youngest in a family of 5. The

World Health Organization (WHO) defines an adolescent as any person between ages
10 and 19. Adolescence is the transitional phase of growth and development between
childhood and adulthood. The transition from childhood to adulthood involves dramatic
physical, sexual, psychological and social developmental changes, all taking place at
the same time. Adolescence undergo three primary developmental stages of
adolescence and young adulthood; early adolescence (10-14), middle adolescence (15-
17), and late adolescence/young adulthood (18-24).
Chief Complaint
Maya is diagnosed with Major Depressive Disorder. Maya appears to be tearful
and distressed when speaking about the circumstances leading to her suicide attempts.
She also appears to be demanding of her boyfriend during her episodes. She also
stated that she feels awful after bouts of anger and described herself as a terrible
person and wanted to die.
History of Present Illness
Prior to admission, Maya stays in her room on most days for the last two weeks
and attempted to kill herself by cutting her wrists. This leads to her parent’s decision to
take her to a psychiatric facility for evaluation. The reasons behind a teen's suicide or
attempted suicide can be complex. Although suicide is relatively rare among children,
the rate of suicides and suicide attempts increases greatly during adolescence.
Past Psychiatric History
Maya is admitted to a local acute mental health ward and it’s her first admission.
She has no history of any psychiatric illness in the past. Though during the assessment
process, she disclosed that she always gets angry whenever things don’t go on her
liking and feel awful afterwards.
Medical History
Maya often stays to her room most of the day for the last two weeks and
attempted to kill herself by cutting her wrists, prior to admission. Rather than that, there
is no known medical issues, allergies or any drug intolerance.
Family History
There was no history of any psychiatric or neurologic illness in the family.

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 III. MENTAL STATUS EXAMINATION

Patient’s Name: Maya

Diagnosis: Major Depressive Disorder
Age: 19 years old
Date of Admission: June 14, 2021
Pavilion: Acute Mental Health Ward

GENERAL APPEARANCE AND BEHAVIOR

The patient is a 19-year-old female diagnosed with Major Depressive Disorder. Prior
to admission, the patient stayed in her room most days for the last two weeks and
attempted to kill herself by cutting her wrists. In the Psychiatric ER, she appears fearful
and distressed, agitated, and angry after asking about the circumstances leading up to
her suicidal attempt. She demands to see her boyfriend and wants a dose of her
medication during bouts of anger. When calmed down, Ms. Maya disclosed that she felt
awful afterwards and described herself as a terrible person and just wanted to die.
AFFECT
The patient was observed to be ambivalent and has inappropriate affect. This
becomes evident when she demands to see her boyfriend while waiting. When her
boyfriend arrived, she immediately calmed down. This was also observed during her
bouts of anger as she feels awful after her episodes.
MOOD
The patient appears to be tearful and distressed during her interview with the nurse.
This is recognizable as dysphoric mood state as she is observed to have mood swings.
It can also be noted that the patient has labile mood. This was manifested when her mood
drastically changes from one emotion to another when asked to wait for her boyfriend and
immediately calmed down when arrived.
THOUGHT PROCESS
The patient was observed to be incoherent. After asking about the circumstances
leading up to her suicide attempt, Ms. Maya became tearful and distressed.
THOUGHT CONTENT
The patient has thoughts of dying and committing a suicide. This was evidenced
by the cut on her wrists she made as she attempts suicide, prior to admission. The patient

4
also described herself as a “terrible person who was out of control” and just wanted to
die.
COGNITIVE EVALUATION
The patient is well-oriented on her surroundings and on herself. She recalls her suicide
attempt vividly and is fully aware of her actions as she stated that she felt awful after her
bouts of anger.
INSIGHT
The patient is aware that she has psychological issues as she admitted her
inappropriate behaviors. She has accepted her mistake and is willing to adhere to
medication and treatment. The patient understands that compliance to rules and
regulations are also vital for her to get better.
JUDGEMENT
The patient realized that her actions during her distressed moments were incorrect.
She has admitted these behaviors and feels terribly sorry for the way she acted. The
patient understands that she needs to control these emotions through compliance of
medication regimen and therapy.

