A nurse is caring for a client prescribed Lithium. Which nur… | MyMerci
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Medication AdministrationPPT
Question
A nurse is caring for a client prescribed Lithium. Which nursing action is most appropriate regarding monitoring serum lithium levels and maintaining adequate fluid and sodium intake?
1Instruct the patient to discontinue phenelzine immediately, take an as-needed benzodiazepine for anxiety, and come to the clinic for a blood pressure check in the morning, while continuing to monitor at home.
2Activate emergency services for a hypertensive crisis, support the patient until IV antihypertensive (phentolamine or nicardipine) can be given, and review tyramine-containing foods.✓ Correct answer
3Advise the patient to take acetaminophen 1000 mg for the headache, monitor blood pressure at home every 2 hours, and schedule a follow-up appointment with her psychiatrist within 24 to 48 hours.
4Instruct the patient to take a prescribed as-needed antihypertensive if available, lie down in a dark, quiet room, apply a cool compress, and contact the clinic if symptoms persist for more than 2 hours.
Explanation
When administering Lithium, key nursing considerations include monitoring patient status, checking critical laboratory values, and providing appropriate safety education. Unsafe practices such as stopping medications abruptly or doubling missed doses are incorrect.
On MAOIs, the dietary "AGE" rule helps — Aged, Cured/Fermented, Etc. (draft beer, soy sauce, fava beans, smoked fish). Patients also carry a wallet card and avoid sympathomimetic OTC decongestants and SSRIs/SNRIs.
Clinical scenario
Scenario 65-year-old woman, treatment-resistant MDD, on phenelzine 60 mg PO daily for 6 weeks. After dinner with aged cheddar, salami, and 2 glasses of red wine, she develops a sudden pounding occipital headache, neck stiffness, palpitations, and nausea within 30 minutes. Clinic BP 230/130 mmHg, HR 110, alert. No focal neuro deficits at this moment. Allergies: none. No SSRI/SNRI/triptan/meperidine in her chart.
Key concepts
MAOI — Monoamine Oxidase Inhibitor — phenelzine, tranylcypromine, isocarboxazid (oral, irreversible) and transdermal selegiline. Used in treatment-resistant or atypical depression. Need 14-day washout before/after most other antidepressants and 5 weeks after fluoxetine.
Tyramine reaction — Hypertensive crisis triggered by tyramine-containing foods on a MAOI. Avoid: aged cheese (cheddar/blue/parmesan), cured/smoked meats, fermented soy products and miso/soy sauce, draft and unpasteurized beer, red wine, fava beans, sauerkraut, overripe avocado, smoked/pickled fish.
Hypertensive crisis management — Sudden severe BP elevation with target organ symptoms; lower BP gradually (no more than ~25% in the first hour) using IV phentolamine (alpha-blockade for MAOI/pheo cases), nicardipine, or labetalol. Avoid sublingual nifedipine due to overshoot risk.