Question

As a nurse who is taking care of patients with mood disorders, what are the significant nursing implications if patient/patients is/are taking monoamine oxidase inhibitors(MAO) , serotonin-norepinephrine uptake inhibitors (SNRIs) and tricyclic antidepressant(TCA) ?

Answer 1

These are vital nursing interventions done in patients who are taking TCAs:

• Limit drug access if patient is suicidal to decrease the risk of overdose to cause harm.
• Administer a major portion of dose at bedtime as ordered if drowsiness and anticholinergic effect are severe to decrease the risk of patient injury.
• Provide comfort measures (e.g. voiding before dosing, taking food with drug, etc.) to help patient tolerate drug effects.
• Provide safety measures (e.g. adequate lighting, raised side rails, etc.) to prevent injuries.
• Educate client on drug therapy to promote compliance.

These are vital nursing interventions done in patients who are taking MAOIs:

• Limit drug access if the patient is suicidal to decrease the risk of overdose to cause harm.
• Monitor patient for 2-4 weeks to ascertain onset of full therapeutic effect.
• Monitor blood pressure carefully to determine the possible need for dose adjustment.
• Secure phentolamine at the bedside as a treatment in case of hypertensive crisis.
• Educate client on a low tyramine-containing diet. Provide a list of potential drug-food interactions that can cause severe toxicity to decrease the risk of a serious drug-food interaction.
• Provide comfort measures (e.g. voiding before dosing, taking food with the drug, etc.) to help patient tolerate drug effects.
• Provide safety measures (e.g. adequate lighting, raised side rails, etc.) to prevent injuries.
• Educate client on drug therapy to promote compliance.

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These are vital nursing interventions done in patients who are taking SSRIs:

• Arrange for lower dose in elderly patients and in those with renal or hepatic impairment because of the potential for severe adverse effects.
• Limit drug access if patient is suicidal to decrease the risk of overdose to cause harm.
• Monitor patient for 4 weeks to ascertain onset of full therapeutic effect.
• Establish suicide precautions for severely depressed patients to decrease the risk of overdose to cause harm.
• Administer drug once a day in the morning to achieve optimal therapeutic effects.
• Suggest that the patient use barrier contraceptives to prevent pregnancy while taking this drug because serious fetal abnormalities can occur.
• Provide comfort measures (e.g. taking food with the drug) to help patient tolerate drug effects.
• Provide safety measures (e.g. adequate lighting, raised side rails, etc.) to prevent injuries.
• Educate client on drug therapy to promote compliance.

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