Chapter 4: What Would You Do?
Sara, a 35-year-old female, has come to your local community health clinic due to a recent onset of symptoms. She has been experiencing severe anxiety, persistent insomnia, irritability, and difficulty concentrating, which have been interfering with her daily life and work. Sara has no significant prior medical history but reports a family history of mental health disorders. Upon initial assessment, her vital signs appear within the normal range, with a blood pressure of 120/80 mm Hg, a heart rate of 80 beats per minute, and a respiratory rate of 16 breaths per minute. During the initial assessment, Sara showed signs of restlessness by constantly fidgeting.
1. What specific verbal and nonverbal cues does Sara exhibit during the assessment that may indicate the presence of a nervous-system-related issue?
2. Based on Sara’s family history of mental health disorders and her reported symptoms, which neurotransmitters or hormonal imbalances could potentially be contributing to her current condition?
José, a 35-year-old male, has been referred to a psychiatric clinic by his primary care physician. José reports persistent feelings of sadness, hopelessness, and loss of interest in activities he used to enjoy. He also experiences significant changes in his appetite and sleep patterns, with frequent early morning awakenings. José mentions that these symptoms have been present for the past six months, and they are affecting his daily life and relationships.
Upon further assessment, José reveals that his family has a history of mood disorders, including depression. His primary care physician has prescribed him an antidepressant medication, fluoxetine, an SSRI. José expresses concerns about starting medication and asks for more information about how it works and its potential side effects.
3. As the nurse, what initial assessment data should you collect from José to better understand his current mental health status and his readiness to begin treatment with fluoxetine? How can you recognize cues that may indicate the severity of his depression?
4. After gathering the assessment data, analyze the information you’ve collected from José. Based on his presentation and family history, what are the psychopharmacological drug classifications that may be relevant to his condition? How do these classifications interact with his current symptoms, and what potential complications should you consider?
5. What are the primary hypotheses regarding the cause of José’s depression, and how would you rank them in terms of likelihood, considering both psychiatric and pharmacological factors? What nursing interventions and client education would be essential in his care plan?
6. José has decided to start taking fluoxetine. What nursing actions should you take during the implementation phase to ensure his safety and therapeutic effectiveness of the medication? How can you support him in adhering to the treatment plan?
