동국대_정신실습1_A+MDD(주요우울장애) 간호과정

문서 내 토픽

• 1. Major depressive disorder(주요 우울장애)

  주요 우울장애는 상실이나 실망감을 경험하면서 정상적으로 나타나는 적응과정인 슬픔, 애도와 우울은 차이를 보인다. 우울은 객관적 현실과 다르게 기분이 가라앉고 감정 표현이 없으며, 무디고 슬픈 감정을 지속적으로 지닌 경우다. 우리나라 주요 우울장애의 평생 유병률 5.1%로 정신장애 중 가장 높은 유병률을 보이지만 이 중에서 30% 정도만 진단이나 치료를 받고 있다. 최근 들어 발병 연령이 낮아졌고, 전 연령층에서 급격하게 증가하고 있으며 심각한 사회문제로 대두되고 있다.

• 2. 간호과정

  간호목표: 우울반응을 보이는 대상자에게 자신의 정서에 적절하게 반응하며 질병 이전의 수준으로 기능하는 것이다. 간호진단 언어적 의사소통 장애, 자존감 저하, 자가간호 결핍, 수면장애, 자살 위험성, 영양 불균형, 비효율적 대응 - 환자를 이해하는 태도, 온화하고 안정된 태도 - 환자에게 지나치게 낙천적, 명랑하게 대하는 태도는 피해야함 의사소통 간호 - 환자가 반응이 없다고 해도 환자 옆에서 일반적인 대화를 이어나감 - 환자에게 구체적이고 간단한 언어사용 - 환자에게 지나친 동정, 위로, 관심은 절망감을 증가시킬 수 있으므로 주의함 환경요법 - 자극적인 요소는 감소시킴(소음, 조명 등 조절)- 요구적, 공격적, 적대적 행위 등은 제한을 둠 - 자살예방: 1:1 간호 및 관찰, 위험한 물품 확인하고 제거함, 자살계획 및 시도에 대해 직접적으로 초점, 불규칙적으로 병실을 순회함, 수면 전까지 혼자 두지 않도록 함, 심한 우울증이 갑자기 호전될 때도 주의해야 함.

• 3. NANDA 사정양식

  NANDA 사정양식을 통해 대상자의 신체적, 정신적, 사회적 상태를 종합적으로 사정하였다. 주요 내용으로는 영양, 배설, 개인위생, 휴식 및 수면, 활동 및 레크리에이션, 신체감각, 순환, 호흡기계, 피부통합성, 성, 의사소통, 감정, 자아개념 등이 포함된다.

• 4. 정신과적 병력청취

  정신과적 병력청취를 통해 대상자의 신원, 현병력, 과거병력, 가족력, 개인력, 인격, 의학적 진단평가, 의사의 치료계획 등을 파악하였다. 주요 내용으로는 발병일시, 촉발사건, 진행과정, 자살시도 경험, 부정망상 등이 포함된다.

• 5. 정신상태 검사

  정신상태 검사를 통해 대상자의 전반적 외모, 태도 및 행동, 기분상태, 지각의 상태, 사고의 상태 및 사고 내용, 의식 및 인지기능, 병식, 자살 등을 평가하였다. 주요 내용으로는 우울, 불안, 자살사고, 망상 등이 포함된다.

• 6. 심리검사

  대상자에게 다양한 심리검사를 실시하였다. 주요 검사로는 몽고메리-아스버그 우울증상 평가척도(MADRS), 해밀턴 불안척도(HAM-A), 해밀턴 우울평가 척도(HAM-D), 양극성장애 평가 척도(BDRS), Beck의 자살생각 척도(SSI) 등이 포함된다.

• 7. 실험실검사, 방사선검사, 심전도검사, 뇌파검사

  대상자에게 실시한 검사 결과를 종합하였다. 주요 검사로는 CBC, QEEG, EKG, Brain MRI 등이 포함된다.

