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Mrs. Smith (Depression (Medications (Zoloft (Side Effects: Sleepiness …

- - - - Indications:
        Depression and Anxiety
      - Side Effects:
        Sleepiness
        Drowsiness
        Nervousness
        Insomnia
        Dizziness
        Nausea
        Skin rash
        Increased sweating
        
        Monitor insomnia
        since the pt
        reported a decreased
        need for sleep
      - Nursing Implications:
        Monitor for serotonin syndrome
        Monitor for increased depression or suicidal thoughts
        Assess dizziness or drowsiness that could affect ambulation
        Monitor daily weight- weigh at the same time, using the same scale, and wearing the same clothes
        
        Serotonin Syndrome Symptoms:
        hyperthermia, rigidity, fluctuating vital signs and extreme agitation
        
        Benzodiazipines are used to reverse serotonin syndrome
      - Education:
        Inform pt of side effects
        Do not stop taking abruptly
        This medication may take 10-14 for it to start relieving symptoms. Continue taking the medication
        Do not drive or do other dangerous activities until you know how Zoloft affects you
        Report signs of bleeding
        Stay alert for changes in your mood and symptoms. Contact HCP with worsening symptoms
    - - Indications:
        Mood disorders
      - Side effects:
        EPS
        Dizziness
        Tiredness
        Drowsiness
        Fatigue
        Fever
        Weight gain
        Feeling hot or cold
        
        EPS Symptoms:
        Pseudoparkinsonism- stooped posture, shuffling gait, rigidity, bradykinesia, tremors at rest, pill rolling
        Akathisia- restless, trouble standing still, pacing, feet in constant motion, rolling back and forth
        Acute dystonia- facial grimacing, involuntary upward eye movement, muscle spasms, back muscle spasms causing trunk to arch forward
        Tardive Dysinesia- rolling of tongue, smacking movement of lips, chewing motion, facial dyskinesia, involuntary movements of body and extremities
      - Nursing Implications:
        Monitor for EPS symptoms
        Monitor blood pressure
        Monitor for neuroleptic malignant syndrome
        
        Neuroleptic malignant syndrome symptoms:
        Fever, respiratory distress, tachycardia, seizures, diaphoresis, hypertension or hypotension, pallor, tiredness
        
        Reduce fever
        Prevent further complications such as
        respiratory issues
        
        Can be life threatening. Notify HCP immediately if symptpms occur
      - Education:
        Inform patient of side effects
        Do not drink while taking this medication
        This medication may cause you to get hot or cold easily- drink plenty of fluids (especially during exercise) avoid getting hot or cold too fast
        It may take several weeks for symptoms to improve; keep using the medication
        May impair your thinking and reaction time- be careful driving and partaking in other dangerous activities until you know the effects Risperadal has on you
  - - - Poor hygiene
        
        Manic symptoms
        
        Decreased need for sleep
        
        Euphoria
        
        bizarre behavior
        
        Racing thoughts
        
        1 more item...
  - - - Monitor for risk of suicide/reduce risk of suicide
        
        Use effective coping mechanisms during presence of depression
        
        Coping mechanisms are different for each patient
        so nurse must partner with Ms. Smith to see what works best for her.
    - - Encourage patient to express feelings
        
        Use Active Listening and repeat/clarify what the patient is saying
  - - - Find effective coping strategies
        
        Perform as many self-care activities and ADLs as possible
        
        Currently on soft wrist restraints so this is more of a long term goal for Ms. Smith
        
        Engage pt in purposeful activities
        
        Point out positive attributes of the patient to instill confidence and worth
        
        Pt is not sleeping well so decrease stimulation before bed as much as possible to promote sleep
        
        Educate pt on why they are taking each of their medications
        
        1 more item...
- - - - giving away personal belongings, saying statements such as, "I won't be a burden to you anymore for long.", "I don't want to do this anymore.", "Life is too hard.", etc.
  - - - call doctor to determine if suctioning can be turned off
        
        If it can be turned off
        
        assess location of tube by aspirating gastric contents and checking the PH or get abdominal X-ray.
        
        raise HOB to 30 degrees, patient identifiers, patient rights, crush medications (if not contradicting with each other and if they can be crushed) and combine in cup, **remove suctioning from NG tube and clamp NG tube, clean gloves, check for placement, drawing up 30 ml of water and flushing tubing, clamping it, and then reinsert a syringe into the NG tube and administer medication and then flush again with 30ml of water between each medication. When done administering the medication, clamp the tube and reattach the cap. DO NOT CONTINUE SUCTION UNTIL 30 MINUTES AFTER MEDICATION ADMINISTRATION
        
        **after 30 minutes you will be able to reattach suction
        
        two of the patients medications cannot be crushed. would need to call doctor to change route of medication for Zoloft and Risperadal.
        
        Zoloft can be ordered as capsule
        
        Risperadal can be given IM.
        
        this is to treat acute mania.
        
        assess lung sounds for aspiration
        
        possible rales or rhonchi
        
        If it cannot be turned off
        
        leave suctioning alone and call doctor to discuss if any of the medications prescribed could be changed to IV medications or any other alternate route. OR would need to ask if patient can have medications PO and nothing else.
        
        it should be noted patients with recent GI surgery or other complications are contraindicated to receive medications orally & down tube. Any alteration in GI function can interfere with absorption of medication
- - - - begin the therapeutic relationship
        
        get to know patient. let them know you care about them and want to help them. Assess the reasoning behind their self harming actions and thoughts. assess if patient has family/friends
        
        Also having an experienced 1:1 with this patient will allow the sitter to establish a rapport and build trust with this patient giving the patient someone other than the nurse to confide in.
        
        be aware of transference
      - assess if patient has a plan and if there are certain triggers to her depression and suicidal thoughts
        
        if there is a plan: get pt a full time sitter, make sure pt door is always open, remove harmful objects, assess what the patients plan is
        
        Keep in mind this patient is in a maniac state of depression and shows psychotic symptoms. Note that these patients are ESPECIALLY vulnerable to suicide especially considering the patients risk factors (previous suicide attempt, hx of family suicide, bipolar disorder, depression, failed relationship, recent self harm)
        
        remove all harmful objects that may be used to self inflict harm. These items could include: metal utensils, electrical cords, glass, belts, shoelaces, tweezers, metal nail files, razors, perfume, drugs, sharp object, exc
        
        Remove sharps container and all cords including the call light. This is another reason why the 1:1 is needed.
        
        place in the nearest bed to the nursing station
    - - restraining order placed on her by her ex-husband
- - - - work left to right to maintain sterility. never turn back to field. hands in front of you and must stay between belly button and eye level. clean from inside out of the wound. (clean to dirty) in a circular motion.
        
        sign, date, time bandage
- - - - monitor cap refill and color of toes. if cap refill is more than seconds or discoloration of toes, indicate poor circulation and the cast is too tight and will need to be replaced.
        
        elevate the leg equivalent with the heart or a tad bit higher to prevent swelling.
- - - - Needs to be a new order by doctor q24h
        
        Try to have the restraints removed ASAP as long as patient is stable