The postpartum nursing diagnosis is considered to be carried out in case if patient is undergoing the postpartum depression. It is considered to be the disorder with mood which is commonly in women during a specific phase of childbirth. It’s also called as baby blues, but has to be taken very serious though. The name baby blues seems to be quite cute but is more serious than you can consider for it to be.
The nursing diagnosis is carried out during the few days or after few weeks from labor. This is due to the factor that, the mood changes would be the disturbance which can last just for few days or sometimes would be for a week after the time of child birth. Normally it fades off as the time passes by. This is not the type of problem that would interfere in between the mothers care to her child. However in rare cases, mother would develop a condition which is also called as the postpartum psychosis after sometime of the childbirth. This is considered to be a severe type of mental disorder. In this case, the mother would suffer from hallucination or delusions that she would unknowingly harm her child by any means. Hence the postpartum nursing diagnosis is undergone in such conditions to help the mother.
Facts:
- Postpartum depression (PPD) is the most common problem associated with childbirth.
- PPD is characterized by depression that a woman experiences within four weeks of delivery.
- PPD can affect up to 10% of new fathers.
- Biological, psychological and social factors play a role in predisposing women develop postpartum depression.
- There is no single test that indicates that someone has finally PPD.
- Treatment options include education for PPD disease, support groups, psychotherapy and / or medication. Particular care is taken into account drugs given the potential risks of exposing a child through breastfeeding drugs.
- Women who have suffered from postpartum depression are much more likely to suffer from depression again in the future. The children of a mother or father with PPD are at risk of emotional problems.
- Intensive nursing intervention can help prevent the development of postpartum depression.
What is postpartum depression? Are there different types of postpartum depression?
Postpartum depression is the most common problem associated with childbirth. It has been described as appalling historical figures as author / suffragette Charlotte Perkins Gilman in the 19th century. This disease is characterized by depression that women experience within four weeks of childbirth, affecting approximately 13% of women who give birth. Postpartum depression occurs after eight deliveries to United States, affecting approximately half a million women each year. Postpartum depression is also called major depression with postpartum onset. Delusional thinking after birth, called postpartum psychosis, affects about one in a thousand women.
Particular, postpartum depression is not a disease that is exclusive to the mother. Fathers can experience as well. In fact, it can affect up to 10% of new fathers. As with women, the symptoms in men can lead to difficulty fathers to care for their children and when suffering from postpartum depression.
Unfortunately 50% of people suffering from postpartum depression or postpartum psychosis are never detected. This can lead to catastrophic results for the patient and his family. For example, postpartum psychosis is thought to have been a potential factor of Andrea Yates drowned her five children in 2001 and has been explored as a factor of Susan Smith drowned her two son.
What are the causes and risk factors for postpartum depression?
Similar to many other mental health conditions, it is thought to be a genetic vulnerability to develop postpartum depression. Rapid changes in the levels of reproductive hormones that occur after delivery are thought to be of biological factors in the development of postpartum depression. Interestingly, men are also known to undergo changes in a number of hormones during the postpartum period may contribute to the development of PPD. In addition, the stress inherent in caring for a newborn is a significant factor.
Other risk factors for developing postpartum depression include marital problems, low self-esteem and a lack of social support with before and after childbirth.
The symptoms and signs of postpartum nursing diagnosis
Some of the symptoms and sings of postpartum depression includes:
- Feelings of sadness, emptiness, emotional numbness or frequent crying
- Feelings of irritability or anger
- A tendency to withdraw from relationships with family, friends or activities that are usually pleasant for the patient PPD
- Fatigue constant, difficulty sleeping, overeating or loss of appetite
- A strong sense of failure or inadequacy
- Intense concern and anxiety about the baby or a lack of interest in the baby
- Thoughts about suicide or hurting the baby fears
- The symptoms in case of postpartum depression would be same as that of major depressive episode.
