C H A P T E R 2 1
Antidepressant agents
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the need for periodic monitoring and evaluation
to enhance knowledge about drug therapy and to
promote compliance.
■
■
Offer support and encouragement
to help the
person cope with the disease and the drug regimen.
Evaluation
■
■
Monitor response to the drug (alleviation of signs
and symptoms of depression, OCD, bulimia, panic
disorder).
■
■
Monitor for adverse effects (sedation, dizziness, GI
upset, respiratory dysfunction, GU problems, skin
rash, serotonin syndrome).
■
■
Evaluate the effectiveness of the teaching plan
(person can give the drug name, dosage, possible
adverse effects to watch for, specific measures to
help avoid adverse effects, importance of continued
follow-up and importance of avoiding pregnancy).
■
■
Monitor the effectiveness of comfort measures and
compliance with the regimen.
CRITICAL THINKING SCENARIO
Selective serotonin reuptake inhibitors
THE SITUATION
D.J., a 46-year-old married woman, complains of weight
gain, malaise, fatigue, sleeping during the day, loss of
interest in daily activities and bouts of crying for no
apparent reason. On examination, she weighs 4 kilograms
more than the standard weight for her height; all other
findings are within normal limits. In conversation with a
nurse, D.J. says that in the past 10 months, several events
have occurred. She lost both of her parents, her only child
graduated from high school and went away to university,
her nephew died of renal failure, her only sister learned she
had metastatic breast cancer, and she lost her job as a day
care provider when the client family moved out of town.
In addition, the family cat of 17 years was diagnosed with
terminal leukaemia. D.J. is prescribed fluoxetine (
Prozac
) and
is given an appointment with a counsellor.
CRITICAL THINKING
What nursing interventions are appropriate at this time?
What sort of crisis intervention would be most appropriate?
Balance the benefits of pointing out all of the losses and points
of grief that you detect in D.J.’s story with the risks of upsetting
her strained coping mechanisms
. What can D.J. expect to
experience as a result of the SSRI therapy? How can you
help D.J. cope during the lengthy period it takes to reach
therapeutic effect? What other future interventions should
be planned with D.J.?
DISCUSSION
Many people in severe crisis do not consciously identify
the many things that are causing them stress. They have
developed coping mechanisms to help them survive and
cope with their day-to-day activities. D.J. seems to have
reached her limit and exhibits many of the signs and
symptoms of depression. However, it is important to make
sure that she does not have some underlying medical
condition that could be contributing to her complaints.
Because of her age, she may also be perimenopausal, which
could account for some of her problems.
It is hoped that the fluoxetine, an SSRI, will enable D.J.
to regain her ability to cope and her normal affect. The drug
should give her brain a chance to reach a new biochemical
balance. Before she begins taking the fluoxetine, she
should receive a written sheet listing the pertinent drug
information, adverse effects to watch for, warning signs
to report, and a telephone number to call in case she has
questions later or just needs to talk. The written information
is especially important because she may not remember
drug-related discussions or instructions clearly.
Once the SSRI reaches therapeutic levels, which can
take as long as 4 weeks, D.J. may start to feel like her “old
self” and may be strong enough to begin dealing with all
her grief. She may recover from her need for the SSRI over
time, and use of the medication can then be discontinued.
CARE GUIDE FOR D.J.: FLUOXETINE
Assessment: History and examination
Allergies to fluoxetine or any other antidepressant
SSRI; renal or hepatic dysfunction; pregnancy or
breastfeeding; diabetes
Concurrent use of TCAs, cyproheptadine, lithium, MAO
inhibitors, benzodiazepines, alcohol, other SSRIs
CV: blood pressure, pulse
CNS: orientation, affect, reflexes, vision
Skin: colour, lesions, texture
Respiratory: respiration, adventitious sounds
GI: abdominal examination, bowel sounds
Laboratory tests: hepatic and renal function tests
Implementation
Administer drug in morning; divide doses if GI upset occurs.
Provide comfort, safety measures; small meals; void before
dosing; side rails; pain medication as needed; suggest
barrier contraceptive; limit dosage with people who
are potentially suicidal; lower dose with renal or hepatic
impairment.
