Author Question: A depressed patient is being seen in the clinic and started a selective serotonin reuptake inhibitor ... (Read 65 times)

amal · **on:** Jul 19, 2018

A depressed patient is being seen in the clinic and started a selective serotonin reuptake inhibitor (SSRI) last week. She tells the nurse that she has some pills that she previously took for depression and that they are called MAOIs.

She tells the nurse she thinks she should start taking them right now instead of her current medication, which isn't seeming to help her. The most important information the nurse should convey is: a. the need to have her blood pressure carefully monitored on MAOIs.
b. that the SSRI antidepressant will be more effective as the weeks go by.
c. the dietary restrictions required to take MAOIs antidepressants.
d. the risk of a serious reaction if she begins the MAOIs on her own.

Question 2

A patient has just learned that all possible treatments for his disease have been exhausted, and it will likely claim his life within the next month. He is alert, has full control of his motor abilities, and is comfortable.

He tells the nurse he cannot bear to leave his 11- and 13-year-old children when they are so young, that they seem so upset by his condition they change the topic when he brings it up, that he does not know how to talk with them, and yet he has so many things he has to say to them while there is still time. Which option would be most helpful for the nurse to endorse? a. Writing down his feelings and thoughts in a journal
b. Talking with a minister, priest, or hospice social worker
c. Telling the children that there is no time, they must face this
d. Praying for guidance and strength to deal with this challenge

owenfalvey · **Reply #1 on:** Jul 19, 2018

Answer to Question 1

D
The patient is at risk for a hypertensive crisis if she takes MAOIs after SSRIs without an appropriate washout period. The duration of the washout period is determined by the half-life of the SSRI. The other options are also part of patient education regarding MAOIs but are of lesser importance because they do not involve as immediate a safety risk as overlapping the SSRIs and MAOIs would present.

Answer to Question 2

A
Writing down thoughts and feelings can be a very helpful means of expressing oneself when speaking them aloud is difficult. It allows one to carefully compose and edit them until they truly reflect what is going on inside the person and to contemplate and adjust them over time. The act of writing down feelings can also help one process them and reduce the anxiety present about sharing these feelings aloud. In this situation, even if the patient's time ends before he can communicate his thoughts and feelings to the children orally, the journals will serve to pass along important reflections and give the children an opportunity to reread them when they are older and more mature. The other options may be of value as well but lack the benefits noted with journaling. Pressing the children to talk may increase their anxiety and distress, leading to further withdrawal at a time when there is so little time remaining to be together. Prayer is a culturally sensitive intervention that may or may not be acceptable to the patient's sensibilities and may or may not lead to the answers he seeks.