- Depressed mood, insomnia, tearfulness, suicidal thoughts
- Obsession, anxiety concerning the well being of her child
- Deliberating or persistent against the blues
- Tiny onset to slowly during the first three months of postpartum depression
The causes for postpartum depression
There are plenty of causes for the postpartum depression hence it would be reduced with the help of postpartum nursing diagnosis.
- It is considered to occur in about 15 percent of women
- Some of the highest risk from PPD is considered to be the previous PP depression, HX of depression and depression during pregnancy.
- The past PP depression with psychosis is recognized with about 30 to 50 percent of reoccurrence at the delivery in subsequent rate.
Postpartum psychosis occurs much more rarely and is thought to be a severe form of postpartum depression. The symptoms of this disorder are:
- Delusions (false beliefs)
- Hallucinations (eg hearing voices or seeing things that are not real)
- Thoughts of harming the baby
- Severe depressive symptoms
There is no single test that indicates that someone has finally PPD. Therefore, health care professionals diagnose this condition by collecting complete medical and family history of mental health. Patients tend to benefit when the business takes into account the entire life of their clients and base. This includes, but is not limited to, the person’s gender, sexual orientation status, cultural, religious, ethnic and socioeconomic. The health care professional will also perform a physical examination or ask the doctor or the individual first aid exercising. The medical examination usually includes laboratory tests to assess the general health of the individual and in the individual screening for medical conditions that might have symptoms of mental health.
Postpartum depression must be distinguished from what is commonly called the “baby blues,” which tend to occur in most new mothers. In the problem of short baby blues mood, symptoms of crying, feelings of sadness, irritability, anxiety and confusion may occur. Unlike symptoms of PPD, symptoms of baby blues tend to peak around the fourth day after delivery, to be resolved by the 10th day after birth and do not tend to affect the parent’s ability to function.
Postpartum psychosis is a psychiatric emergency that requires immediate action because of the danger that the patient could kill their child or themselves. Postpartum psychosis usually begins in the first two weeks after childbirth. The symptoms of this condition tend to involve extremely disorganized thinking, bizarre behavior, hallucinations, unusual, and delusions. Postpartum psychosis is often a symptom of bipolar disorder, also called manic depression. While seasonal affective disorder (SAD) characteristics of depression, it occurs at a particular time of the year, usually during the dark winter months.
The assessment includes:
- Screen during the period of P
- Physical examination
- Evaluation of psychiatry
- The Edinburgh postnatal depression scale or EPDS would read as self rated questionnaire.
- Lab tests have to be considered with routine. The lab test include TFT (anemia or thyroid), CBC.
The interventions of postpartum nursing diagnosis
- Pharmacological includes the SNRI’s, TCA’s (insomnia), SSRI’s; which comprises dry mouth, weight gain, sedation using TCA’s.
- Anxiolytics
- Psychosis which comprises of mood stabilizers, hospitalization, ECT, antipsychotics
- ECT
- CBT for individual or group psychotherapy.
Educational programs and support groups
Treatment of postpartum depression in men and women is similar. Mothers and fathers of this condition have been found to benefit greatly from being educated about the disease, as well as support from other parents who have been in this position.
Psychotherapies
Psychotherapy (“talk therapy”) is to work with a trained therapist to find ways to solve problems and deal with all forms of depression, including postpartum depression. It can be a powerful intervention, even producing positive biochemical changes in the brain. This is particularly important as an alternative to medication while breastfeeding women. In general, these therapies take weeks or months to complete. More intense psychotherapy may be necessary to treat depression even longer when severe or depression with other psychiatric symptoms.
Interpersonal Therapy (IPT): It helps to relieve symptoms of depression and help the person with PPD develop more effective skills to cope with social and interpersonal relationships. IPT employs two strategies to achieve these objectives.
The first is education about the nature of depression. The therapist will emphasize that depression is a common disease and most people can expect to get better with treatment.