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 IV. PSYCHOPATHOLOGY

MAJOR
↑ (2x the risk) 1st degree ↓ (low risk) General
DEPRESSION
relatives of a patient with Population
MDD.

Figure 1. Genetic Theory of Major Depression.

Genetic studies implicate the transmission of major depression in first-degree

relatives who are at twice the risk for developing depression compared with the general
population.

Neurotransmitters

2 Major biogenic
amines:

Serotonin Norepinephrine

Figure 2.1 Neurochemical influences of neurotransmitters.

Neurochemical influences of neurotransmitters (chemical messengers) focus on

serotonin and norepinephrine as the two major biogenic amines implicated in mood
disorders.

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 Serotonin
↓ Norepinephrine precursor and
Serotonin levels metabolite
(neuroendocrine
process)

↓ Tryptophan
↓ 5-hydroxyindole
↓ Growth acetic acid
Hormone
DEPRESSION
↑ Cortisol
↑ Prolactin Found in the
blood/CSF of
patients with:
PET results show:
↓ metabolism in
prefrontal cortex

Figure 2.2. Neurochemical Theory of Depression

Serotonin has many roles in behavior: mood, activity, aggressiveness and

irritability, cognition, pain, biorhythms, and neuroendocrine processes (i.e., growth
hormone, cortisol, and prolactin levels are abnormal in depression). Deficits of
serotonin, its precursor tryptophan; negative mood states occur because of lack
of tryptophan and lower tryptophan consumption also led to depressed mood states, or
a metabolite (5-hydroxyindole acetic acid); low levels of 5-hydroxyindole acetic acid can
cause tendency to suicidal behavior, also outside the setting of depression. Deficit of
precursor and metabolite of serotonin found in the blood or cerebrospinal fluid occur in
people with depression.

Positron emission tomography (PET) demonstrates reduced metabolism in the

prefrontal cortex, which may promote depression. Norepinephrine levels may be
deficient in depression and increase in mania. This catecholamine energizes the body
to mobilize during stress a inhibits kindling.

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 V. PROCESS RECORDING (ORIENTATION PHASE)

Name of the Client: Maya

Age: 19 y/o
Diagnosis: Major Depressive Disorder
Setting: Psychiatric Emergency Room
Date of Admission: June 11, 2021
Date/Time of interaction: June 14, 2021

Description of the Patient: The client is a 19-year-old female, youngest in a family of five
and diagnosed with Major Depressive Disorder with self-directed violence.

Description of the Environment: The environment has no source of stressors and only
the psychiatrist and nurse are in the Psychiatric Emergency Room.

Objectives of the Activity: To assess the patient’s mental condition in order to know the
stressors and origin of the patient’s behavior to serve as bases for appropriate
therapeutic techniques for the healing process of Ms. Maya. This activity also wants to
encourage the patient to verbalize her feelings.

NURSE THERAPEUTIC PATIENT ANALYSIS

COMMUNICATION
(Verbal and (Verbal and
TECHNIQUES
Nonverbal) Nonverbal)

“Good Morning Ms. Giving recognition. (Has eye contact to Therapeutic.

Maya. I will be your the nurse and
Have recognized
nurse for today.” became extremely
the patient and
tearful)
giving greeting.

“How are you Broad Openings. “I am not okay! I Therapeutic.

feeling?” feel like I’m always
Recognizing the
out of control!”
patient and
(The patient began encouraging broad
to cry and became openings to
distressed.) conversation

8
"Is this the reason Encouraging “When I lose Therapeutic.
for your sadness?" expression. myself, I feel like I
Encourages the
am a bad person.”
client to verbalize
(Her voice became her feelings
quiet and modest towards her
and her body condition.
posture reveals
that she is
uncomfortable.)
"How are you Exploring "I want to see my Therapeutic.
reducing or boyfriend."
To explore the
eliminating these
(The patient was problem of the
feelings?"
stunned and client to understand
became silent, with his own perceptions
a sad expression with regards to the
on her face.) topic.

