Postpartum Mood Disorders

Notes

Description
  1. The Diagnostic and Statistical Manual of Mental Disorders contains official guidelines for the assessment and diagnosis of psychiatric illness. The disorders recognized during the postpartum period are:
    • Postpartum blues
    • Postpartum depression without psychotic features
    • Postpartum depression with psychotic features (postpartum psychosis)
  2. Between 50% and 80% of all new mothers report some form of postpartum blues.
  3. The incidence of moderate or major postpartum depression or postpartum bipolar disorder ranges from 30 to 200 per every 1,000 live births; the incidence of brief psychotic disorders with postpartum onset is about 1 in every 1,00 live births.
Etiology
  1. Predisposing factors include a history of puerperal psychosis, bipolar (for merly manic-depressive) disorder, delirium and hallucinations, rapid mood changes, agitation or confusion, and the potential for suicide or infanticide.
  2. Postpartum depression with and without psychosis is being studied from three perspectives.
    • Biologic theories include alteration in hypothalamic function, possibly related to altered hormonal influence.
    • Psychological theories include poor support systems, psychologic stress, or poor relationship with partner.
    • Socio-cultural theories include low levels of social gratification, support, and control both at work and in the parenting role.
Comparison of Postpartum Blues, Depression and Psychosis
POSTPARTAL BLUES POSTPARTAL DEPRESSION POSTPARTAL PSYHOSIS
ONSET 1-10 days after giving birth 1-2 months after giving birth Within first to third month after giving birth
SYMPTOMS Sadness, tears Anxiety, feelings of loss, sadness Delusions or hallucinations of harming infant or self
INCIDENCE 70% of all births 10% of all births 1% to 2% of all births
ETIOLOGY Probably caused by hormonal changes, stress of life changes History of previous depression, hormonal response, lack of social support Possible activation of previous mental illness, hormonal changes, family history of bipolar disorder
THERAPY Support, empathy Counseling, drug therapy Psychotherapy, drug therapy
NURSING NOTE Offering compassion and understanding Referring to counseling Referring to counseling, safeguarding mother from injury to self or to newborns.

Comparison Table Source: Pillitteri, A. (2007). Maternal and Child Health Nursing: Care of the Childbearing and Childbearing Family. 5th Edition

Assessment Findings
  • Serious postpartum depression or psychosis usually does not occur until 3 to 5 days after delivery, at which time the client is usually discharged from the hospital or birthing center. Clinical manifestations depend on the type of mood disorder.

Postpartum Mood Disorders

  1. Postpartum blues manifestations include fatigue, weeping, anxiety, mood instability with onset 1 to 10 days postpartum and lasting 2 weeks or less.
  2. Postpartum depression without psychosis manifestations include confusion, fatigue, agitation, feelings of hopelessness and shame, and alterations in mood.
  3. Postpartum depression with psychosis manifestations include symptoms of postpartum depression plus delusions, auditory hallucinations, and hyperactivity.

Nursing Management

1. Identify postpartum mood disorders.

  1. Be aware of signs and symptoms of postpartum mood disorders.
  2. Teach the client and family about these disorders.

2. Support and treat the client and family.

  1. Develop specific therapeutic goals.
  2. Maintain the prescribed medication schedule.
  3. Keep communication open with the health care providers; coordinate social services.
  4. Include family participation and involvement in plans of care.
  5. Make appropriate referrals.

3. Support efforts at parent-newborn bonding.

  1. Provide support for the mother’s continued are of the newborn, if appropriate and safe for the newborn.
  2. Plan for continuity of are for the mother, newborn, and family.

Interventions for Postpartum Depression

Exam

Welcome to your Postpartum Mood Disorders Practice Exam! This exam is carefully curated to help you consolidate your knowledge and gain deeper understanding on the topic.

 

Exam Details

  • Number of Questions: 20 items
  • Mode: Practice Mode

Exam Instructions

  1. Practice Mode: This mode aims to facilitate effective learning and review.
  2. Instant Feedback: After each question, the correct answer along with an explanation will be revealed. This is to help you understand the reasoning behind the correct answer, helping to reinforce your learning.
  3. Time Limit: There is no time limit for this exam. Take your time to understand each question and the corresponding choices.

Remember, this exam is not just a test of your knowledge, but also an opportunity to enhance your understanding and skills. Enjoy the learning journey!

