1. A: Assess General Appearance and Motor Behavior ("sad, slouched with head down, make minimal eye contact"), Mood and Affect ("hopeless, down, or anxious"), Thought Process and Content ("they tend to ruminate"), Sensorium and Intellectual Processes ("memory impairment common, extreme difficulty concentrating"), Judgment and Insight ("impaired judgment, insight may be intact"), Self-Concept ("self-esteem is greatly reduced"), Roles and Relationships ("difficulty fulfilling roles and responsibilities"), Physiological and Self-Care ("weight loss, sleep disturbances, impotence, constipation"), and Depression Rating Scales ("Beck Depression Inventory")
2. D: Nursing Diagnoses commonly established for clients with major depressive disorder include Risk for suicide, Anxiety, Ineffective coping, Self-care deficit, and Impaired Social Interaction
3. P: Some explores of outcomes for a client with major depressive disorder include "The client will not injure him or herself," "The client will establish a balance of adequate nutrition, hydration, and elimination," and "The client will comply with an antidepressant regimen"
4. I: Interventions include Providing for Safety ("first priority is to determine whether a client with depression is suicidal"), Promoting a Therapeutic Relationship ("shorter visits may help the nurse assess status and establish a therapeutic relationship"), Promoting Activities of Daily Living and Physical Care ("related to the level of psychomotor retardation, start with 'global task' then break task into smaller segments to increase self-esteem and build competency for a more complex task next time"), Using Therapeutic Communication ("listen attentively, encourage clients and validate the intensity of the experience"), Managing Medications ("increased activity and improved mood that antidepressants can provide the energy for suicidal clients to carry out the act"), and Providing Client and Family Teaching ("depression is an illness, not a lack of willpower or motivation")
5. E: Evaluation based on achievement of individual client outcomes. Participation in therapy and medication compliance produces more favorable outcomes for clients with major depressive disorder