“Does he help you Clarifying "I need medicine! Therapeutic.

relax?” Give me medicine
Restating the
to make me feel
“We called your patient’s
better!"
boyfriend and he verbalization to
said he will be here (The patient avoid
in ten minutes.” became angry and misunderstanding.
her voice became
hostile.)

"It's not yet Disagreeing "I want to go home! Non therapeutic.

necessary to take I want to go home!
Disagreeing to the
your medications Let me go home!"
patient to present
ma'am; let us finish
(The patient yelled reality.
this interview first."
and run towards
the ward’s door.)

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 At that moment her boyfriend arrived on the ward and the patient immediately calmed
down.
“How do you feel Encouraging "I'm embarrassed Therapeutic.
after your bouts of description of of my sudden
Encouraging the
anger?" perceptions outburst of anger."
patient to verbalize
(Maya’s speech his own perception
turned quiet and in regards to the
polite. She also situation.
made eye contact
as if she was about
to cry.)
“How do you feel Focusing “I feel terrible…... I Therapeutic.
when you’re just want to die."
Focusing on the
completely out of
(The patient starts topic to delve in
control?"
frowning her with the patient’s
eyebrows and perception.
started tearing up
due to extreme
frustration and
irritation.)

Evaluation: The objective was met, the appropriate therapeutic techniques for the
healing process of Ms. Maya were correctly identified. The patient was also able to
verbalize her feelings towards her condition.
Inclusive date of Duty: June 14, 2021

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 VI. NURSING CARE PLANS

PHINMA University of Pangasinan

College of Health Sciences

ASSESSME EXPLANATION OF THE PLANNING INTERVENTIO RATIONALE EVALUATIO

NT PROBLEM NS N
Objective Disturbed Thought Goal: 1. Developing a 1. Reduce Goal met.
Data: supportive anxiety and
- Patient Processes describes an - After a day environment emotion. After a day of
appears individual with altered of nursing and client- 2. Noise is a nursing
tearful and perception and cognition intervention, nurse sensory intervention,
distressed the patient relationships overload, the patient
that interferes with daily
during the will be able are which was able to
interview. living. Causes are
to therapeutic. increases demonstrate
- Demanding biochemical or demonstrate 2. Maintain a neuronal the cognitive
behavior. psychological disturbances the cognitive pleasant and disorders. ability to
like depression and person ability to quiet 3. Improve undergo the
ality disorders. For undergo the environment. understandi consequence
consequenc 3. Use a rather ng. Speech s of stressful
instance, Maya has major es of low voice high and events on the
depressive disorder and it stressful and speak hard to emotions and
can be said that she is events on slowly to the cause stress thoughts of
suspicious of others, that’s the emotions client. which suicide.
and 4. Give positive sparked
why she appears
thoughts of feedback for angry
demanding to see her suicide. the client’s confrontatio After 8 hours
boyfriend. This results into successes of nursing

11
 NURSING alteration in societal 5. Show ns and intervention,
DIAGNOSIS empathy responses. the patient is
Disturbed participation (evidenced by
Objectives: regarding 4. Positive able to:
Thought her social isolation and the client’s feedback for
Process disinterest in interaction), After 8 hours of feelings; genuine - Develop
related to nursing reassure the success strategies
inability to meet basic
depressed intervention, client of your enhances to
mood. needs, and inappropriate the patient will presence the client's overcome
use of defense mechanisms be able to: and sense of negative
such as being in angry state acceptance well-being self-
- Develop
when being asked and helps assumptio
strategies 6. Scheduled
questions about her suicide make non- n.
to structure delusional - Recognize
attempts which results into overcome activity and reality a behavior.
shouting or running towards negative rest periods. more
self-
the door. positive
assumptio
situation for
n.
the client
- Recognize
5. Empathy
behavior.
conveys
your caring,
interest and
acceptance
of the client.
6. Provides
stimulation
while
reducing the
fatigue.