• 8. 가족사정

  대상자의 가족체계도와 가족의 역할, 의사소통 형태, 가치관, 정서적 분위기, 현재 문제에 대한 인식, 치료에 대한 기대 등을 파악하였다.

• 9. 환자 관찰 보고서

  대상자의 방어기제, 사고장애, 정서장애, 지각장애, 행동장애, 의식 및 기억장애, 주의력/지남력/지능/판단장애 등을 관찰하여 보고하였다.

• 10. 투약

  대상자에게 처방된 약물(Mag-o, Loravan, Riperidon, Indenol, Nexium, Buspar, Rivotril, Quetapin, Motilitone, Proimer)의 작용기전, 부작용, 간호중재 등을 정리하였다.

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• 1. Major depressive disorder(주요 우울장애)

  Major depressive disorder (MDD) is a serious mental health condition that can have a significant impact on an individual's daily life. It is characterized by persistent feelings of sadness, hopelessness, and loss of interest in activities that were once enjoyable. MDD can lead to a range of physical and emotional symptoms, including fatigue, changes in appetite and sleep patterns, difficulty concentrating, and suicidal thoughts. Effective treatment for MDD often involves a combination of psychotherapy, medication, and lifestyle changes. Cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT) are two of the most widely used and effective forms of psychotherapy for MDD. Antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), can also be helpful in managing the symptoms of MDD. Additionally, lifestyle changes, such as regular exercise, a healthy diet, and stress management techniques, can play a crucial role in supporting recovery. It is important to note that MDD is a complex and multifaceted condition, and the treatment approach should be tailored to the individual's unique needs and circumstances. Early intervention and a comprehensive, multidisciplinary approach to care can be crucial in helping individuals with MDD achieve and maintain recovery.

• 2. 간호과정

  The nursing process is a fundamental framework that guides the delivery of nursing care. It is a systematic, problem-solving approach that helps nurses to assess, plan, implement, and evaluate the care provided to patients. The nursing process consists of five key steps: 1. Assessment: This involves gathering comprehensive information about the patient's physical, psychological, social, and spiritual needs. Nurses use various assessment tools and techniques, such as interviews, physical examinations, and diagnostic tests, to gather this information. 2. Nursing diagnosis: Based on the assessment findings, nurses identify the patient's actual or potential health problems and formulate nursing diagnoses. These diagnoses provide a clear and concise description of the patient's health status and guide the development of the care plan. 3. Planning: In this step, nurses collaborate with the patient and other healthcare team members to establish realistic and measurable goals for the patient's care. They also develop a plan of care that outlines the specific nursing interventions and strategies to be implemented. 4. Implementation: Nurses put the care plan into action by carrying out the planned nursing interventions. This may involve providing direct patient care, coordinating with other healthcare providers, and educating the patient and their family. 5. Evaluation: Throughout the nursing process, nurses continuously assess the patient's progress and the effectiveness of the interventions. They make adjustments to the care plan as needed to ensure that the patient's goals are being met. The nursing process is a dynamic and iterative process, with each step informing and influencing the others. By following this framework, nurses can provide comprehensive, patient-centered care that addresses the unique needs of each individual.

• 3. NANDA 사정양식

  The NANDA (North American Nursing Diagnosis Association) assessment format is a widely used tool in nursing practice that helps nurses systematically gather and organize information about a patient's health status. This format is based on the NANDA-I (NANDA International) taxonomy, which provides a standardized language and framework for nursing diagnoses. The NANDA assessment format typically includes the following components: 1. Patient identification: This section includes the patient's name, age, gender, and other relevant demographic information. 2. Chief complaint or reason for admission: This section captures the patient's primary concern or the reason they are seeking healthcare. 3. History of present illness: This section provides a detailed account of the patient's current health problem, including the onset, duration, and any associated symptoms. 4. Past medical history: This section covers the patient's previous health conditions, hospitalizations, surgeries, and any relevant family history. 5. Review of systems: This comprehensive assessment examines the patient's physical, psychological, and social functioning across various body systems, such as the cardiovascular, respiratory, and neurological systems. 6. Physical examination: This section includes the findings from the nurse's physical assessment, including vital signs, general appearance, and any observable abnormalities. 7. Nursing diagnoses: Based on the information gathered, the nurse identifies the patient's actual or potential nursing diagnoses using the NANDA-I taxonomy. 8. Plan of care: This section outlines the specific nursing interventions and goals that will be implemented to address the identified nursing diagnoses. The NANDA assessment format provides a structured and comprehensive approach to patient assessment, which helps nurses to identify and prioritize the patient's healthcare needs, develop appropriate nursing diagnoses, and create an effective plan of care. By using this format, nurses can ensure that they are gathering and documenting all the relevant information needed to provide high-quality, patient-centered care.

