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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.
Medications
- 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.
Psychosocial
- 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.