Nursing diagnosis

Nursing diagnosis

  • Risk for suicide
  • Risk for injury
  • Social isolation
  • Risk for constipation
  • Insomnia

Drug Classification

Drug trade/ Generic names

Actions

Side effects

Nursing implication

Tricyclic (TCAs)

Elavil (Amitriptyline)

Tofranil (Imipramine) Pamelor (Nortriptyline).

Blocks re-uptake of serotonin and nor-epinephrine.

Anti-cholinergic effects : dry mouth, blurred vision, urinary retention, sedation, and drowsiness

Not a first line treatment! Can overdose on these, and can cause cardiac conduction disturbances.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Prozac (Fluoxetine)

Zoloft (Sertraline)

Paxil (Paroxetine)

Celexa (Citalopram), Lexapro (Escitalopram), Luvox (Fluvoxamine)

(Most widely prescribed)

Blocks the re-uptake and thus the destruction of serotonin.

Apathy and low libido.

Low lethality! 

Difficult to overdose.

Serotonin-  Norepinephrine Reuptake Inhibitors (SNRIs)

Effexor (Venlafaxine)

Cymbalta (Duloxetine).

In low doses blocks reuptake of Serotonin; in high doses blocks reuptake of Norepinephrine

Monoamine Oxidase Inhibitors (MAOIs)

Marplan (Isocarboxazid), Nardil (Phenelzine), Parnate (Tranylcpromine) Ensam (Selegiline).

Inhibits the action of Monoamine Oxidase (Oxidase destroys Monoamines such as Serotonin, Epinephrine, Dopamine, and Norepinephrine).

Do not take with other anti-depressants

Avoid foods containing tyramine such as wine, smoked fish and aged cheese!

Toxic effect can develop into hypertensive crisis. (headache, increased respirations, light headed, vomiting, and increased heart rate)

If so, hold med, call MD, and take client to the ER

Mood Stabilizers

Lithium, anticonvulsant medications, and second-generation atypical antipsychotics

Interactions

  • Because lithium is an imperfect substitute for sodium, anything that depletes sodium will make more receptor sites available to lithium and increase the risk for lithium toxicity

Common causes for Increased Lithium levels

  • Decreased sodium intake
  • Diuretic therapy
  • Decreased renal functioning
  • Fluid and electrolyte loss, sweating, diarrhea, dehydration, fever, vomiting
  • Medical illness
  • Overdose
  • Nonsteroidal anti-inflammatory therapy

Nursing diagnosis

  • Risk for injury
  • Risk for self-directed or other-directed violence
  • Risk for injury related to lithium toxicity
  • Risk for injury related to adverse effects of mood-stabilizing drugs
  • Risk for activity intolerance

Lithium Maintenance

  • Therapeutic range
    • 1.0 to 1.5 milliequivalents per liter (acute mania)
    • 0.6 to 1.2 milliequivalents per liter (maintenance)
  • Ensure that client consumes adequate sodium and fluid in diet.
  • Using Lithium
    • Needs initial and ongoing health assessment, laboratory monitoring
    • Excreted by kidneys, can adversely affect thyroid, has narrow therapeutic index
    • Blood levels can quickly become fatal
    • Need health teaching of patient, family, support system
    • Patients differentiate side effects from potentially life-threatening toxic effects, maintain stable lithium level

Educate client and family about the medication