Mr. Jones is a 35-year-old male with severe depression and has had failed treatment with SSRIs such as Citalopram (Celexa) and Fluoxetine (Prozac). He has a passive concentration and anhedonia. He has also lost 20 lbs in the last 3 months and has a poor appetite. He is scheduled for ECT tomorrow, and you are his nurse.Some important considerations prior to ECT may be on a Pre-Op checklist that the nurse completes and some interventions include (select all that apply):
Advising the patient he will have permanent memory loss.
Authorizing MD signs off medical clearance that may require pre-op checklist to include EKG or lab work.
Signed informed consent by MD and patient and nurse follows up using “Teach Back Method” answering any further post-op or pre-op questions.
NPO after midnight and hold all meds unless specified such as a sip of water and blood pressure pill ordered by MD.
Correct Answer : B,C,D
Choice A reason:
Advising the patient he will have permanent memory loss is incorrect. While temporary memory loss can occur with ECT, it is not typically permanent. It is important to provide accurate information about potential side effects without causing unnecessary fear.
Choice B reason:
Authorizing MD signs off medical clearance that may require pre-op checklist to include EKG or lab work is an important consideration. Medical clearance ensures that the patient is physically fit for the procedure and helps identify any potential risks.
Choice C reason:
Signed informed consent by MD and patient and nurse follows up using “Teach Back Method” answering any further post-op or pre-op questions is essential. Informed consent ensures that the patient understands the procedure, risks, and benefits. The “Teach Back Method” confirms that the patient comprehends the information provided.
Choice D reason:
NPO after midnight and hold all meds unless specified such as a sip of water and blood pressure pill ordered by MD is a standard pre-op instruction. Fasting reduces the risk of aspiration during anesthesia, and holding medications ensures that the patient does not take anything that could interfere with the procedure.
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Correct Answer is B
Explanation
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While some may consider tricyclic antidepressants outdated, they are still used for certain conditions, including neuropathic pain.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.
Correct Answer is A
Explanation
Choice A reason:
Yogurt is one of the foods that can interact with MAOI inhibitors like Nardil. MAOIs can cause dangerous increases in blood pressure when taken with foods containing high levels of tyramine, such as aged cheeses, yogurt, fermented foods, and certain meats. Patients on MAOIs must follow strict dietary restrictions to avoid these interactions.
Choice B reason:
Vegetable salad is generally safe for individuals taking MAOI inhibitors. Fresh vegetables do not contain high levels of tyramine and do not pose a risk of interaction with MAOIs.
Choice C reason:
Oatmeal is also safe for individuals taking MAOI inhibitors. It does not contain high levels of tyramine and is not associated with adverse interactions with these medications.
Choice D reason:
Crackers are typically safe for individuals taking MAOI inhibitors, provided they do not contain aged cheeses or other high-tyramine ingredients. Plain crackers do not pose a risk of interaction with MAOIs.