• 4. 정신과적 병력청취

  Conducting a comprehensive psychiatric history is a crucial component of the assessment process for individuals with mental health concerns. This process involves gathering detailed information about the patient's current symptoms, past mental health history, and any relevant personal and family background. The key elements of a psychiatric history include: 1. Chief complaint: The patient's primary reason for seeking care, including any specific symptoms or concerns. 2. History of present illness: A detailed account of the onset, duration, and progression of the current mental health problem, including any associated behaviors, thoughts, or emotions. 3. Past psychiatric history: Information about any previous mental health diagnoses, hospitalizations, treatments, and the patient's response to interventions. 4. Medical history: A review of any physical health conditions, medications, and substance use that may be relevant to the patient's mental health. 5. Family history: Gathering information about any mental health or substance use disorders in the patient's family, as these can have a genetic component. 6. Developmental and social history: Exploring the patient's childhood, educational, occupational, and relationship experiences, as these can provide important context for understanding the current mental health concerns. 7. Mental status examination: An assessment of the patient's appearance, behavior, mood, affect, thought processes, perception, cognition, and insight. By conducting a thorough psychiatric history, healthcare providers can gain a comprehensive understanding of the patient's mental health needs, identify any underlying factors contributing to the current problem, and develop an appropriate treatment plan. This information is crucial for making an accurate diagnosis, selecting the most effective interventions, and monitoring the patient's progress over time.

• 5. 정신상태 검사

  The mental status examination (MSE) is a crucial component of the psychiatric assessment process, as it provides a structured and comprehensive evaluation of an individual's cognitive, emotional, and behavioral functioning. The MSE is typically conducted by a healthcare professional, such as a psychiatrist, psychologist, or psychiatric nurse, and is used to gather information about the patient's current mental state. The key elements of the mental status examination include: 1. Appearance and behavior: Observations about the patient's physical appearance, grooming, posture, eye contact, and overall behavior. 2. Mood and affect: Evaluation of the patient's subjective emotional state (mood) and the observable expression of emotion (affect). 3. Speech and language: Assessment of the patient's speech patterns, including rate, volume, and coherence. 4. Thought process and content: Evaluation of the patient's thought processes, including the logical flow of ideas, and any unusual or delusional thoughts. 5. Perception: Identification of any disturbances in the patient's sensory experiences, such as hallucinations or illusions. 6. Cognition: Assessment of the patient's orientation, attention, memory, and problem-solving abilities. 7. Insight and judgment: Evaluation of the patient's awareness of their own mental health condition and their ability to make reasonable decisions. The mental status examination provides valuable information that, when combined with the patient's history and other clinical data, helps healthcare professionals to make an accurate diagnosis, develop an appropriate treatment plan, and monitor the patient's progress over time. By conducting a thorough MSE, clinicians can gain a comprehensive understanding of the patient's current mental state and identify any areas that may require further assessment or intervention.

