Concept map for major depressive disorder

CONCEPT MAP TEMPLATE Schizophrenia Objective: Subjective: Nsg. Dx: Disturbed Thought Process Nsg. Dx: Ineffective Coping Nursing Action: Nursing Action: Outcome: Outcome: Nsg. Dx: Disturbed Sensory Perception r/t Nursing Action: Outcome: Case study 1 - Schizophrenia Caroline, age 22, was diagnosed with schizophrenia at age 19. She led a relatively normal life during school age and high school years. She left her parents at age 17 to attend a college somewhat distant to her home. She apparently had no problems during her first year, but when she returned for Thanksgiving break during her second year, her parents noticed her distancing herself from others. She spent a lot of time alone, was irritable, and had begun chain smoking and drinking alcohol. She failed two courses that fall and was placed on probation. When she went back to school in the spring, her former roommate refused to stay with her, saying, “She acts so crazy sometimes. She talks out of her head, and I’m afraid of her.” In late February, Caroline’s parents got a call from the dean of students who related that the campus police had to be called to Caroline’s room to quiet her. She had been “yelling and screaming” and no one could understand what it had all been about. She had apparently really frightened the other students in the dormitory. These bizarre behaviors continued and during spring break in March, Caroline’s parents moved her back home and made an appointment with a psychiatrist for an evaluation. During the assessment, Caroline’s thought processes were loose, vague, and often circumstantial. She exhibited behaviors that suggested auditory hallucinations (stopping midsentence and “cocking” her head to the side as if listening), although when questioned about whether or not she heard voices, she denied it. Paranoid delusional thinking was evident. She made statements such as, “There is no one I can trust at that college. Every student in that dorm has been told to keep an eye on me. They all know I am too smart to be there, so they will do what they can to make me fail. If I pass, then everyone else fails.” She also expressed somatic delusions, “I’m pregnant, you know. It will be a virgin birth. That’s another reason the college kids are out to get me. They are so jealous! I am the chosen one.” Since that time, she has been on several antipsychotic medications (chlorpromazine, clozapine, and risperidone), each with only minimal success, and which she would eventually quit taking altogether. She currently lives at home with her parents who are beside themselves with concern and frustration. The psychiatrist has admitted Caroline to the hospital at this time to evaluate her behavior and to begin her on a trial of fluphenazine decanoate which will eventually be administered only every 3 weeks by IM injection in an effort to encourage increased medication compliance on Caroline’s part. Design a nursing care plan for Caroline during this hospital admission. Case study 2 - MDD Valerie, age 25, is admitted to the psychiatric unit by her psychiatrist after stating that she no longer wanted to live. She has a long history of psychiatric problems, beginning at age 15, when she swallowed a handful of aspirin and acetaminophen. Valerie’s mother has a history of depression and her father is very authoritarian.