MENNONITE COLLEGE OF NURSING AT ILLINOIS STATE UNIVERSITY

Gerontological Nursing – NUR 326

Possible Nursing Diagnoses and Interventions for persons with Depression

Nursing Diagnoses / Expected Goals/ Outcomes / Interventions
Altered family processes r/t death of spouse
Dysfunctional grieving r/t denial of death of loved one
Anxiety r/t recent retirement
Hopelessness r/t change in living environment
Ineffective individual coping r/t numerous recent losses
Anxiety r/t recent retirement / Will cope with loss. / 1. Discuss with the client the emotional experience/loss.
2. Assist client in recognizing feelings, such as anxiety, anger, or sadness.
3. Discuss consequences of not dealing with guilt and shame.
4. Listen to expressions of feelings and beliefs.
5. Facilitate client’s identification of usual response pattern in coping with fears.
6. Provide support during denial, anger, bargaining, and acceptance phases of grieving.
7. Identify the function that anger, frustration, and rage serve for the client.
8. Encourage talking or crying as means to decrease the emotional response.
9. Stay with the client and provide assurance of safety and security during periods of anxiety.
10. Provide assistance in decision making.
11. Reduce demand for cognitive functioning when client is ill or fatigued.
12. Refer for counseling, as appropriate.
(McCloskey & Bulechek. (2000). Nursing Interventions Classification, pp. 300.)
Body image disturbance r/t decreased mobility / Will enhance appearance.
Will go about daily routine. / 1. Determine client’s body image expectations based on developmental stage.
2. Assist client to discuss changes caused by illness or surgery, as appropriate.
3. Determine if a recent physical change has been incorporated into client’s body image.
4. Assist client to separate physical appearance from feelings of personal worth, as appropriate.
5. Assist client to discuss changes caused by aging, as appropriate.
6. Teach the client the normal changes in the body associated with aging.
7. Determine if a change in body image has contributed to increased social isolation.
8. Identify means of reducing the impact of any disfigurement through clothing, wigs, or cosmetics, as appropriate.
9. Assist client to identify actions that will enhance appearance.
(McCloskey & Bulechek. (2000). Nursing Interventions Classification, pp. 182.)
High risk for self-directed violence r/t depressed mood
Risk for self-directed violence r/t hopelessness
Risk for self-mutilation r/t body image disturbance / Will not harm self. / 1. Determine presence and degree of suicidal risk.
2. Refer client to mental health care provider for evaluation and treatment of suicide ideation and behavior, as needed.
3. Treat and manage any psychiatric illness or symptoms that may be placing client at risk for suicide (e.g., mood disorder, hallucinations, delusions, panic, substance abuse, grief, personality disorder, organic impairment, crisis).
4. Administer medications as appropriate to decrease anxiety, agitation, or psychosis and to stabilize mood.
5. Monitor for medication side effects and desired outcomes.
6. Contract with client, as appropriate, for “no self-harm” for a specified period of time, recontracting at specified intervals.
7. Interact with the client at regular intervals to convey caring and openness and to provide an opportunity for client to talk about feelings.
8. Utilize direct, nonjudgmental approach in discussing suicide.
9. Encourage client to seek out care providers to talk as urge to harm self occurs.
10. Assist client to identify network of supportive persons and resources (e.g., clergy, family, providers).
11. Initiate suicide precautions for the client who is at serious risk of suicide.
12. Place client in least restrictive environment that allows for necessary level of observation.
13. Search environment routinely and remove dangerous items to maintain it as hazard free.
14. Facilitate support of client by family and friends.
(McCloskey & Bulechek. (2000). Nursing Interventions Classification, pp. 621.)
Impaired social interaction r/t activity intolerance / Will interact with others. / 1. Give positive feedback when patient reaches out to others.
2. Encourage client to change environment, such as going outside or to room.
3. See also Self-esteem disturbance r/t awareness of cognitive deficits.
4. Provide unconditional positive regard.
(McCloskey & Bulechek. (2000). Nursing Interventions Classification, pp. 249-250, 311, 604.)
Powerlessness r/t impaired decision making / Will interact with others. / 1. Monitor client’s statements of self-worth.
2. Determine client’s locus of control.
3. Encourage client to identify strengths.
4. Encourage eye contact in communicating with others.
5. Reinforce the personal strengths that the client identifies.
6. Refrain from negatively criticizing.
7. Assist client to accept dependence on others, as appropriate.
8. Reward or praise client’s progress toward reaching goals.
(McCloskey & Bulechek. (2000). Nursing Interventions Classification, pp. 580.)
Self-care deficit r/t depressed mood / Self care needs will be met. / 1. Monitor client’s ability for independent self-care.
2. Provide assistance until client is fully able to assume self-care.
3. Use consistent repetition of health routines as a means of establishing them.
4. Encourage client to perform normal activities of daily living to level of ability.
5. Encourage independence, but intervene when client is unable to perform.
6. Establish a routine for self-care activities.
(McCloskey & Bulechek. (2000). Nursing Interventions Classification, pp. 575.)
Social isolation r/t recent move
Risk for loneliness r/t social isolation / Will develop a relationship with new neighbor(s). / 1. Encourage enhanced involvement in already established relationships.
2. Encourage patience in developing relationships.
3. Encourage relationships with persons who have common interests and goals.
4. Encourage social and community activities.
5. Encourage sharing of common problems with others.
6. Encourage involvement in totally new interests.
7. Give positive feedback when client reaches out to others.
(McCloskey & Bulechek. (2000). Nursing Interventions Classification, pp. 604.)
Spiritual distress r/t frequent thoughts of death / Will have spiritual needs met. / 1. Be open to client’s expressions of loneliness and powerlessness.
2. Encourage attendance at religious events, if desired.
3. Encourage the use of spiritual resources, if desired.
4. Refer to spiritual advisor of client and family’s choice.
5. Be available to listen to client’s feelings.
6. Express empathy with client’s feelings.
7. Facilitate client’s use of meditation, prayer, and other religious rituals.
(McCloskey & Bulechek. (2000). Nursing Interventions Classification, pp. 607.)

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