• 6. 심리검사

  Psychological testing is a valuable tool in the assessment and treatment of mental health conditions. These tests are designed to measure various aspects of an individual's cognitive, emotional, and behavioral functioning, providing healthcare professionals with a more comprehensive understanding of the patient's overall mental health. Some common types of psychological tests include: 1. Intelligence tests: These assess an individual's cognitive abilities, such as problem-solving, reasoning, and memory. 2. Personality tests: These evaluate an individual's personality traits, coping mechanisms, and interpersonal styles. 3. Neuropsychological tests: These assess cognitive functions, such as attention, memory, and executive functioning, which can be impaired in various neurological or psychiatric conditions. 4. Projective tests: These involve ambiguous stimuli, such as inkblots or incomplete sentences, which the individual interprets, providing insights into their unconscious thoughts and emotions. 5. Symptom-specific tests: These assess the presence and severity of specific mental health symptoms, such as depression, anxiety, or trauma-related disorders. Psychological testing can serve several important purposes in the context of mental health care, including: - Diagnosis: Helping healthcare professionals to identify the presence and nature of mental health conditions. - Treatment planning: Informing the development of personalized treatment strategies based on the individual's unique strengths and challenges. - Monitoring progress: Tracking changes in the patient's functioning over the course of treatment. - Vocational and educational assessment: Evaluating an individual's cognitive and personality characteristics to guide career or educational decisions. By incorporating psychological testing into the assessment and treatment process, healthcare professionals can gain a more comprehensive understanding of the patient's mental health, leading to more effective and tailored interventions. This can ultimately improve the patient's overall well-being and quality of life.

• 7. 실험실검사, 방사선검사, 심전도검사, 뇌파검사

  Laboratory tests, radiological examinations, electrocardiograms (ECGs), and electroencephalograms (EEGs) are important diagnostic tools that can provide valuable information to healthcare professionals in the assessment and management of various mental health conditions. 1. Laboratory tests: - These include blood, urine, and other bodily fluid analyses that can help identify underlying medical conditions, rule out potential causes of mental health symptoms, and monitor the effects of medications. - Examples include tests for thyroid function, vitamin deficiencies, and substance use. 2. Radiological examinations: - These imaging techniques, such as magnetic resonance imaging (MRI) and computed tomography (CT) scans, can help detect structural abnormalities or changes in the brain that may be associated with mental health disorders. - These tests can be particularly useful in the evaluation of conditions like dementia, traumatic brain injury, and certain neurological disorders. 3. Electrocardiograms (ECGs): - ECGs measure the electrical activity of the heart and can be used to assess the potential cardiovascular side effects of certain psychiatric medications. - This information can be crucial in monitoring the safety and efficacy of pharmacological interventions. 4. Electroencephalograms (EEGs): - EEGs record the electrical activity of the brain and can be used to identify abnormalities in brain wave patterns that may be associated with various mental health conditions, such as seizure disorders, sleep disturbances, and certain types of dementia. - EEGs can also be helpful in ruling out neurological causes of psychiatric symptoms. These diagnostic tests can provide valuable objective data that, when combined with the patient's history, clinical presentation, and other assessment findings, can help healthcare professionals make more accurate diagnoses, develop more targeted treatment plans, and monitor the patient's progress over time. By incorporating these various diagnostic tools into the assessment process, clinicians can gain a more comprehensive understanding of the patient's overall health and well-being, leading to more effective and personalized care.

• 8. 가족사정

  Family assessment is a crucial component of the comprehensive evaluation and treatment of mental health conditions. By gathering information about the patient's family dynamics, history, and support system, healthcare professionals can gain valuable insights that can inform the development of an effective, holistic treatment plan. The key elements of a family assessment typically include: 1. Family structure and composition: Identifying the members of the patient's immediate and extended family, their relationships, and any significant changes or disruptions in the family system. 2. Family history: Gathering information about any mental health, physical health, or substance use disorders that may be present in the patient's family, as these can have a genetic or environmental influence. 3. Family functioning: Evaluating the overall dynamics and patterns of interaction within the family, including communication styles, problem-solving strategies, and the presence of any conflicts or stressors. 4. Family support: Assessing the level and quality of support the patient receives from their family members, as well as the family's willingness and ability to participate in the patient's treatment and recovery. 5. Family coping mechanisms: Identifying the strategies the family uses to manage stress, cope with the patient's mental health condition, and maintain their own well-being. By conducting a thorough family assessment, healthcare professionals can: - Identify any familial factors that may be contributing to or exacerbating the patient's mental health condition. - Develop treatment interventions that involve the family, such as family therapy or psychoeducation, to address these factors. - Leverage the family's strengths and support systems to enhance the patient's overall treatment outcomes and long-term recovery. - Provide guidance and resources to help the family cope with the challenges of supporting a loved one with a mental health condition. Incorporating family assessment into the overall evaluation and treatment process can lead to a more comprehensive, holistic, and effective approach to mental healthcare, ultimately improving the well-being of both the patient and their family.