 

Click 'Start Exam' when you're ready to begin. Best of luck!

💡 Hint

Consider the severity and duration of postpartum depression compared to more common and mild emotional changes after childbirth.

1 / 20

1. Nurse Jane is educating a new mother about postpartum mental health. How should Nurse Jane best describe Postpartum Depression?

💡 Hint

Focus on factors that are strongly associated with emotional or psychological stress, as well as previous mental health challenges.

2 / 20

2. Nurse Karen is evaluating a new mother for potential postpartum depression. She reviews the risk factors that could increase the likelihood of developing this condition. Which of the following should Nurse Karen consider? (Select all that apply)

💡 Hint

The focus of postpartum depression care is on providing the mother with the necessary treatment and support. Child removal is not a standard response unless there are severe safety concerns.

3 / 20

3. Nurse Rachel is addressing a new mother's concerns about the implications of a postpartum depression diagnosis. The mother is worried that a diagnosis might lead to her baby being taken away. How should Nurse Rachel respond?

💡 Hint

Cultural sensitivity involves recognizing and respecting diverse practices and beliefs, especially those that may influence how parents interact with their newborns.

4 / 20

4. Nurse Maria is developing a culturally sensitive plan of care to promote parental-infant attachment. Which cultural practices should she consider?

💡 Hint

Think about a way to involve the older children that fosters positive feelings toward the new sibling.

5 / 20

5. Nurse Kelly is counseling new parents, John and Emily, on how to help their older children adjust to the arrival of a new sibling. What strategy should Nurse Kelly recommend to ease this transition?

💡 Hint

Consider a common and usually short-lived emotional response experienced by many new mothers after childbirth.

6 / 20

6. Nurse Claire is discussing postpartum emotional changes with a new mother. How should Nurse Claire best describe the "Baby Blues"?

💡 Hint

Postpartum blues are common and usually resolve with rest, support, and self-care. Encouraging the mother to rest and accept help is key to recovery.

7 / 20

7. Nurse Sarah is supporting a new mother experiencing postpartum blues. What suggestions should Nurse Sarah offer?

💡 Hint

Understanding the comfort level of peers in discussing sensitive topics requires direct communication or feedback, rather than assumptions or relying solely on experience level.

8 / 20

8. Nurse Lisa is preparing to have a conversation with a new mother about postpartum depression. As she considers the task ahead, she reflects on how comfortable most nurses feel discussing this sensitive topic with their patients. How might Nurse Lisa assess this general comfort level among her peers?

💡 Hint

Consider the importance of visual and emotional connection in the early bonding process between a mother and her newborn.

9 / 20

9. Nurse Anna is monitoring the interactions between a new mother, Rachel, and her newborn son during her postpartum stay. Which behavior observed by Nurse Anna might suggest a concern with the mother-infant attachment process?

💡 Hint

Think about behaviors that demonstrate attentiveness and involvement in the newborn's presence and actions.

10 / 20

10. During a follow-up visit, Nurse Laura is assessing the attachment behaviors of new parents with their infant. Which behavior would Nurse Laura recognize as one that facilitates positive parent-infant attachment?

💡 Hint

At one week postpartum, it’s common for new mothers to reflect on and process their birth experience. This is a normal part of the adjustment period.

11 / 20

11. Nurse Lydia visits Sarah, a postpartum mother, at her home one week after giving birth. During the visit, Nurse Lydia observes Sarah’s behavior and emotional state to ensure she is adjusting well to her new role. What characteristic behavior should Nurse Lydia expect Sarah to display at this stage?

💡 Hint

Consider what would be the most compassionate and supportive approach for a mother who is physically and emotionally exhausted after a difficult labor.

12 / 20

12. Nurse Emily is attending to a first-time mother, Sarah, who had a challenging labor and delivery. Four hours after the birth, Sarah expresses that she is too exhausted to feed her newborn and just wants to sleep. How should Nurse Emily respond to Sarah’s request?

💡 Hint

Focus on the symptoms that reflect significant changes in mood or emotions after childbirth, rather than temporary or positive adjustments.

13 / 20

13. Nurse Jenna is assessing a new mother who has been experiencing emotional and physical changes since giving birth. To identify possible signs of postpartum depression, Nurse Jenna reviews the common symptoms. Which of the following should she recognize as potential indicators?

