Post-Partum Depression - Group 2 Presentation

Information about Post-Partum Depression - Group 2 Presentation

Published on August 8, 2014

Author: ashleyraleyrn



Group 2 Presentation: Postpartum depression: Group 2 Presentation: Postpartum depression AshlEY Raley, Patty Whaley, Jessica Vanlaere, and Ying Chin Nurs 629 Maryville University POSTPARTUM DEPRESSION BASIC Scenario : POSTPARTUM DEPRESSION BASIC Scenario A 25-year-old woman presented to her general practitioner 6 weeks after the birth of her first child. history of 2 previous episodes of major depression in her late teens and early twenties However, has been well for more than 2 years. finding it difficult to cope with the new baby and feels empty of all emotion. When asked, she says she has been feeling low in mood for the last 3 weeks and that it is getting worse. no appetite even when the baby is sleeping, she wakes early in the morning and is unable to get back to sleep. Reports feeling anxious and is often agitated lacks concentration, has reduced self- esteem, and is avoiding contact with her family and friends. On closer questioning she admitted to difficulty bonding with the baby and is very concerned that she feels no strong emotion for him. POSTPARTUM DEPRESSION Chief complaint: POSTPARTUM DEPRESSION Chief complaint C.C. “low in mood over the past 3 weeks”, “no appetite”, “difficulty sleeping”, “anxiety and agitated” POSTPARTUM DEPRESSION HPi: POSTPARTUM DEPRESSION HPi Patient is a 25-year-old new mother of a 6-week-old infant that presented with complaints of anxiety, agitation, and decreased mood increasing in frequency and severity over the past 3 weeks. Patient stated that she is having difficulty bonding with her infant and finds herself void of emotion for the baby. Mom states that she has a history of depression 2 years ago that was treated with Zoloft but has done well till the birth of her baby. Patient stated that she lacks concentration, low-self esteem, and purposely avoids social contact. Patient also stated that she often does not eat or do anything for herself when help from family is offered. Denies any other recent life changes. Denies any thought of suicide or homicidal ideation. Patient stated she often finds herself crying for no reason. Patient denies any use of medication or homeopathic supplements. POSTPARTUM DEPRESSION Additional information : POSTPARTUM DEPRESSION Additional information It important to make sure that mom is meeting the needs of the infant. Watching how the mother interacts and attends to the infant’s cue would be important. Assessing how often the mother is feeding the infant. Is she getting up in the middle of the night to feed the infant at 6-weeks-old the infant will still eat approx. every 2-3 hours or sometimes more often. POSTPARTUM DEPRESSION ROS: POSTPARTUM DEPRESSION ROS General: difficulty falling asleep or staying asleep, little to no appetite, + wt loss Heent: Noncontributory Cardiovascular: intermittent palpitations , no dizziness, no cyanosis, no racing pulse Respiratory: Noncontributory GI: loss of appetite , no vomiting or diarrhea, no abd pain GU and Skin: noncontributory Musculoskeletal: intermittent general aches in back and shoulders Neurologic: no numbness or tingling, tremors, or weakness Hematologic, Endocrine: noncontributory Psychiatric: anxiety, agitation, low-self esteem, avoids social contact POSTPARTUM DEPRESSION PMH: POSTPARTUM DEPRESSION PMH 2 previous episodes of major depression about 3-6 years ago, treated with zoloft, controlled for the last 2 years All other noncontributory Diagnostic Tests: Diagnostic Tests No specific laboratory testing Screening using a depression scale should be done initially within the first six weeks of delivery The Edinburgh Postnatal Depression Scale a widely used 10- question survey questions are scored from zero to three with a maximum score of 30. Patients who score over 12 or 13 identify most women with postpartum depression (Roy-Byrne, 2014). Patients who score five to nine on this particular scale should be re-evaluated in one month. Diagnosis: Post-partum depression: Diagnosis: Post-partum depression Differential diagnoses Maternity Blues Usually self-limiting Consists of periods of elation Post-partum thyroid disorders Diagnosed with thyroid function test Post-Partum Anemia Diagnosed with complete blood count Diagnosis Overview : Diagnosis Overview Post-Partum psychiatric Disturbances ( Youngkin et al., 2013) Mild- Maternity Blues aka “Baby blues” 2 nd /3 rd day post-partum up to Day 14th Moderate- Post-Partum Depression 2 nd /3 rd week post-partum up to 1 year Severe- Post-Partum Psychosis 48 to 72 hours post-delivery, up to 3 months at time of onset Post-Partum Depression: Post-Partum Depression Etiology Exact etiology is unknown Most likely due to: Neuroendocrinologic changes fluctuation of hormonal levels Estrogen, progesterone, testosterone, thyroid hormone, and cholesterol, corticotropin-releasing hormone & cortisol ( Roy-Byrne, 2014) Post- Partum Depression: Post- Partum Depression Common presentation (Roy-Byrne, 2014) Decreased appetite Rapid weight loss Does not enjoy food/has to force oneself to eat Lack of energy, difficulty getting out of bed panic attacks & anxiety Irritability & anger Feeling overwhelmed/ inadequate- unable to attend to the baby’s needs Feelings of guilt or shame as a mother Post-Partum Depression: Post-Partum Depression Risk Factors (Youngkin et al., 2014) History of depression History of post-partum depression Prenatal depression Life stress Child care stress Prenatal anxiety Lack of social support Marital stress Stressful life event during pregnancy/near term Post-partum depression: Post-partum depression Patient teaching (Youngkin, 2013) Recognize the problem Seek for help Medication intervention Interpersonal therapy Cognitive-behavioral therapy Coping Strategies Follow a well-balanced diet Low sodium & sugar High complex carbohydrates, protein & fiber Ensure adequate hydration, limit caffeine Daily pre-natal vitamins Daily light-weight exercises Set aside personal time & adult relationship Allows friends & family to help Post-Partum Depression: Post-Partum Depression Adverse Outcomes Poor Mother-infant bonding (Youngkin et al., 2013) Fussier babies Impaired cognitive/emotional development Marital discord (Roy- Byrne, 2014) Suicide/infanticide Treatment plan: Treatment plan Referral to psychiatry may be initiated through the women’s health provider or primary care provider but most often are referred Providers should ensure that patients agree to follow up with a psychiatrist and follow through should be checked to validate the appointment Diagnosis of mild to moderate depression Treatment plan: Treatment plan several psychotherapies can be tried if the patient does not want or need medications at that time. First , interpersonal psychotherapy remission and improving interpersonal functioning is the main objective (Swartz, 2014). In this case, it would focus on life stressors and that attachment between the mother and her infant is necessary for proper development. This therapy can be used with or without medications. The second is cognitive and behavioral therapy, which focuses on education, coping skills, relaxation exercises and stress management (Swartz, 2014). Lastly , behavioral activation focuses on increasing rewarding activities, improving problem-solving skills and decreasing rumination (Roy-Byrne, 2014). Any of these therapies can be used and patients be receptive to one more compared to the other. Treatment plan: Treatment plan Women that are not breastfeeding, the initial treatment should include a serotonin-norepinephrine reuptake inhibitor or selective serotonin reuptake inhibitor (SSRI). For mild to moderate unipolar major post-partum depression , SSRIs are effective and well tolerated, as it is by most patients Patient previously did well with zoloft and ssri- consider placing her back on the same medication Zoloft is safe in breastfeeding women Treatment plan: Treatment plan If she does not show some improvements within four to six weeks, it is acceptable to begin the next step of treatment whether that is a medication adjustment or referral to behavioral counselor/therapy ( Roy-Byrne, 2014). Finally, I would consider bringing in her family to the office and discussing safety and emphasize familial support and knowing when and if she needs to seek additional help for any suicidal or homicidal thoughts. Patient education: Patient education Possible side effects of not addressing postpartum depression can lead to a lack of energy, difficulty focusing, feeling moody, not being able to meet the child’s needs and the possible loss of feeling confident as a mother A mother that does not have her post partum depression address can impact the development of the infant and lead to delays in language development, problems with mother-child bonding, behavior problems and increased crying encouraged to get plenty of rest and recruit help for caring for the baby especially at night to help with sleep. Providers should also encourage her to communicate her feelings and thoughts with her family and medical providers. Weekly follow ups either through the office or through phone calls and can help monitor her progress. Patient education: Patient education She should take her medication as prescribed and keep a diary of her thoughts and feelings so as time progresses, repeating patterns and the effectiveness of medication can be evaluated Education on how to communicate any suicidal or homicidal thoughts is necessary. Referral to a psychiatrist is needed if the healthcare provider is not comfortable managing her postpartum depression or she is not making improvements with her oral medication and therapy. She is a risk for developing severe depression, which could jeopardize her safety or the baby’s development. Patient education: Patient education Postpartum depression action plan will encourage her to set goals for the week and rate the likelihood that she will complete them. The action plan could be tailored to each patient and the current situation. Areas to focus on should include staying active and to make time everyday for physical activity or do something that she finds fun such as going to lunch or watching a certain television station. Spend time with people who help or support her, relaxation and having her future goals planned Start slow and not set unrealistic goals/expectations Patient education: Patient education She should bring the action plans to the healthcare visits to monitor progress. A safety plan can also be established that will give the patient avenues for new or worsening symptoms. communication , encouragement and support is essential for the success of her therapy. Her partner and family should be included in her therapy and action plan while monitoring her progress to determine of she is falling into severe depression. References: References (2014). Sertraline use while breastfeeding. Retrieved from http :// Family Doctor. (2014). Postpartum depression- postpartum depression action plan. Retrieved from plan.printerview.all.html Roy -Byrne, P. (2014, April 14). Postpartum blues and unipolar depression: Epidemiology, clinical features, assessment, and diagnosis. Retrieved from http:// partum depression&selectedTitle=1~83 Youngkin, E. Q., Davis, M. S., Schadewald, D. M., & Juve, C. (2013). Women's health: A primary care clinical guide. (4 ed.). Upper Saddle River, NJ: Pearson Education Inc. references: references Swartz, H. (2014). Interpersonal psychotherapy (IPT) for depressed adults: indications, Theoretical foundation, general concepts, and efficacy. Up To Date. Retrieved From Women’s Health. (2012). Depression during and after pregnancy fact sheet. U. S. Department of Health and Human Services. Retrieved from

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