• 9. 환자 관찰 보고서

  Patient observation reports are a crucial component of comprehensive patient care, as they provide healthcare professionals with detailed, first-hand information about the patient's behavior, symptoms, and response to interventions. These reports are typically completed by nurses, mental health workers, or other members of the healthcare team who have direct, ongoing contact with the patient. The key elements of a patient observation report typically include: 1. Identifying information: The patient's name, date of birth, and any other relevant demographic details. 2. Observation period: The specific date(s) and time(s) during which the observations were made. 3. Behavioral observations: Detailed descriptions of the patient's appearance, mood, affect, speech, activity level, and any unusual or concerning behaviors. 4. Symptom monitoring: Documentation of any changes in the patient's physical, emotional, or cognitive symptoms, including the onset, duration, and severity of these symptoms. 5. Interventions and responses: Descriptions of any interventions or treatments provided, as well as the patient's response and any changes in their condition. 6. Safety and risk assessment: Evaluation of the patient's risk of harm to themselves or others, and any measures taken to ensure their safety. 7. Communication and collaboration: Documentation of any interactions with the patient, their family members, or other healthcare providers, and any relevant information shared or decisions made. Patient observation reports serve several important purposes: - They provide a comprehensive, real-time record of the patient's condition and progress, which can inform clinical decision-making and treatment planning. - They facilitate communication and collaboration among the healthcare team, ensuring that all members have access to the same up-to-date information about the patient. - They can be used to identify patterns, trends, or changes in the patient's condition over time, which can help to guide the ongoing management of their care. - They can serve as legal documentation of the care provided and the patient's response, which can be important in the event of any legal or regulatory inquiries. By maintaining thorough and accurate patient observation reports, healthcare professionals can ensure that they are providing the most comprehensive, personalized, and effective care possible for their patients.

• 10. 투약

  Medication management is a critical component of the comprehensive treatment of mental health conditions. Proper medication administration and monitoring can play a significant role in managing symptoms, improving overall functioning, and supporting the patient's recovery. Some key considerations in the area of medication management include: 1. Medication selection: Healthcare providers, in collaboration with the patient, must carefully select the most appropriate medications based on the patient's specific diagnosis, symptoms, and individual factors, such as age, medical history, and potential side effects. 2. Dosage and administration: Medications must be prescribed at the appropriate dosage and administered in the correct manner (e.g., oral, injectable, topical) to ensure optimal therapeutic effects and minimize the risk of adverse reactions. 3. Medication adherence: Ensuring that the patient consistently takes their medications as prescribed is crucial for the effectiveness of the treatment. Healthcare providers may need to employ various strategies, such as patient education, medication reminders, and addressing any barriers to adherence. 4. Monitoring and evaluation: Ongoing monitoring of the patient's response to medication, including any changes in symptoms, side effects, and overall functioning, is essential. This allows healthcare providers to make necessary adjustments to the medication regimen to optimize the patient's care. 5. Coordination of care: Effective communication and collaboration among the patient, healthcare providers, and any other relevant parties (e.g., family members, caregivers) is crucial to ensure the safe and appropriate use of medications. 6. Medication safety: Healthcare providers must be vigilant in identifying and addressing any potential medication-relate