💡 Hint

Effective communication with parents who have sensory impairments involves using tools and resources that cater to their specific needs, ensuring they can fully understand and participate in their care.

14 / 20

14. Nurse Amy is developing a care plan for parents with sensory impairments. Which considerations should Nurse Amy keep in mind?

💡 Hint

A supportive partner can play a crucial role in early detection and intervention for postpartum depression by being aware of the signs and encouraging open communication.

15 / 20

15. Nurse Sarah is planning a postpartum depression education session for a new mother and her partner. She considers whether involving the support person might hinder the recognition of postpartum depression. What should Nurse Sarah conclude?

💡 Hint

A history of postpartum depression increases the likelihood of recurrence in subsequent pregnancies. Awareness and early intervention are crucial in managing this risk.

16 / 20

16. Nurse Emily is assessing a new mother who previously experienced postpartum depression with her last pregnancy. As part of the care plan, Nurse Emily considers the likelihood of the mother experiencing postpartum depression again in the future. How should Nurse Emily assess the risk?

💡 Hint

Think about a condition that shares similar emotional and psychological symptoms with postpartum depression.

17 / 20

17. Nurse Emily is educating a new mother about postpartum depression (PPD). She explains that the symptoms of PPD closely resemble which other condition?

💡 Hint

Think about what a new mother might need most immediately after childbirth, particularly in terms of emotional and psychological recovery.

18 / 20

18. Nurse Jenna is caring for a first-time mother, Maria, who is in the taking-in stage of postpartum recovery. Understanding the typical needs of mothers during this stage, how should Nurse Jenna best support Maria?

💡 Hint

Consider the challenges in recognizing postpartum depression and how that might impact the early detection and treatment of the condition.

19 / 20

19. Nurse Grace is creating a care plan for a new mother who may be at risk for postpartum depression (PPD). Which fact should Nurse Grace be particularly mindful of when planning care?

💡 Hint

The overlap between normal postpartum experiences and symptoms of postpartum depression can make it challenging to distinguish between the two, leading to underdiagnosis.

20 / 20

20. Nurse Amanda is reviewing the reasons why postpartum depression often goes unnoticed or is underdiagnosed in new mothers. She considers various factors that could contribute to this issue. Which of the following are common reasons?

Nursing Care Plan

Nursing Diagnosis
Risk for Ineffective Coping Related to Depression in response to stressors associated with childbirth and parenting.
Expected Outcome
After implementation of nursing care, client will verbalize feelings with the significant other and health care provider throughout the postpartum period.
Nursing Intervention
Intervention Rationale
Active- listen and identify client’s
perceptions of current situation.
To assess client’s coping
abilities and evaluate her ability to understand present situation.
Encourage significant other (SO) to spend time with the client. One of the best strategy to help mothers decrease their well-being during the postpartum period is conveying a caring attitude. This is demonstrated by the SO spending quality time with her.
Emphasize the need for continued communication with the partner or a close friend who is available to provide support when loneliness or anxiety becomes a problem. Frequent contact with other adults (SO or close friend) keeps away feelings of isolation.
Encourage verbalization of fears and anxieties and expressions of feelings depression.
Allowing the client to vent out negative feelings helps meet the new mother’s psychological needs. It is important to recommend to her though, to acknowledge these ‘negative feelings’.
Discuss the realities of parenting and the fact that it may be exhausting. It may be helpful to rehearse some of the situations that may occur such as a fussy baby or being home alone. This is a good way to help the woman develop perspective and accept her new role as a mother.
Point out infant cues and explain their meaning. Suggest measures that may enhance her sensitivity to infant cues.
Model behavior to show the mother how to respond to the infant’s cues can help her be more sensitive to her infant’s needs. This helps her feel better about herself and her ability to care for the infant.
Include the spouse in discussions about the
woman’s condition. Offer practical ways the spouse can help the new mother manage the changes in their lives.
The way the spouse responds and handles the situation can affect the woman positively or negatively.
Emphasize the importance of the mother taking the medication as ordered. Antidepressants are often used for PPD and may be continued for 6months or more.
Assist the mother and her partner in identifying people who are available to provide support.  Depression responds best to a combination of psychotherapy, social support and medication. It is important to identify other support

people (apart from the spouse) to serve as the woman’s social
support.