Western Mindanao State University

College of Nursing
Zamboanga City
Alternative Learning System
Related Learning Experience
NCM 117-B

DARUNDAY, EZRA M. BSN III-B

Summary Case Scenario: Major Depressive Disorder || Patient: Sarah Dada

Assessment

Subjective:
 Body aches, headache, stomachache and knee pain
 Strange tingling sensation in cheeks
 Worried that the symptoms presented are related to cancer
 Worried about her husband who isn’t getting a job for the family
 Keeps forgetting things
 Does not sleep well
 Cannot eat well
 Lost 5 kg in the past month
 Getting angry with children even with normal things and body aches worsens while doing so
 Lost interest in taking care of children and with normal activities around the house
 Feels hopeless especially when thinking about the future
 Does not want to take any depression medication
 Blames herself for what is happening and feels sad about it.

Objective:
 Anxious
 Crying a lot
 Minimum eye contact

Management:
 Keeping constant on a daily regular basis and leaving and sleeping in the bed at the same time.
 Take a 45-minute walk three times a week even feeling tired
 Trying to do things that used to bring pleasure like doing social activities with family and friends comfortable with
Follow-up:

Before Taking Medication:

 Everything is still the same but talking to Sarah about her problems made her more relaxed since her husband might find a job in an organization.
 Though there is a possibility of hiring, she does not feel any hope
 Waking up on time is difficult as well as doing things. Though, she walked 2 times this week. She didn’t like it at first but it felt better afterwardrds.
 She doesn’t want to leave her husband alone since he’s having a hard time.
 Worries about the side effects and outcomes of antidepressants

After Taking Medication:

 Eat and sleeps better
 More patient with husband and children
 Regained a few kilos
 Does not get tired and achy
 Does not feel miserable anymore
 Now enjoys visiting neighbors and sees her families often.
 Inquires to stop medication
1. Study of the Illness Condition
ASSESSMENT ANATOMY PHYSIOLOGY PATHOPHYSIOLOGY ANALYSIS
Subjective: The system involved is the Central Nervous system employs The biogenic amines, also Physical pain and depression have a deeper
 Body aches, Nervous System. electrical means to send called the monoamines, biological connection than simple cause and effect;
headache,
stomachache messages from cell to cell. are a class of five the neurotransmitters that influence both pain and
and knee pain Some of its roles are (1) neurotransmitters mood are serotonin and norepinephrine.
 Strange receive information about synthesized from amino Dysregulation of these transmitters is linked to both
tingling changes in the body and acids. Most biogenic depression and pain.
sensation in external environment and amines are widely used by
cheeks Though anxiety or worry is different, it can
 Worried that transmits to CNS. (2) CNS the CNS and the PNS, and
the symptoms now, processes these have diverse functions manifest to people with depression and is a normal
presented are information and determines including regulation of response to stressful or depressive situations.
related to what appropriate response is homeostasis and cognition
cancer needed. The central nervous (thinking). The biogenic When someone experiences a depressive episode,
 Worried about the body goes into a stress response and releases a
her husband system consists of the brain amines are implicated in a
who isn’t and the spinal cord. wide variety of psychiatric hormone called cortisol. Too much cortisol in the
getting a job disorders, in this case, brain inhibits the growth of new brain cells in a
for the family Moreover, The organ involved is the part of the brain called the hippocampus, causing it
The brain is composed major depressive disorder.
 Keeps Brain’s neurons. to shrink. The hippocampus is very important for
primarily of nervous tissue.
forgetting This remarkable organ With these monoamines, memory formation. It helps the brain form,
things
 Does not sleep consists its actions are directly organize, and store memories. This suggests that
well of about 100 billion cells proportional with each the stress response activated by depressive episodes
 Cannot eat called neurons, or nerve other, thus reduction of may affect memory.
well cells, that enable everything monoamine
 Lost 5 kg in from the regulation of neurotransmitters and Depression and sleep issues have a bidirectional
the past month relationship. This means that poor sleep can
 Getting angry breathing, mood and increased sensitivity to
with children the processing of algebra to monoamine regulation will contribute to the development of depression and
even with performing in the creative result to homeostatic that having depression makes a person more likely
normal things arts. Neurotransmitters are failure that will lead to to develop sleep issues. This complex relationship
and body chemical messengers that the depression. can make it challenging to know which came first,
aches worsens sleep issues or depression.
while doing so References: body can't function without.
 Lost interest in Betts, J. G., Desaix, P., Johnson, E., Its job is to carry chemical
taking care of signals from one neuron to the References: Some people experiences psychomotor agitations.
children and Johnson, J. E., Korol, O., Kruse, D., Amerman, E. C. (2019). These would burn more calories combined with
next target cell to perform a
with normal Poe, B., ... Rice University. (2016). Human anatomy & restless movements and decreased appetite.
function.
activities Anatomy & physiology. physiology.
around the
 house References: Mostafa A. (2018). Major Self-esteem is neither a sufficient nor a necessary
 Feels hopeless Saladin, K. S., Gan, C. A., & Depressive Disorder criterion of a depressive symptom. Low self-esteem
especially
when thinking Cushman, H. N. (2018). (MDD). Pharmacotherapy is not only related to depression, but also to
about the Anatomy & physiology: The III. Dubai Pharmacy learning disorders, antisocial behavior, eating
future unity of form and function. College. disturbances, and suicidal ideation That is, self-
 Does not want Amerman, E. C. (2019). esteem is a predisposing factor for other mental
to take any Human anatomy & health issues, including depression.
depression
medication physiology.
 Blames herself References:
for what is Trivedi M. H. (2004). The link between depression
happening and and physical symptoms. Primary care companion to
feels sad about the Journal of clinical psychiatry, 6(Suppl 1), 12–
it. 16.
Objective:
 Anxious Anxiety disorders. In: Diagnostic and Statistical
 Crying a lot Manual of Mental Disorders DSM-5. 5th ed.
 Minimum Arlington, Va.: American Psychiatric Association;
contact 2013. http://dsm.psychiatryonline.org.

