NSG 325 Module 3Case study 5 Anti-depressantsA 28-year-old patient who is a high school science teacher with two children comes to the community mental health center at her family’s urging because of lack of interest in usual activities, difficulty concentrating, excessive sleepiness and feeling “down” every day for the past three months. Desipramine (Norpramin) 50 mg at bedtime is prescribed. 1. What are the particular advantages of this particular TCA for this patient?a. Blocks reuptake of NE and serotonin into neurons which increases their levels in the synapse. This medication improves mood, sleep, appetite, and energy level. May also help restore interest in daily activities. Less likely to have sexual dysfunction than other antidepressants. 2. The patient is hopeful that the medication will help. She asks “If the drugs work, why do I have to meet with the doctor every week?” What is the basis of the response to this question? a. Meeting with the doctor is important to monitor serum levels, assess your mood and mental status, and make sure that the medication is not giving you any unbearable adverse effects. 3. What symptoms should the patient, family members, and/or caregivers be told to report?a. Blurred vision, hallucinations, arrhythmias, urinary retention, mental or mood changes, and confusion. Suicidal thoughts4. The patient asks why the drug is supposed to be taken at bedtime. How should the nurse respond? a. This medication may cause drowsiness, fatigue, and hypotension so if you are sleeping the medication will not affect your daily activities.5. What teaching should the nurse provide regarding these common adverse effects of TCA’s?a. Sedation- Do not drive or complete activities that require alertness.b. Orthostatic hypotension- Change position slowly, dangle feet before standing.c. Anticholinergic effects- Do not mix with other TCA, increase intake of fiber and fluids will help with constipation, and frequent oral care and sugarless gum will help with dry mouth.6. The patient is concerned about cost because the prescriber has prescribed one weeks’ supply at a time. What would be the rationale for such a small prescription amount?a. Risk for abuse and overdose with this medication. The patient has to have serum levels and mood assessed frequently to see if the dose is correct.7. The patient is admitted for a laparoscopic cholecystectomy. When providing history information the patient states that she has been taking Norpramin 200 mg at bedtime for 3months. She tells the nurse that some nights she forgets to take the medication, but does not feel different the next day. She thinks the medication is not working and is a waste of money. The nurse notifies provider and a change is made in her medication while she is in the hospital. She is started on Sertraline (Zoloft) 50 mg daily. What patient teaching needs to be done before the patient is discharged?a. Zoloft is a SSRI, which is a different type of anti-depressant medication. It only inhibits the reuptake of serotonin, not norepinephrine. Tell patient to notifyprovider if they have any suicidal thoughts. Major adverse effects for this medication include sexual dysfunction, increased sweating, headache, fatigue, dizziness, drowsiness, diarrhea, dry mouth, nausea, and serotonin
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