The second is the definition of specific issues (such as the pressures of childcare and interpersonal conflicts). After the problems are identified, the therapist is able to help set realistic goals to solve these problems. Together, the individual with the PPD and the therapist will use different processing techniques to achieve these goals.
Cognitive behavioral therapy (CBT): This helps relieve depression and reduce the likelihood that it will go to help the victim PPD change his way of thinking. In CBT, the therapist uses three techniques to achieve these goals.
Didactic component: This phase can develop positive expectations for therapy and to promote cooperation.
Cognitive component: This identifies the thoughts and assumptions that affect the behavior, particularly those that may predispose the person with PPD to be depressed.
Behavioral component: This uses behavior modification techniques to teach individuals with PPD strategies more effective in treating problems.
Pharmaceuticals
Drug treatment for postpartum depression usually involves the use of antidepressant medications. The main types of antidepressants are selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), monoamine oxidase (MAO) inhibitors, and atypical antidepressants. SSRIs affect serotonin levels in the brain. For many physicians prescribing these drugs are the first choice because of the high level of efficiency and the overall safety of this group of drugs. Examples of antidepressants are listed here. The generic name is the first, with the brand name in parentheses.
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Fluvoxamine (Luvox)
- Citalopram (Celexa)
- Escitalopram (Lexapro)
Atypical antidepressant medications work differently than SSRIs commonly used. The following medications may be prescribed when SSRIs have not worked:
- Bupropion (Wellbutrin)
- Mirtazapine (Remeron)
- Nefazodone (Serzone)
- Trazodone (Desyrel)
- Venlafaxine (Effexor)
- Duloxetine (Cymbalta)
- Desvenlafaxine (Pristiq)
ATC are sometimes prescribed in severe cases of depression or when SSRI antidepressants or atypical drugs do not work. These medications affect a number of brain chemicals (neurotransmitters), particularly adrenaline and noradrenaline (also called epinephrine and norepinephrine, respectively). Examples include
- amitriptyline (Elavil)
- clomipramine (Anafranil)
- desipramine (Norpramin)
- doxepin (Adapin)
- imipramine (Tofranil)
- nortriptyline (Pamelor)
About two thirds of people taking antidepressants feel better. It can last from one to six weeks to take medications at the dose effective to start to feel better. It is therefore important not to give the medication because the benefits are not felt immediately. MAOIs are not used as often since the introduction of SSRIs. Because of interactions with certain antidepressants and specific foods, MAOIs can not be taken with many other medications, and certain types of foods that are rich in tyramine (aged cheeses like, wines and meats) should be avoided as well. Examples of MAOIs include phenelzine (Nardil) and tranylcypromine (Parnate). Atypical antipsychotics are often prescribed in addition to a mood stabilizer medication in people suffering from postpartum psychosis.
Examples of atypical neuroleptics are:
- aripiprazole (Abilify)
- olanzapine (Zyprexa)
- Paliperidone (Invega)
- Quetiapine (Seroquel)
- risperidone (Risperdal)
- Ziprasidone (Geodon)
- Asenapine (SAPHRIS)
- iloperidone (Fanapt)
Non-anti-psychotic mood stabilizer drugs are also sometimes used to treat neuroleptic with people suffering from postpartum psychosis as bipolar disorder may be underlying some patients.
Examples of mood stabilizers include non neuroleptics:
- lithium (lithium carbonate, lithium citrate)
- divalproex sodium (Depakote)
- carbamazepine (Tegretol)
- lamotrigine (Lamictal)
The postpartum nursing diagnosis includes the consideration of both family along with personal history of the patient with depression and other type of mood disorders. Normally, doctors would give a blood test to the patient to ensure the moodiness with other type of symptoms is not due to underactive thyroid gland. The doctor would also ask the patient to populate the EPDS questionnaire. This would easily clarify if the patient requires postpartum nursing diagnosis. If confirmed then the patient would be treated with a combination of both psychotherapy and antidepressant medications. This combination is considered on the fact of mother breastfeeding her child as they can easily pass to baby as well which should not be the case.