Ongoing Assessment

The nurse monitors vital signs at least daily as part of the ongoing assessment. In some instances, such as when hypotensive episodes occur, the nurse monitors the vital signs more frequently. The nurse reports any significant change in the vital signs to the primary health care provider. Initially, the patient may need assistance with self-care because patients with depression often do not have the physical or emotional energy to perform self-care activities. Some antidepressants cause excessive drowsiness during the initial stages of treatment, and patients may need assistance with ambulation and self-care activities. These reactions usually subside as the depression lifts and with continued use of the antidepressant. Patients with a high suicide potential require protection from suicidal acts and a well-supervised environment.

The nurse writes behavioral records at periodic intervals, the frequency of which depends on hospital or unit guidelines. An accurate assessment of the patient's behavior aids the primary health care provider in planning therapy and thus becomes an important part of nursing management. Patients with a poor response to drug therapy may require dosage changes, a change to another antidepressant drug, or the addition of other therapies to the treatment regimen.

OUTPATIENT ASSESSMENT. The hospitalized patient may ultimately be discharged from the acute care setting. Some patients, such as those with mild depression, do not require inpatient care. These patients are usually seen at periodic intervals in the primary health care provider's office or in a psychiatric outpatient setting.

At the time of each visit to the primary health care provider or clinic visit, the nurse observes the patient for a response to therapy. In some instances, the nurse may question the patient or a family member about the response to therapy. The type of questions asked depends on the patient and the diagnosis and may include questions such as

• Do you seem to be less depressed?

• How would you rate your depression?

• Would you like to tell me how everything is going?

Many times the nurse may need to rephrase questions or direct conversation toward other subjects until these patients feel comfortable and are able to discuss their therapy.

The nurse should ask the patient or a family member about adverse drug reactions or any other problems occurring during therapy. It is important to bring these reactions or problems to the attention of the primary health care provider. The nurse documents in the patient's record a general summary of the patient's outward behavior and any complaints or problems. Then the nurse compares these notations with previous notations and observations.

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