Pauline white nursing diagnosis, rationale and nursing care planPauline white suffers from clinical depression that satisfies the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV) (Ladwig, 1999). These depressive events are not subject to physical or mental disorder but may have relation with medical disorders (Ladwig, 1999). Etiology and pathology of depression is hypothesized by various theories that include psychoanalytic, cognitive, biochemical, genetic and socio-cultural but there exists no evidence of any theory that pinpoints the main cause (Kapoor, 1994). Rice (2006) indicates that depression affects women more than men.
Elderly women are at a greater risk for depression secondary to medical conditions, cognitive distortions, lack of resources and side effects of commonly prescribed medication (Ladwig, 1999). The course of depression is characteristic of recurrence and remission (Kapoor, 1994). The Nursing diagnosis for Pauline is characterized by a major depressive disorder, severe with characteristic melancholic and atypical feature and portrays full remission, severe with and without psychotic feature secondary to catatonic feature (Fortinash and Hooliday-Worret, 1991). The two primary priority problems for Pauline white are risk of suicide and impaired social interaction (Orem, 1999; Rice, 2006:332). Pauline’s first rationale for nursing diagnosis and criteria subject to her impaired social interaction is based on the fact that Pauline White suffered depression episode after delivery of her daughter Mary therefore Pauline is subject to postpartum onset depression (Rice, 2006:334).
Pauline has been experiencing full remission aspect of depression characterized by periodic occurrence of depression episodes for the past five years (Rice, 2006:331). Pauline exhibits psychotic feature characterized by inability to evaluate and make upright decisions regarding the effects of her actions as outlined by her failure to take care of her daughter Mary and to perform activities of daily living like attending to her work both at home and workplace and failing to keep appointments with the company psychologists (Rice, 2006:246).
Pauline’s psychotic feature is concurrent to cognitive clinical signs impairment that have affected negatively her thinking faculties as illustrated by her husband’s “dissatisfaction on Pauline’s inability to plan for the future and her failure to keep appointments with the company psychologist (Rice, 2006:246). Pauline has characteristic melancholic feature portrayed by her withdrawal from activities of pleasure like sex, failure to eat food secondary to loss of appetite and failure to attend or take part in planning family outings (Ladwig, 1999).
Pauline behavioral clinical signs provide a clear picture that she suffers clinical depression because of presence of catatonic feature that is a function of unusual behaviors like freaking and her difficulties to bond with other patients in the psychiatric unit (Rice, 2006:331). Pauline is very sensitive and tends personal that reinforces her unusual behavior and need to be alone in the psychiatric unit.
Pauline clinical depression has been catalyzed by induced mood disorder that is a function of Pauline’s seasonal affective disorder (Kapoor, 1994). Pauline’s current elevated depression is primary to her admission with overdose of diazepam tablets that had been prescribed by her general practitioner (Rice, 2006:439). Pauline’s second rationale for nursing diagnosis and criteria subject to her risk of suicide is based on her potential to exhibits insomnia (Ladwig, 1999) by virtue of her inability to fall asleep and hypersomnia exhibited by Pauline’s long hours of sleep (Orem, 1999).
Both insomnia and hypersomnia are indicators of Pauline’s state of loneliness that is secondary to Pauline’s affective clinical sign (Ladwig, 1999). Manifestation of affective diagnosis is portrayed by Pauline’s feelings of worthlessness that predisposes psychotic feature of clinical depression (Rice, 2006:440-443).