Depression r/t incapability to bear child

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My client is a 37 y/o F. She underwent hysterectomy and now she is depressed because she knows that she cannot bear a child.

nsg dx: depression r/t incapability to bear child

what could be my interventions?

i just need ideas...

as of now...i haven't thought of any interventions but i'm working on it...still thinking...

any idea is very much appreciated...thanks! Ü

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Specializes in DOU.

I don't know what the nursing textbooks say, but enouraging her to vocalize her feelings, offering emotional support, and exploring alternative ways to create a family would probably be included.

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thanks! Ü

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I agree with the other poster...offer yourself to her to listen and explore possible alternatives.

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yeah..i think that's the only intervention i can do for this nsg dx...

thanks! Ü

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Specializes in med/surg, telemetry, IV therapy, mgmt.

depression is not a nanda diagnosis. it is, in fact, a medical diagnosis. beside that, all nursing diagnoses must have a definition, an etiology, and symptoms. with depression r/t incapability to bear child you are saying that the reason for this patient's depression is caused by the inability to become pregnant and have a baby. but what are the signs and symptoms of this depression? there has to be clear evidence of this depression because that is what your interventions will target. that is why you are having trouble coming up with interventions. doctors treat symptoms and underlying causes, so do we.

i am hesitant to continue on with any intervention suggestions because the diagnosis of depression is a medical one. however, it is most appropriate that you research what the symptoms of depression are:

  • from http://vsearch.nlm.nih.gov/vivisimo/cgi-bin/query-meta?v%3aproject=medlineplus&query=depression&x=51&y=9
    • sadness
    • loss of interest or pleasure in activities you used to enjoy
    • change in weight
    • difficulty sleeping or oversleeping
    • energy loss
    • feelings of worthlessness
    • thoughts of death or suicide

    [*]from http://www.nlm.nih.gov/medlineplus/ency/article/000945.htm

    • a dramatic change in appetite, often with weight gain or loss

    • fatigue

    • feelings of worthlessness, self-hate, and inappropriate guilt

    • extreme difficulty concentrating

    • agitation, restlessness, and irritability

    • feelings of hopelessness and helplessness

    [*]does this describe your patient? from the online merck manual of diagnosis and therapy: http://www.merck.com/mmpe/sec15/ch200/ch200b.html#s15_ch200_t001

    • "depressive disorders are characterized by sadness severe enough or persistent enough to interfere with function and sometimes by decreased interest or pleasure in activities. exact cause is unknown but probably involves heredity, changes in neurotransmitter levels, altered neuroendocrine function, and psychosocial factors. diagnosis is based on history. treatment usually consists of drugs, psychotherapy, or both, and sometimes electroconvulsive therapy." is this patient's depression that serious?

    [*]depression, the medical diagnosis, is defined in taber's cyclopedic medical dictionary as "a mental disorder marked by altered mood". if you have a copy of taber's i urge you to look at the entry for depression because it lists the defining medical symptoms of which the patient must have at least 3:

    • poor appetite with significant weight loss or gain
    • insomnia or hypersomnia
    • psychomotor agitation or retardation
    • feelings of hopelessness
    • loss of energy or fatigue
    • feelings of worthlessness, self-reproach or excessive or inappropriate guilt
    • diminished ability to think or concentrate
    • recurrent thoughts of death, suicidal ideation, a wish to be dead, or attempt at suicide

typically, the way a nursing diagnosis is determined is by doing an extensive assessment of the patient and then collecting all the abnormal data together. the abnormal data represents the evidence that supports any nursing diagnoses that you will decide upon. doctors do this too. they do histories and physical exams and order lab tests and x-rays. they assemble all the data and shift through the abnormal findings. every medical diagnosis has a specific list of symptoms that the patient had better have.

a diagnosis is the resulting decision or opinion that is made after the process of examination or investigation of the facts. doctors have rules by which they diagnose and we nurses have our rules for diagnosing. in most cases, and unless your instructors have given you other directions, we in nursing use the nanda guidelines. we're not as strict about the patient needing to have all the symptoms of a diagnosis to be tagged with it, but they do need to fit within the confines of the problem as it is defined. we're a bit more open and loose about that because we are looking at patient's responses to what is happening to them and that can be very individualized.

let me make this very clear. . .a nursing diagnosis is actually only a short worded label, or name, for a nursing problem. the nursing problem is more precisely stated in the definition of the nursing diagnosis. that is why i mentioned that you needed to define what your nursing problem was.

unless your instructors have told you it is ok to use depression as a nursing diagnosis, i will give you a better way to go with this. see all those symptoms of depression i found and listed above for you? some of them are valid symptoms, or abnormal data, that you should have seen in this patient while you were interacting with her. that is what you need to be interested in as well as her statements she made about her subsequent infertility. we use those symptoms to match them to the defining characteristics (the fancy nanda word for symptoms) that have already been determined for, and are listed with, all the existing nanda nursing diagnoses. every nursing diagnosis has a list of symptoms assigned to it.

