When caring for hospitalized patients with depression, the nurse must develop a nursing care plan to meet the patient's individual needs. When the antidepressants are given parenterally, the nurse gives these drugs intramuscularly in a large muscle mass, such as the gluteus muscle. The nurse keeps the patient lying down (when possible) for about 30 minutes after the drug is given.
Oral administration requires great care because some patients have difficulty swallowing (because of a dry mouth or other causes). Other patients may refuse to take the drug. If the patient refuses to take the drug, the nurse contacts the primary health care provider regarding this problem because parenteral administration of the drug may be necessary.
After administration of an oral drug, the nurse inspects the patient's oral cavity to be sure the drug has been swallowed. If the patient resists having his or her oral cavity checked, the nurse reports this refusal to the primary health care provider. Patients planning suicide may try to keep the drug on the side of the mouth or under the tongue and not swallow in an effort to hoard or save enough of the drug to commit suicide at a later time.
If the drug is prescribed on an outpatient basis, the primary health care provider may prescribe only a week's supply of the antidepressant to reduce the risk of suicide.
TCAs. Once-a-day dosing may be prescribed for maintenance therapy. When the nurse administers the total daily dosage at night, the sedative effects promote sleep, and the adverse reactions appear less troublesome. Because pro-triptyline may produce a mild stimulation in some patients, it is usually not given as a single bedtime dose.
MAOIs. The MAOIs are less frequently prescribed than other antidepressants, probably because of the risk of hypertensive crisis when food containing tyramine is ingested during MAOI therapy. Patients receiving MAOIs require strict dietary control because foods containing tyramine should not be eaten. The nurse asks family members and visitors not to bring food to the patient and explains why this is important. Close observation of the patient when eating in a community setting may be necessary so that food is not taken or accepted from other patients.
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