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Are outdated medications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While some may consider tricyclic antidepressants outdated, they are still used for certain conditions, including neuropathic pain.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","C","D"]
Explanation
Choice A reason:
Hopelessness with poor concentration is a common symptom of major depression. Individuals with depression often feel a pervasive sense of hopelessness and find it difficult to concentrate on tasks or make decisions.
Choice B reason:
Increased energy is not a typical symptom of major depression. In fact, individuals with depression often experience fatigue and a lack of energy. Increased energy may be more indicative of a manic episode in bipolar disorder.
Choice C reason:
Difficulty falling asleep and early morning awakening are common symptoms of major depression. Sleep disturbances, including insomnia and early morning awakening, are frequently reported by individuals with depression.
Choice D reason:
Anhedonia, or the loss of interest or pleasure in previously enjoyed activities, is a hallmark symptom of major depression. Individuals with depression often find it difficult to experience joy or satisfaction in activities they once found pleasurable.
Correct Answer is ["A","C","D"]
Explanation
Choice A reason:
If Mr. Greene has memory retention and a neurological evaluation that has demonstrated understanding of how to follow the sliding scale and recognize proper dosage, use, and potential side effects of insulin, he is a candidate for self-administration. This ensures he can manage his insulin therapy safely and effectively.
Choice B reason:
If Mr. Greene states “I can do it” but has severe hand tremors, he is not a candidate for self-administration of insulin. Severe hand tremors can impair his ability to accurately draw up and administer the correct dose of insulin, increasing the risk of errors.
Choice C reason:
If Mr. Greene demonstrates the ability to self-administer insulin over a period of time successfully using the “Teach Back” method by a number of staff or visiting nurse, he is a candidate for self-administration. The “Teach Back” method confirms that he understands and can perform the procedure correctly.
Choice D reason:
If Mr. Greene no longer is actively suicidal and has hand-eye coordination that is accurate, he is a candidate for self-administration of insulin. Accurate hand-eye coordination is essential for safely drawing up and administering insulin.