some of those are going to be the same symptoms of the medical diagnosis of depression. no one owns exclusive rights on the use of symptoms, so they are free for all of us to use as we like. grieving, the nursing diagnosis, is defined as "a normal complex process that includes emotional, physical, spiritual, social, and intellectual responses and behaviors by which individuals, families, and communities incorporate an actual, anticipated, or perceived loss into their daily lives." (page 96, nanda-i nursing diagnoses: definitions & classification 2007-2008). while the ackley/ladwig website states this is not an accepted nanda diagnosis, their information is old. grieving was previously called "anticipatory grieving" and renamed in 2006 and made an official diagnosis by nanda. both these websites have nursing interventions listed on them: grieving and [color=#3366ff]anticipatory grieving

for example, the nursing diagnosis of grieving has the symptoms of

  • alteration in activity level
  • alterations in immune function
  • alterations in neuroendocrine function
  • alterations in sleep patterns
  • alterations in dream patterns
  • anger
  • blame
  • detachment
  • despair
  • disorganization
  • experiencing relief
  • maintaining a connection to the deceased (in this case, her uterus)
  • making meaning of the loss
  • pain
  • panic behavior
  • personal growth
  • psychological distress
  • suffering
  • other symptoms that nanda does not list, but do apply are:
    • sadness
    • crying
    • difficulty in expressing loss
    • reliving of past experiences
    • interference with life function

the related factors for this diagnosis include loss of significant object (possession, job, status, home, parts & processes of the body). so, a more appropriate diagnosis for this patient might be grieving r/t loss of the ability to bear children aeb [her symptoms: is she. . . sad? angry? blaming herself? trying to make some kind of meaning out of this event? having difficulty sleeping?] your nursing interventions target the manifestations (the evidence that supports the diagnosis) or those symptoms. so, if she is sad, your interventions are to treat the sadness. if she is angry, you find interventions for anger. if she is blaming something about herself or something she could have done to have prevented this hysterectomy from happening, then you are going to have interventions that address this. make sense? care planning is all about thinking rationally and the whole think making sense.

another possible nursing diagnosis that could be used here is ineffective coping which is the "inability to form a valid appraisal of internal or external stressors, inadequate choices of practiced responses, and/or inability to access or use available resources." you might want to look at the defining characteristics (symptoms) of this diagnosis because your patient may have some of them too. ineffective coping

hopelessness (nanda definition: subjective state in which individual sees limited or no alternatives or personal choices available and is unable to mobilize energy on his or her own behalf) is also something you might want to look at. [color=#3366ff]hopelessness

if one of her symptoms is fatigue there is a nursing diagnosis of fatigue. here is a link to a webpage about it with nursing interventions: [color=#3366ff]fatigue

for poor appetite consider [color=#3366ff]imbalanced nutrition: less than body requirements

you can access about 75 nursing diagnoses and suggested interventions for them on the webpages i've been posting for you by clicking the "diagnoses" link at the top right of each diagnosis page you link in to on the ackley/lagwig website.

one of the tasks of solving your patient's problem is to research it when you are at a loss for treatment strategies. here's some help:

if you haven't already, read the first couple of posts on this sticky thread on how to write a care plan:

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I am pretty sure Daytonite is not human. You are a computer arent you?

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Specializes in med/surg, telemetry, IV therapy, mgmt.
I am pretty sure Daytonite is not human. You are a computer arent you?

Last time I looked I had all the body parts minus a few that have been surgically removed. I answered the OPs questions. I gave her plenty of ideas. Interventions have to be based upon the symptoms the patient is having. Depression is not a symptom--it is a diagnosis. The nursing diagnosis was off track. I just wanted to make sure the OP was pointed in the right direction.

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Specializes in Telemetry/Med Surg.
Last time I looked I had all the body parts minus a few that have been surgically removed. I answered the OPs questions. I gave her plenty of ideas. Interventions have to be based upon the symptoms the patient is having. Depression is not a symptom--it is a diagnosis. The nursing diagnosis was off track. I just wanted to make sure the OP was pointed in the right direction.

:yeah:You're amazing Daytonite!

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Last time I looked I had all the body parts minus a few that have been surgically removed. I answered the OPs questions. I gave her plenty of ideas. Interventions have to be based upon the symptoms the patient is having. Depression is not a symptom--it is a diagnosis. The nursing diagnosis was off track. I just wanted to make sure the OP was pointed in the right direction.

I did not mean it in a bad way. I was just commenting on your exhaustive database of knowledge and thouroughness of your answers.

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Specializes in Trauma, Teaching.
I am pretty sure Daytonite is not human. You are a computer arent you?

No, but I do get jealous sometimes, or is that just standing in awe of her massive depth of knowledge and willingness to share it. :yeah::yeah:

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Specializes in Psych.
No, but I do get jealous sometimes, or is that just standing in awe of her massive depth of knowledge and willingness to share it. :yeah::yeah:

I'm standing in awe of her willingness to type it.:specs::specs::specs::specs::specs::specs::specs:

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