Moica T, Gligor A, Moica S. The Relationship

between Cortisol and the Hippocampal Volume in
Depressed Patients – A MRI Pilot Study. Procedia
Technology. 2016;22:1106-1112.
https://www.sciencedirect.com/science/article/pii/S
2212017316001572.

Franzen PL, Buysse DJ. Sleep disturbances and

depression: risk relationships for subsequent
depression and therapeutic implications. Dialogues
Clin Neurosci. 2008;10(4):473-81. doi:
10.31887/DCNS.2008.10.4/plfranzen. PMID:
19170404; PMCID: PMC3108260.

Anderberg RH, et al. (2017). Glucagon-like

peptide-1 and its analogues act in the dorsal raphe
and modulate central serotonin to reduce appetite
and body weight. DOI:10.2337/db16-0755

Park, K., & Yang, T. C. (2017). The Long-term

 Effects of Self-Esteem on Depression: The Roles of
Alcohol and Substance Uses during Young
Adulthood. The Sociological quarterly, 58(3), 429–
446.
https://doi.org/10.1080/00380253.2017.1331718

Pathophysiology and Complications

FACTORS

BIOLOGICAL ENVIRONMENTAL GENETICAL

REDUCTION OF MONOAMINE
INCREASE SENSITIVITY TO
NEUROTRANSMITTERS IN THE
MONOAMINES TRANSMISSION
BRAIN

MOOD CHANGES HOMEOSTATIC ANXIETY

FAILURE
BODY ACHES PESSIMISM

DEPRESSION
 COMPLICATIONS

Obesity or Severe Chronic Illness and Self-harm or

Substance Misuse Cognitive Changes
Weight Loss Pain Suicidal Ideations
2. Mental Status Examination

I. General Observations
1. Appearance
 Client was noted clean, free from soiled grooming, average personal hygiene
 Client was having an uncombed hair
 Client was noted no signs of make-ups nor any facial effects
 Client was having no jewelries
2. Speech
 Client was noted to have low-toned voice
 Client was noted to speak slowly and stutters
 Client was noted dropping of intonation as for assessment
3. Behavior
 Client was to be tensed and showing signs of distress
 Client was sitting in a slouched manner and does not lead her back
 Client was having no constant eye contact
 Client was noted to display hand gestures that shows anxiousness
4. Cooperativeness
 Client was able to reply to the questions and was able to express her thoughts freely
 Client was able to express the need for notes and guidelines of her objectives
 Client was not hesitant in the interview and was cooperative enough to make follow-up checkups
 Client was noted to be defensive in expressing and answering some questions
II. Thinking
1. Thought Process
 Client was noted to show logical and circumstantial, but most often loosened thought process
2. Thought Content
• Client was noted to be distressed that her condition might get worse that if affects everyone surrounds her
• Client was able to discuss stressing family and specially to her children
• Client was able to idealize ceasing to exist to refrain self from pain
3. Perceptions
• Client was noted to have tactile hallucinations in her left cheek
• Client was noted to have this paranoia of having cancer
III. Emotion
1. Mood
• The client was depressed about her husband’s unemployment and anxious enough to her condition status. (Client was unable to rate her mode scale from 1 to 10)
• Client is notably sad throughout the session
2. Affect
• The client shows restricted affect as expresses somber facial expression
IV. Cognition
1. Orientation/Attention
• Client was able to attain the interview’s time and date so as the doctor expects her
• Client was able to make a follow-up checkup on date and time
2. Memory
• Client was incompetent in remembering things, hence she made the doctor write her down what her objectives.
• Client has limited memories when being asked about the specifics about her.
3. Insight
• The client was able to recognize the need for help as she understands its purpose towards her depression, which is good enough as she sees her future by marking
what she can do about it.
4. Judgment
• Client’s judgments were noted to be good; remarkable enough towards deciding that she seeks the help of mental experts is good
• And she also reiterates that she cannot recall things and request a jot down of objectives.

