A home health patient previously lived with her sister for more than 20 years.Although it has been over a year since her sister died,the patient tells the nurse,"It's no worse now,but I never feel any relief from this overwhelming sadness.I still can't sleep a full night.The house is a mess; I feel too tired,even to take a bath.But,sometimes at night,she comes to me and I can see her plain as can be." The patient's clothing is not clean and her hair is not combed.She is apparently not eating adequately.What can the nurse conclude? The patient is probably

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The patient is likely experiencing a depressive disorder.Her symptoms include unrelieved,overwhelming sadness; insomnia; difficulty carrying out ADLs; fatigue; and visual hallucinations.Note that her sadness is pervasive,not created by a trigger event (holiday).Of those symptoms,insomnia is common to both grief and depression,but the other symptoms are signs of depressive disorder.There is,of course,no "correct" timeline for what constitutes "longer than usual" grieving; however,the patient's symptoms are typical of depression,not grief.She has not said she feels guilty or worthless,and there is nothing from which the nurse could infer that.She has specifically said that the holiday has not made her feel any worse-that is,it has not been a trigger event.

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