12
 ASSESSMENT EXPLANATION OF PLANNING INTERVENTIONS RATIONALE EVALUATION
THE PROBLEM
Subjective Data: Ineffective coping is Goal: 1. Provide a safe 1. Physical safety - Goal met.
“I am a terrible environment for of the client is a
person who was the inability to form the client. priority. Many
- After a day After a day of
out of control.” As a valid appraisal of of nursing 2. Continually common items nursing
verbalized by the the stressors, intervention, assess the may be used in intervention,
patient. the patient client’s potential self-destructive the patient is
inadequate choices
will be able for suicide. manner. able to:
- Suicidal of practiced Remain aware of 2. Clients with
to:
thoughts or response and/or this suicide depression may
- Engage in - Engage in
ideas. potential at all have a potential
inability to use reality-based reality-based
times. for suicide that
Objective Data: available resources. interactions 3. Spend time with may or may not interactions
- Suicidal In Maya’s case, within 24 the client. be expressed within 24
behavior and hours, and; 4. Use silence and and that may hours, and;
when she is being
attempts. - Express active listening change in time. - Express
- Extreme guilt asked about anger and when interacting 3. Your physical anger and
as she stated questions that led to hostility with the client. presence is hostility
she feel awful her suicide outwardly in Let the client realty. outwardly in
after her bouts a safe know you are 4. Your presence a safe
attempts, she concerned and and use of
of anger. manner. manner such
- Hostile became tearful and you consider the active listening as make
behavior is distressed. Instead Objectives: client a will simple talks
evident during worthwhile communicate with the staff.
of answering and
interview as - After 8 hours person. your interest and
she appears finishing the 5. Encourage the concern.
of nursing After 8 hours of
distressed and interview first, she client to ventilate 5. Expressing
intervention, nursing
angry demands to see her feelings in feelings may
the patient intervention,
demanding to whatever way is help relieve

13
 see her boyfriend will be able comfortable. Let despair, the patient is
boyfriend. to: the client know hopelessness, able to:
- Poor immediately. She that you’ll listen and so forth. you
- Express
concentration also asks for feelings and accept what must remain - Express
due to running medications to directly with is being nonjudgmental feelings
through the congruent expressed. about the client’s directly and
make her calm
ward’s doors verbal and 6. Talk with the feelings and verbally in
during the instead of waiting client about express this to
nonverbal with
interview. patiently for him. coping strategies the client.
messages. nonverbal
in the past. 6. The client may
She also ran - Identify a cues.
NURSING Explore which have had
DIAGNOSIS towards the ward’s support strategies have success using - Identify a
Ineffective coping doors and will not system in the been successful coping support
related to community. and which may strategies in the system in the
stop unless she
depression as have led to past but may community
sees her boyfriend. negative have lost the such as her
evidenced by
lack of problem- consequences. confidence in boyfriend and
solving skills, 7. Teach the client herself or in her mother.
about positive ability to cope
poor
coping strategies with stressors
concentration
and stress and feelings.
and alteration in management 7. The client may
social interaction. skills. have limited or
no knowledge of
stress
management
techniques.

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ASSESSMENT EXPLANATION PLANNING INTERVENTIONS RATIONALE EVALUATION
OF THE
PROBLEM
Objective Risk for Self- Short term: 1. Introduce self 1. This will help Short term:
Data: and intention client build his
- The patient Directed Violence ● At the end of 4 trust with the ● After 4 hours of
during the first
appears can possibly be hours of phase of nurse; ensuring nursing
tearful, evidenced by nursing that it is a intervention,
interaction
stressed, interventions, professional the patient is
previous attempts 2. Interact with
angry and type of
the patient will the client at a able remain
demanding. of violence, interaction and
remain safe slow pace, will ensure
safe without
suicidal plan, and without any using a low any self-harm
- Cuts on her confidentiality.
suicidal behavior. self-harm firm tone. 2. This will during
wrists.
In congruent with during 3. Do not hurry promote a hospitalization
- Suicidal hospitalization the client into positive and and is able to
Maya, she also
behavior. and verbalize an interaction, trusting and verbalize
had a history of feelings; environment feelings;
instead
suicide attempts 2 express maintain a with the client expressed
- Self-isolation
weeks prior to decreased considering that decreased
therapeutic
anxiety and depressed anxiety and
admission by and reassuring
clients may be
anger atmosphere anger
cutting her own unresponsive
appropriately. that you are for some
appropriately.
NURSING wrists. Risk available if he reasons.
DIAGNOSIS factors may Long term goal: is already 3. Sometimes
Risk for self- include loneliness, ready to talk or clients who are Long term goal:
directed ● After a day of share his depressed may
social isolation, ● After a day of
violence as nursing thoughts with have some
evidenced by major depression interventions, emotional nursing
you.
suicide anhedonia or the patient will 4. Determine outbursts. Be interventions,
attempts substance abuse. verbalize 2 wary of these the patient is
whether the
people she can nonverbal cues able to
With Maya she patient shows
talk to when and provide verbalize 2
signs that will

