About stopping medication without medical supervision

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Case Study

James is a 55-year old widower. He lives alone in an apartment and has a 32-year-old married daughter who lives 1000 miles away. Three months ago, James was forced to take early retirement from his job in middle management at a computer firm. Over the past month he has exhibited depressed affect and has become so withdrawn that he no longer attends church or his weekly evening out with his friends. He reports difficulty falling asleep and staying asleep, agitation, a weight loss of 15 pounds in 1 month, difficulty concentrating and making decisions, and ruminations and guilt about his wife's death 10 years ago. He was admitted to the hospital after his neighbor brought him to the emergency department. There, James admitted plans to kill himself with a handgun he kept at home. He had one previous episode of major depression at age 45, about the time of his wife's death. He has never made an actual suicide attempt. James has been in the hospital for 13 days. He has been taking sertraline (Zoloft) 100 mg every day and amitriptyline (Elavil) 100 mg before bed, and is being considered for discharge.

1. Identify four SSRI's and three tricyclics that would be options for treating James' depression. Give both generic and trade names.

Generic Trade

2. Compare and contrast the onset of action, action and major side effect of the SSRI's and Tricyclics that James is being treated with.

SSRI's Tricyclics

Onset

Action

Side Effects

3. Since James is suicidal what safety concern should be addressed when he is given a prescription?

4. In discharge teaching with James what should he be told about stopping his medication without medical supervision?

Because James has not responded well to the tricyclic medication it was discontinued and a MAOI, tranylcypromine (Parnate) was added.

5. How is the action of a MAOI similar and different to that of an SSRI and Tricyclic?

6. James is discharged and in two weeks you follow-up with a home visit. When you arrive, James is in the middle of lunch that includes the following: A grilled cheese sandwich with a side salad. On the kitchen counter is an open bottle of Chianti wine. What is the outcome of your discharge dietary teaching? Why?

7. James reports that he has had a cold and last night took an over the counter cold preparation for sleep. What actions do you take?

8. James starts to get up from the table and suddenly looses his balance. Explain why this would be happening to James and what nursing action you would take.

 

Reference no: EM133543312

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