Question

Case Study- Depression

PART I- Steve, an adolescent patient who has been irritable, refusing to go to school, or eat meals for several months is admitted to an adolescent psychiatric unit. Counseling is started and the psychiatrist prescribes fluoxetine, an SSRI antidepressant. The patient’s insurance allows only 10 days of inpatient hospitalization, and the patient is to be discharged to the care of his parents. All antidepressants have a boxed warning for suicide risk, especially in children and adolescents.

1. The nurse would caution the patient’s parents that suicide risk is greatest at what point in antidepressant therapy?
2. The patient asks you how this medicine works. He is planning to be a pre-med major in college and wants to understand his treatment.  How would you explain the medicine to him?
3. What teaching is required for Steve regarding his drug therapy?

Part II

4. Six days have passed and Steven calls the doctors office. He complains that he is not feeling any better, and that the medication is not working. What do you tell him?

Part III

5. Two weeks have past and Steve's mother calls and says Steven is sweating profusely and running a high temperature. What do you think is happening and what do you you tell her to do?

Answer 1

1.The antidepressant therapy are generally recommended to treat a patient suffering from depression. During the therapy the most crucial period is the first and the second month where the risk of suicide is very high .This happens because of the major chemical change in the brain.

2.The patient has to be explained in the following ways

• It is a selective serotonin reuptake inhibitor
• The serotonin is needed for a variety of body functions like cognition, digestion,maintain behavior, etc.,
• The low levels generally depresses the mood ,this medicine increases its levels and reuptake and relieves depression by neuro transmission between nerves

3.The following teaching are necessary

• Take the medication as prescribed.Overdose can lead to fatal state and death ,underdose can be of no use in relieving symptoms
• Do not smoke,drink,drive while on medication
• Report any side effects immediately
• Regular follow up
• Monitor weight ,as it can increase weight
• Daily exercise to decrease the risk of cardiovascular issues

4.These types of medication generally takes about four to six weeks to act .It may even take months to get a full effect.The reason behind this is because of the action of serotonin on the different parts of the brain and reduce the symptoms

5.Hogh fever,sweating, tremors,alteration in consciousness, tachycardia, tachypnea, etc.,are sinds of Seratinin syndrome (accumulation of the serotonin in excess quantity) Inform to stop the medication and advice to visit the health care provider to get treated if symptoms are more than 24 hours or if there is any alteration in consciousness, blood pressure.