Greene is an 85-year-old male placed on a 5150 by the crisis team after his nurse called them. He has taken a fall in his driveway after his dialysis. He has end-stage kidney disease, diabetes, and a history of myocardial infarction 4 years ago. He was living alone until his home health nurse found him crying out in pain, clutching onto his leg in the kitchen. “I’m so tired,” he says.Nortriptyline and some tricyclic antidepressants may be helpful with neuropathic pain but are often contraindicated in elderly clients such as Mr. Greene because (select the best answer)
Are outdated medications
Can increase cardiac side effects and urinary retention
Are only taken at night
Are expensive
Are expensive
The Correct Answer is B
Choice A reason:
While some may consider tricyclic antidepressants outdated, they are still used for certain conditions, including neuropathic pain. The primary concern with their use in elderly clients is not their age but their side effect profile.
Choice B reason:
Tricyclic antidepressants, including nortriptyline, can increase cardiac side effects and urinary retention, which are significant concerns in elderly clients. These medications can cause orthostatic hypotension, arrhythmias, and exacerbate urinary retention, making them less suitable for older adults with pre-existing health conditions.
Choice C reason:
The timing of medication administration (e.g., only taken at night) is not the primary issue with tricyclic antidepressants. The concern lies in their side effects, which can be particularly problematic for elderly clients.
Choice D reason:
While the cost of medication can be a factor in treatment decisions, it is not the primary reason tricyclic antidepressants are contraindicated in elderly clients. The main concern is their potential to cause serious side effects.
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Correct Answer is ["A","B","C"]
Explanation
Choice A reason:
Reframing “all or nothing” thinking and that it is all “her fault” is an important cognitive behavioral approach. This technique helps Tiffany recognize and challenge irrational thoughts that contribute to her low self-esteem and anxiety. By learning to see situations in a more balanced way, she can reduce feelings of guilt and self-blame.
Choice B reason:
Having Tiffany identify self-soothing activities for decreasing anxiety is another effective cognitive behavioral approach. Self-soothing activities, such as deep breathing, listening to music, or engaging in hobbies, can help her manage anxiety and reduce the urge to engage in compulsive behaviors like handwashing.
Choice C reason:
Reframing self-criticism and giving positive feedback for insightful comments during group therapy can help Tiffany build self-esteem and develop a more positive self-image. Positive reinforcement encourages her to recognize her strengths and achievements, which can counteract negative self-perceptions.
Choice D reason:
Telling Tiffany she “has her entire life ahead of her and shouldn’t be worried about her former boyfriend” is not a cognitive behavioral approach. While it may be intended to provide reassurance, it does not address the underlying cognitive distortions or provide strategies for managing anxiety and low self-esteem.
Correct Answer is A
Explanation
Choice A reason:
Duloxetine (Cymbalta) is an SNRI antidepressant commonly used for both chronic pain and depression. It works by increasing the levels of serotonin and norepinephrine in the brain, which helps improve mood and alleviate pain. Duloxetine is often prescribed for conditions such as fibromyalgia, diabetic neuropathy, and chronic musculoskeletal pain, in addition to its use in treating major depressive disorder.
Choice B reason:
Sertraline (Zoloft) is an SSRI antidepressant used primarily to treat depression, anxiety disorders, and other mood disorders. While it is effective for these conditions, it is not specifically indicated for chronic pain management.
Choice C reason:
Fluoxetine (Prozac) is another SSRI antidepressant used to treat depression, anxiety disorders, and certain eating disorders. Like sertraline, it is not typically used for chronic pain management.
Choice D reason:
Citalopram (Celexa) is also an SSRI antidepressant used to treat depression. It is not indicated for chronic pain management and is primarily used to improve mood and alleviate symptoms of depression.