15
stayed on her she needs lead to comforting people she can
emotional harming self gestures as it talk to when
room most of the would lessen
assistance, 5. Determine she needs
time for 2 weeks and; history of his exaggerated emotional
emotions.
and has been ● The patient will suicide/self- assistance.
4. To prevent
diagnosed with verbalize 3 harming ● The patient is
occurrence of
major depression coping attempts harming oneself able to
techniques to 6. Identify the planned suicide verbalize 3
disorder. These help her. level of suicide 5. To know if there coping
can be the caused precautions is a pattern of techniques that
for her self- needed. occurrence to can help her.
directed harm. 7. Encourage anticipate and
clients to intervene
express immediately
feelings 6. A client with a
(anger, high-risk will
sadness, guilt) require constant
and come up supervision and
with alternative a safe
ways to handle environment.
feelings of 7. Clients can
anger and learn
frustration. alternative
ways of
dealing with
overwhelming
emotions and
gain a sense of
control over
his/her life.

16
 VII. DRUG STUDY

PHINMA University of Pangasinan

College of Health Sciences

NAME OF DRUG MECHANISM CONTRAINDICATION SIDE ADVERSE NURSING

OF ACTION S EFFECTS EFFECTS RESPONSIBILITIE
S
GENERIC NAME Fluoxetine is a The following ● Headache • Excessive ● Administer drug
Selective conditions are • Nervousnes sweating in the morning.
Fluoxetine reuptake inhibitor contraindicated with s ● Pruritus
(SSRI) and as this drug: • Sedation ● Skin rashes ● Monitor
BRAND NAME the name ● Diabetes • Tremor ● Chills nutritional status.
Prozac, Adepssir, suggests, it ● Seizures • Sexual ● Chest pain
Deprexone, exerts it's ● Liver problems dysfunction ● Insomnia ● Monitor mood
Deprizac, therapeutic effect ● Manic behavior • Anorexia ● Fatigue changes and
Neuxetin, by inhibiting the ● Bleeding from • Constipation assess for suicidal
Oxedep, Prodin presynaptic stomach, esophagus • Nausea ideation.
CLASSIFICATIO reuptake of the or duodenum
• Diarrhea
neurotransmitter ● Suicidal thoughts ● Closely monitor
N • Weight loss
Antidepressants, serotonin. As a ● Serotonin Syndrome for serotonin
Selective result, levels of ● Hardening of the syndrome.
Serotonin, 5- liver
Reuptake hydroxytryptamin ● Decreased appetite ● Instruct patient to
Inhibitors e (5-HT) are maintain good oral
(SSRIs) increased in hygiene.
various parts of
the brain. ● Assess for
Further, sensitivity reactions
fluoxetine has

17
 INDICATION high affinity for 5- after administration
Major Depressive HT transporters, of this drug.
Disorder, weak affinity for
Obsessive noradrenaline ● Document hour,
Compulsive transporters and amount, and
Disorder, Panic no affinity for medication.
Disorder, Bulimia dopamine
Nervosa, transporters
Depressive indicating that it
Episodes is 5-HT selective.
associated with
bipolar I disorder Fluoxetine
interacts to a
DOSAGE & degree with the
FREQUENCY 5-HT2C receptor
and it has been
20mg OD suggested that
through this
mechanism, it is
able to increase
noradrenaline
and dopamine
levels in the
prefrontal cortex.

