PSYCH 209 Major Depressive Disorder
(MDD )UNFOLDING Reasoning Marilyn
Smith 28 years old
,Major Depressive Disorder (MDD)
UNFOLDING Reasoning
STUDENT
Marilyn Smith, 28 years old
Primary Concept
Mood and Affect
Interrelated Concepts (In order of emphasis)
1. Stress
2. Coping
3. Clinical Judgment
4. Communication
5. Collaboration
6. Patient Education
, History of Present Problem:
Marilyn Smith is a single, African American 28-year-old female who presents to the emergency
department with complaints of “feeling crummy” for the past six months. She reports that she no longer feels
like doing any of the things she used to enjoy. “It all seems so pointless.” She can’t even bother to eat most
days and has lost weight recently. Although she has no energy, she finds it difficult to both fall sleep and stay
asleep. Even when she does manage to fall asleep, she never feels rested when she awakes. She reports having
difficulty at work as a computer support person because it is so hard for her to concentrate. Last week she
called in sick and spent the day in bed crying off and on all day. Last night she found herself crying again and
this time she also thought about suicide, which scared her and prompted a visit to the ED. “I don’t want to live
like this anymore. I feel like I will never be happy again.”
Personal/Social History:
Marilyn graduated from high school and obtained an associate degree in computer science. She enlisted in the
Army to have an adventure and hoped the GI bill would pay for further education once she completed her
service. She reports she still feels guilty about making the decision to enlist instead of marrying her high
school sweetheart. She was deployed to Iraq and returned home a year ago. She enjoyed her time in the
service because she felt she was doing something useful for her country. She did not see combat and did not
experience any significant problems while in Iraq. When she returned home, she found out her old boyfriend
had married. She recently attempted to contact local universities to explore completing her baccalaureate
degree but found the process too overwhelming and just gave up.
When questioned about use of alcohol or drugs, Marilyn reported that she is an occasional drinker, but recently
has been drinking more in an attempt to sleep. Denies another drug use. Marilyn has no history of clinical
depression. Her grandmother had periods of becoming withdrawn and not leaving the house for days.
What data from the histories are RELEVANT and have clinical significance for the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
1. States “feeling crumby” for 6 months 1. This is a symptom of depression. DSM 5
2. No longer feels like doing anything
3. Little appetite with weight loss 2. Symptom of depression, anhedonia. DSM-5
4. Sleep disturbances
3. This is called anhedonia, symptom of major depressive
5. States she has no energy, Fatigue disorder (Halter, 9-1-2017, p. 245)
6. Concentration Problems. 4. Symptom of MDD, DSM-5
7. No longer feels like doing anything 5. Symptom of MDD, DSM-5
she likes to do anymore, crying a lot 6. Symptom of MDD, DSM-5
7. Symptom of MDD, DSM-5
8. I don’t want to live like this. 8. Comments on not wanting to do anything could indicate
9. Increased alcohol consumption. intentions to commit suicide.
9. Assess patient’s alcohol consumption to see if patient is
detoxing from alcohol and not suffering from depression.
Differential diagnosis.
RELEVANT Data from Social History: Clinical Significance:
She is sad her old boyfriend is married and not This could add to her depression.
to her.
Grandmother had symptoms of depression. Could be a genetic component to her depression
Didn’t go back to school This could seem overwhelming to her life right now and add to much
(MDD )UNFOLDING Reasoning Marilyn
Smith 28 years old
,Major Depressive Disorder (MDD)
UNFOLDING Reasoning
STUDENT
Marilyn Smith, 28 years old
Primary Concept
Mood and Affect
Interrelated Concepts (In order of emphasis)
1. Stress
2. Coping
3. Clinical Judgment
4. Communication
5. Collaboration
6. Patient Education
, History of Present Problem:
Marilyn Smith is a single, African American 28-year-old female who presents to the emergency
department with complaints of “feeling crummy” for the past six months. She reports that she no longer feels
like doing any of the things she used to enjoy. “It all seems so pointless.” She can’t even bother to eat most
days and has lost weight recently. Although she has no energy, she finds it difficult to both fall sleep and stay
asleep. Even when she does manage to fall asleep, she never feels rested when she awakes. She reports having
difficulty at work as a computer support person because it is so hard for her to concentrate. Last week she
called in sick and spent the day in bed crying off and on all day. Last night she found herself crying again and
this time she also thought about suicide, which scared her and prompted a visit to the ED. “I don’t want to live
like this anymore. I feel like I will never be happy again.”
Personal/Social History:
Marilyn graduated from high school and obtained an associate degree in computer science. She enlisted in the
Army to have an adventure and hoped the GI bill would pay for further education once she completed her
service. She reports she still feels guilty about making the decision to enlist instead of marrying her high
school sweetheart. She was deployed to Iraq and returned home a year ago. She enjoyed her time in the
service because she felt she was doing something useful for her country. She did not see combat and did not
experience any significant problems while in Iraq. When she returned home, she found out her old boyfriend
had married. She recently attempted to contact local universities to explore completing her baccalaureate
degree but found the process too overwhelming and just gave up.
When questioned about use of alcohol or drugs, Marilyn reported that she is an occasional drinker, but recently
has been drinking more in an attempt to sleep. Denies another drug use. Marilyn has no history of clinical
depression. Her grandmother had periods of becoming withdrawn and not leaving the house for days.
What data from the histories are RELEVANT and have clinical significance for the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
1. States “feeling crumby” for 6 months 1. This is a symptom of depression. DSM 5
2. No longer feels like doing anything
3. Little appetite with weight loss 2. Symptom of depression, anhedonia. DSM-5
4. Sleep disturbances
3. This is called anhedonia, symptom of major depressive
5. States she has no energy, Fatigue disorder (Halter, 9-1-2017, p. 245)
6. Concentration Problems. 4. Symptom of MDD, DSM-5
7. No longer feels like doing anything 5. Symptom of MDD, DSM-5
she likes to do anymore, crying a lot 6. Symptom of MDD, DSM-5
7. Symptom of MDD, DSM-5
8. I don’t want to live like this. 8. Comments on not wanting to do anything could indicate
9. Increased alcohol consumption. intentions to commit suicide.
9. Assess patient’s alcohol consumption to see if patient is
detoxing from alcohol and not suffering from depression.
Differential diagnosis.
RELEVANT Data from Social History: Clinical Significance:
She is sad her old boyfriend is married and not This could add to her depression.
to her.
Grandmother had symptoms of depression. Could be a genetic component to her depression
Didn’t go back to school This could seem overwhelming to her life right now and add to much
