Depression CoStep

Disease Process

  • Surveillance
    • Assess level of anxiety.
    • Assess sleep/rest pattern.
    • Assess for causative factors of anxiety.
    • Evaluate log for number of anxiety episodes since last encounter and activities used to alleviate the episodes.
  • Teaching, Guidance and Counseling
    • Instruct on signs and symptoms of escalating anxiety, and ways to interrupt its progression (e.g., relaxation techniques, deep- breathing exercises, physical exercises, brisk walks, jogging, meditation) and actions to take.
    • Instruct patient to keep a log of episodes of anxiety to include what is experienced and the events leading up to and surrounding the event.
    • Instruct on anxiety behaviors and issues that can be caused by anxiety.
    • Instruct on defense mechanisms that may be used to cope with anxiety.
    • Instruct on use of techniques to decrease experienced anxiety.


  • Surveillance
    • Assess attitude toward taking prescribed medications with standardized tool, e.g. HOGAN Drug Attitude Inventory.
    • Assess history of medication compliance and relationship to exacerbation of anxiety.
    • Assess for side effects from anxiety medications.
    • Assess for S/S of drug toxicity/interactions (tremors, muscle stiffness, tics, dizziness, weight gain, agitation, involuntary movements).
  • Treatment, Procedure
    • Perform blood draw for medication levels as ordered.
    • Identify/confirm mental health drug levels are within therapeutic range, as applicable.
  • Teaching, Guidance and Counseling
    • Instruct on the use of medications to help control anxiety.
    • Evaluate compliance with prescribed mental health medication regimen.


  • Teaching, Guidance and Counseling
    • Support verbalization of feelings, concerns and fears using motivational interviewing. (Motivational interviewing focuses on exploring and resolving ambivalence and centers on motivational processes within the individual that facilitate change)
    • Promote social support activities and relationships (i.e., identify/mobilize a support person(s) such as family, friends, support groups, visitors, and confidant).
    • Encourage patient to write in a journal expressing thoughts and reflections daily.
    • Evaluate readiness to make behavior changes using behavioral activation techniques (replacing negative avoidance behaviors with new rewarding behaviors. This increases a person's positive reinforcement and reduces negative reinforcement.)
  • Care Management
    • Instruct on community resources to access in emergency situations.
    • Initiate request for referral for Mental Health evaluation or counseling.