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Capella University
NURS-FPX4015 Pathophysiology, Pharmacology, and Physical Assessment: A Holistic Approach to Patient-Centered Care
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Major Depressive Disorder (MDD) is a significant mental health condition that stands as the third leading cause of global disease burden (Bains & Abdijadid, 2023). The psychological, physiological, and pharmacological factors—collectively known as the 3Ps—play a vital role in the onset and management of MDD. These factors, when understood in depth, contribute to evidence-based mental health care practices. The following concept map organizes these elements visually to provide a comprehensive framework for treating individuals with MDD.
Ivy Jackson, a 61-year-old woman, displays symptoms that align with Major Depressive Disorder (MDD) following a significant life event. Symptoms such as persistent sadness, weight loss, sleep disturbances, and emotional distress are consistent with the criteria for MDD outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). A thorough approach to her care is essential, addressing risk factors, diagnostic processes, medications, potential complications, and appropriate nursing interventions.
Ivy Jackson, at 61, shows clear signs of MDD, as defined by the DSM-5. This disorder is marked by persistent sadness, loss of interest in daily activities, cognitive dysfunction, sleep disturbances, and severe functional impairment (Bains & Abdijadid, 2023). Ivy experiences a sustained low mood, frequent crying episodes, and hopelessness following the sudden end of her 38-year marriage. She also exhibits anhedonia, having lost interest in activities she once enjoyed, such as walking and spending time with family. Her weight loss of 10 pounds, sleep disruptions, fatigue, and difficulty concentrating further point to MDD. Although she denies suicidal thoughts, her emotional distress and social isolation place her at increased risk, requiring close monitoring.
Several risk factors contribute to Ivy’s depressive episode. Psychosocial stressors, notably the dissolution of her marriage, have significantly impacted her emotional well-being. A family history of depression in her mother and brother heightens her genetic vulnerability to MDD. Ivy’s history of hypertension and previous depressive episodes, especially after major life changes like her youngest child leaving for college, further complicate her mental health. She had previously been prescribed venlafaxine, a Serotonin-Norepinephrine Reuptake Inhibitor (SNRI), but discontinued it due to withdrawal symptoms, which may have led to her current relapse. Non-adherence to antidepressant medication is a well-known risk factor for depression recurrence and symptom exacerbation (Naudín et al., 2022).
While Ivy’s symptoms were triggered by her divorce, her case aligns more closely with MDD than with situational depression. Unlike situational depression, which typically resolves once the stressor is addressed, MDD persists and is influenced by biological factors, such as neurotransmitter imbalances and dysregulation of the Hypothalamic-Pituitary-Adrenal (HPA) axis (Remes, 2021). Given the chronicity of her symptoms, her previous history of depression, and the severity of her distress, her diagnosis of MDD is strongly supported. Treatment will likely involve pharmacological interventions (e.g., escitalopram), psychotherapy, and lifestyle modifications to enhance emotional well-being, improve medication adherence, and boost overall quality of life.
Factors | Psychological | Physiological | Pharmacological |
---|---|---|---|
Risk Factors | Divorce, family history of depression, social isolation | Hypertension, past depressive episodes | Discontinuation of venlafaxine, non-adherence to medications |
Signs & Symptoms | Persistent sadness, crying, hopelessness, anhedonia | Fatigue, weight loss, sleep disturbances, poor appetite | Side effects of antidepressants, withdrawal symptoms |
Diagnostics | DSM-5 Criteria for MDD | Thyroid function tests, CBC, Vitamin D screening | Past medication responses, adherence patterns |
Complications | Chronic depression, social detachment, impaired decision-making | Unregulated hypertension, nutritional deficiencies | Relapse, medication non-adherence |
Nursing Interventions | Cognitive Behavioral Therapy (CBT), Interpersonal Therapy (IPT), social support | Sleep hygiene, dietary counseling, physical activity | Medication adherence support, side effect management |
Ivy Jackson’s case of Major Depressive Disorder (MDD) is clearly illustrated through a structured concept map that highlights her risk factors, symptoms, diagnostic criteria, pharmacological treatments, potential complications, and necessary nursing interventions. A comprehensive approach combining clinical expertise and patient-centered care will lead to effective treatment planning, enhancing Ivy’s mental health and overall well-being.
Bains, N., & Abdijadid, S. (2023, April 10). Major depressive disorder. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559078/
Chand, S., & Arif, H. (2023). Depression. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430847/
Lieshout, R. J. V., Layton, H., Savoy, C. D., Haber, E., Feller, A., Biscaro, A., Bieling, P. J., & Ferro, M. A. (2022). Public health nurse-delivered group cognitive behavioural therapy for postpartum depression: A randomized controlled trial. The Canadian Journal of Psychiatry, 67(6), 432–440. https://doi.org/10.1177/07067437221074426
Naudín, M. A.-P., Abejón, E.-G., Gómez, F.-H., Lázaro, D.-F., & Álvarez, F. J. (2022). Non-adherence to antidepressant treatment and related factors in a region of Spain: A population-based registry study. Pharmaceutics, 14(12), 2696. https://doi.org/10.3390/pharmaceutics14122696
Remes, O. (2021). Biological, psychological, and social determinants of depression: A review of recent literature. Brain Sciences, 11(12), 1–33. https://doi.org/10.3390/brainsci11121633
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