A patient with major depression will begin electroconvulsive ...

[Marty]

A patient with major depression will begin electroconvulsive therapy tomorrow. Which interventions are routinely implemented before the treatment? Select all that apply.
 
  a. Administer pretreatment medication 30 to 45 minutes before treatment.
  b. Withhold food and fluids for a minimum of 6 hours before treatment.
  c. Remove dentures, glasses, contact lenses, and hearing aids.
  d. Restrain the patient in bed with padded limb restraints.
  e. Assist the patient to prepare an advance directive.

Question 2

A patient being treated with paroxetine (Paxil) 50 mg/day orally for depression reports to the clinic nurse, I took a few extra tablets earlier in the day and now I feel bad. Which assessments are most critical? Select all that apply.
 
  a. Vital signs
  b. Urinary frequency
  c. Increased suicidal ideation
  d. Presence of abdominal pain and diarrhea
  e. Hyperactivity or feelings of restlessness

[janieazgirl]

Answer to Question 1

ANS: A, B, C
The correct interventions reflect routine electroconvulsive therapy preparation, which is similar to preoperative preparation: sedation and anticholinergic medication before anesthesia, maintaining nothing-by-mouth status to prevent aspiration during and after treatment, airway maintenance, and general safety by removing prosthetic devices. Restraint is not part of the pretreatment protocol. An advance directive is prepared independent of this treatment.

Answer to Question 2

ANS: A, D, E
The patient is taking the maximum dose of this SSRI and has ingested an additional unknown amount of the drug. Central serotonin syndrome must be considered. Symptoms include abdominal pain, diarrhea, tachycardia, elevated blood pressure, hyperpyrexia, increased motor activity, and muscle spasms. Central serotonin syndrome may progress to a full medical emergency if not treated early. Although assessing for suicidal ideation is never inappropriate, in this situation physiologic symptoms should be the initial focus. The patient may have urinary retention, but frequency would not be expected.

[Marty]

Gracias!

[Alyson.hiatt@yahoo.com]

TYSM