ok, i am looking at your care plan. let me first say, that in the u.s. we cannot use medical diagnoses as patient problems when we are writing plans of care. i don't know if that is also true in australia. so, the use of the word "depression" would be used on the care plan very carefully.
i took a look at the signs and symptoms of depression and it's treatment. here are the websites i looked at:
in addition, i also have a book here at home that had some information about depression. based on the information you have given in your posts and the information i've been able to put together about depression, this is the list of symptoms i've come up with for aaron:
- sleeping a lot (given information) - normal should be 7 to 8 hours a day
- reduced social interaction (given information)
- impaired communication skills (given information)
- withdrawn (given information)
- feelings of hopelessness and/or pessimism, guilt, worthlessness, helplessness
- loss of interest in activities that were once enjoyable
- loss of energy
- insomnia (very typical symptom in children)
- loss of appetite
- mother has had lumpectomy (given information) (does this represent a stressful life event for patient, or helplessness over the situation?)
- sister has recurrent tonsillitis (given information)
two thoughts keep playing around in my mind:
- sleep and fatigue are major components of major depression
- what are the normal activities that someone aaron's age should be engaged in?
all of the above is the data collection. because this is a case scenario and not a real patient, we have to improvise a little. normally, you would find aaron's actual symptoms of his depression in the doctor's history and physical exam or the psychologist's or psychiatrist's exam of him. we have to kind of put one together based on what we know about depression, in general.
next step, would be to take this list of symptoms and look for nursing diagnoses that would accommodate them. right off the bat you saw the problem with sleep. the nanda (north american nursing diagnosis association) nursing diagnosis for this would be: disturbed sleep pattern.
however, if you are not using nanda diagnoses, saying "sleeping most of day" will suffice. i might want to be more specific and add a number of hours to that, if known, such as "sleeping 14 hours out of a 24 hour day". the rationale is correct, over sleeping is a symptom of depression.
another symptom he has is isolation. the nanda nursing diagnosis would be: social isolation.
again, this is another symptom of depression.
third step in the nursing process is developing your nursing interventions.
for the sleeping:
- review aaron's diet and medication. (rationale: something in his diet or a side effect of his medication could be responsible for his extended sleeping.)
- review what activities and hobbies aaron used to participate in (rationale: determining which activities he likes will make him more likely to perform these activities.)
- encourage aaron to become involved in a physical activity that he likes (such as taking a walk or jogging) (rationale: increasing physical activity will keep aaron from wanting to lie down and sleep.)
- if continued long bouts of sleeping continue, refer aaron for psychological evaluation. (rationale: behavior intervention will help aaron to gain greater understanding of his life situation and learn better methods of coping.)
for an outcome, i would list something like, aaron will limit his total sleep time to no more than 8 hours within a 24 hours period. that is in line with what is normal for a person of his age.
here is a link to a list of common anti-depressants:
is that perhaps what your instructor was looking for with a medication review? they are listed by their categories. you might want to find the reasons each of those particular category of antidepressants might be ordered and what the expected outcome of taking them should be. for example, tricyclics-tertiary amines, the first group listed, are given to block the reuptake of norepinephrine and serotonin into the nerve endings and increase the action of norepinephrine and serotonin in nerve cells. when given to patients, you would expect to see their depressive behavior improve.
i hope this has given you some direction. because i don't have the advantage of having sat in and listened to your instructor's lectures or seen the written instructions you have, i have to go by what you have told me and what i know from many years of writing care plans. i'm sure you can find a happy medium in there somewhere! if i have helped you, even the slightest bit, i will be thrilled. good luck!