A 32-year-old female visits a nurse practitioner with concerns about feeling tired, having difficulty concentrating, problems sleeping and generally feeling down. The nurse practit... A 32-year-old female visits a nurse practitioner with concerns about feeling tired, having difficulty concentrating, problems sleeping and generally feeling down. The nurse practitioner prescribed fluoxetine. The client tells the nurse one of my friends told me i have to be careful or i might get serotonin syndrome if i take medications. What places a client at risk for serotonin syndrome and what symptoms should the nurse teach the client about this condition? The nurse knows that anyone starting an antidepressant is at risk of suicidal thoughts. How should the nurse therapeutically discuss this potential adverse effect with the client? What potential common side effects should the nurse discuss with the client?
Understand the Problem
The prompt presents a clinical scenario where a 32-year-old female is prescribed fluoxetine by a nurse practitioner for symptoms including fatigue, difficulty concentrating, insomnia, and feeling down. The patient expresses concern about serotonin syndrome based on a friend's advice. The prompt requires you to identify risk factors for serotonin syndrome and its symptoms, explain how to therapeutically discuss the risk of suicidal thoughts, and describe potential common side effects of the medication.
Answer
Serotonin syndrome risk factors include multiple serotonergic medications or increased dose. Teach client mild (restlessness, tremor) & severe (rigidity, fever) symptoms. Discuss risk of suicidal thoughts by acknowledging the risk and encouraging the patient to report these thoughts. Common side effects: nausea, headache, insomnia, sexual dysfunction.
Here's the information about serotonin syndrome, suicidal thoughts, and common side effects related to fluoxetine:
Serotonin Syndrome
- Risk Factors:
- Taking multiple serotonergic medications (e.g., other antidepressants, St. John's Wort, certain pain medications).
- Increased dose of fluoxetine.
- Drug interactions.
- Symptoms to Teach the Client:
- Mild: Restlessness, tremor, shivering, diarrhea, dilated pupils.
- Severe: Muscle rigidity, high fever, rapid heart rate, seizures, delirium, coma. Seek immediate medical attention if these occur.
Suicidal Thoughts
- Therapeutic Discussion: Acknowledge the risk; Normalize that these thoughts may occur; Encourage the patient to report suicidal thoughts and feelings immediately. Encourage the patient to contact you or emergency services.
Common Side Effects
- Nausea, vomiting, diarrhea.
- Headache.
- Insomnia.
- Sexual dysfunction.
- Anxiety or nervousness.
- Dry mouth.
- Weight changes.
Answer for screen readers
Here's the information about serotonin syndrome, suicidal thoughts, and common side effects related to fluoxetine:
Serotonin Syndrome
- Risk Factors:
- Taking multiple serotonergic medications (e.g., other antidepressants, St. John's Wort, certain pain medications).
- Increased dose of fluoxetine.
- Drug interactions.
- Symptoms to Teach the Client:
- Mild: Restlessness, tremor, shivering, diarrhea, dilated pupils.
- Severe: Muscle rigidity, high fever, rapid heart rate, seizures, delirium, coma. Seek immediate medical attention if these occur.
Suicidal Thoughts
- Therapeutic Discussion: Acknowledge the risk; Normalize that these thoughts may occur; Encourage the patient to report suicidal thoughts and feelings immediately. Encourage the patient to contact you or emergency services.
Common Side Effects
- Nausea, vomiting, diarrhea.
- Headache.
- Insomnia.
- Sexual dysfunction.
- Anxiety or nervousness.
- Dry mouth.
- Weight changes.
More Information
Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) antidepressant. Serotonin syndrome is caused by excessive serotonin in the body.
Tips
It is important not to provide false reassurances when discussing the potential for suicidal ideation with patients. Instead, be open and honest about monitoring and reporting any changes in mood or thoughts.
Sources
- 8.7 Antidepressants – Fundamentals of Nursing Pharmacology - opentextbc.ca
- 8.7 Antidepressants – Nursing Pharmacology-2e - WisTech Open - wtcs.pressbooks.pub
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