18
NAME OF DRUG MECHANISM CONTRAINDICATION SIDE ADVERSE NURSING
OF ACTION S EFFECTS EFFECTS RESPONSIBILITIE
S
GENERIC NAME ⚫ Myeloprofilerative ⚫ Constipatio ⚫ Akathisia ⚫ Inspect IM
The activity of disorder n ⚫ Dizziness solution for
Olanzapine olanzapine is ⚫ Severe CNS ⚫ Insomnia ⚫ Nervousnes particulate
achieved by the depression ⚫ Dry mouth s matter and
BRAND NAME antagonism of ⚫ Comatose state ⚫ Drowsines ⚫ Tardive discoloration
multiple neuronal ⚫ Lactation s dyskinesia before
Zyprexa receptors ⚫ Tremor ⚫ Neuroleptic administration.
including the ⚫ Weight malignant ⚫ Encourage
dopamine gain syndrome patient to void
CLASSIFICATIO receptor D1, D2, ⚫ Orthostatic before taking
N D3 and D4 in the hypotension the drug to help
brain, the ⚫ Peripheral decrease
serotonin edema anticholinergic
Antiphysotic,
receptors effects of
Dopaminergic
5HT2A, 5HT2C, urinary
blocker
5HT3 and 5HT6, retention
the alpha-1 ⚫ Monitor
adrenergic elevations of
INDICATION receptor, the temperature
histamine and
receptor H1 and differentiate
Schizophrenia multiple between
muscarinic infection and
receptors. neuroleptic
malignant
Olanzapine syndrome.
presents a wide ⚫ Monitor for
profile of targets, orthostatic
however, its hypotension

19
 DOSAGE & antagonistic and provide
FREQUENCY effect towards appropriate
the dopamine D2 safety
20 mg, OD receptor in the measures as
mesolimbic needed.
pathway is key ⚫ Check the
as it blocks patient’s
dopamine from medical record
having a for an allergy or
potential action contraindicatio
at the post- n to the
synaptic prescribe
receptor. The medication.
binding of
olanzapine to the
dopamine D2
receptors is
easily
dissociable and
hence, it allows
for a certain
degree of
dopamine
neurotransmissio
n

20
 VIII. REFERENCES

Kerr, M. (2020). Major Depressive Disorder (Clinical Depression). Healthline.

https://www.healthline.com/health/clinical-depression

Bhandari, S. (2020). Major Depression (Clinical Depression). WebMD.

https://www.webmd.com/depression/guide/major-depression

World Health Organization. (2017). Depression and other Mental Disorders. Global
Health Estimates, 7-9. https://apps.who.int/iris/bitstream/handle/10665/254610/WHO-
MSD-MER-2017.2-eng.pdf

Halverson, J.L. (2019). What are common expressions of dysphoric moods in major
depressive disorder? (Clinical Depression). Medscape.
https://www.medscape.com/answers/286759-14686/what-are-common-expressions-of-
dysphoric-moods-in-major-depressive-disorder-clinical-depression

Gulanick, M., & Myers, J.L. (2017). Nursing Care Plans: Diagnosis, Care Plans &
Outcomes. St. Louis, MO: Elsevier. https://nursestudy.net/self-care-deficit-nursing-care-
plans/

Bains, N., & Abdijadid, S. (2021). Major Depressive Disorder. NCBI.

https://www.ncbi.nlm.nih.gov/books/NBK559078/

Jain, N.K. (2018). Pathology of Depression.

https://www.slideshare.net/NemkumarJain2/pathophysiology-of-depression-
93240319?fbclid=IwAR07JBxaUczxEZGSJIg75z-
8LsT5mswNP1RFu6OwqM2uuDeVd9l-CN6c_9U

Cunha, J.P. (2020). Olanzapine. RxList.

https://www.rxlist.com/consumer_olanzapine/drugs-condition.htm

21
Videbeck, S.L., (2020). Psychiatric-Mental Health Nursing. (Eight Edition). Wolters
Kluwer.

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