Reference/s:

• Snyderman, D., & Rovner, B. (2009, October 15). Mental status examination in primary care: A Review. American Family Physician. Retrieved February 7, 2022, from
https://www.aafp.org/afp/2009/1015/p809.html

• Memon, M. (2021, October 17). Panic disorder clinical presentation: History, Physical Examination, mental status examination. MDD Clinical Presentation: History,
Physical Examination, Mental Status Examination. Retrieved February 7, 2022, from https://emedicine.medscape.com/article/287913-clinical#b4 Page 3 of 7
Major Depressive Disorder

The specific DSM-5 criteria for major depressive disorder are at least 5 of the following symptoms have to have been present during the same 2-week period (and at least 1 of the
symptoms must be diminished interest/pleasure or depressed mood):

 Depressed mood
 Diminished interest or loss of pleasure in almost all activities (anhedonia)
 Significant weight change or appetite disturbance
 Sleep disturbance (insomnia or hypersomnia)
 Psychomotor agitation or retardation
 Fatigue or loss of energy
 Feelings of worthlessness
 Diminished ability to think or concentrate; indecisiveness
 Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or specific plan for committing suicide

Conditions:
 The symptoms cause significant distress or impairment in social, occupational or other important areas of functioning.
 The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
 The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum
and other psychotic disorders
 There has never been a manic episode or a hypomanic episode
 Depressive disorders can be rated as mild, moderate, or severe.
 The disorder can also occur with psychotic symptoms, which can be mood congruent or incongruent. Depressive disorders can be determined to be in full or partial
remission.

DSM-5 further notes the importance of distinguishing between normal sadness and grief from a major depressive disorder. While bereavement can induce great suffering, it does
not typically induce a major depressive disorder. When the two exist concurrently, the symptoms and functional impairment is more severe and the prognosis is worse compared to
bereavement alone. When major depressive disorder is most likely to be induced by bereavement in persons with other vulnerabilities to depressive disorders. A diagnosis of major
depressive disorder following a significant loss requires clinical judgement based on the individuals history and the cultural context for expression of grief.
Possible Nursing Diagnoses:
 Hopelessness related to stressful events as evidenced by despondent verbal cues
 Self-care deficit related to decreased or lack of motivation as evidenced by 5kg weight loss
 Impaired social interaction related to feelings of worthlessness as evidenced by minimum eye contact

Nursing Care Plan

ASSESSMENT NURSING PLANNING IMPLEMENTATION EVALUATION

DIAGNOSIS OBJECTIVE OF INTERVENTION RATIONALE
CARE

Subjective: Hopelessness related After 6 hours of nursing After 6 hours of nursing

• Worried that the to stressful events as interventions, the patient interventions, the patient
symptoms presented evidenced by will be able to: was able to:
are related to cancer despondent verbal - To identify and - Ask question about - History of poor coping, - Client went to seek - Identified and
• Worried about her cues verbalize the cause familial/social disordered familial help for professional verbalize the cause
husband who isn’t of hopelessness history that relating patterns, due to social problem of hopelessness. The
getting a job for the contributes to the emotional and social (husband can’t get hopelessness is due
family current problem. problems to an work) and contributes to social problem
• Lost interest in individual can affect to sense of (husband can’t find
taking care of client’s feeling of hopelessness work)
children and with hopelessness. - Assisted the client to
normal activities identify her feelings
around the house - Identify the current - as well as to cope up
• Feels hopeless By identifying the - Client mostly
with her problem
factors contributing factors contributing mentioned about
especially when to sense of using simple
that results to giving Familial factors,
thinking about the hopelessness. interventions such as
up, may formulate social problem, and
future sleeping
appropriate plan of care brief about physical
• Blames herself for consistently, taking a
specifically based on pain.
what is happening walk at least 3 times
and feels sad about the patient’s situation. a week and
it. - Determine client’s socializing with
- Internal locus of control - Client has external
Objective: locus of control and tend to be more optimistic locus of control loved ones.
• Anxious associated cultural to deal with adversity. - Promoted wellness
• Crying a lot factors influencing Individual with external to the client and
self-view. locus of control attribute went to follow-up
feelings of hopelessness to check ups to give
an external source, positive feedbacks
perceiving it as beyond to current life events.
his or her control. GOALS ARE MET.
- Identify coping - It is important to identify - Client is close with
behaviors and client’s her family and
strengths and wanted to seek help
defense mechanisms encourage to use it to deal
but they are too far
with what is currently and worried about the
happening situation with her
husband.

- Let the client

- To clearly identify - Client verbalized
describe and about the situation of
sources of frustration
verbalize events that her husband, taking
and define problems so
leads to feeling of care of kids, doesn’t
action can be taken in
inadequate or having have energy to do
more positive ways.
no control activities as well as
hopelessness.

- Ask questions about - Maladaptive coping - The client strongly

recent alcohol or may be used by the stated that she does
substance use. patient to lessen the not take alcohol.
pain of the situation
that may contribute to
sense of hopelessness.
- Determine any - Client strongly stated
presence of self- - Hopelessness is
that she is not
harm, attempted identified as a central
suicidal as it is
suicide, or suicidal underlying factor in the
prohibited by her
ideation. predisposition to
religion.
suicide, and the client
sees no other way out
of a hopeless situation
 - Perform physical
examination and - Current situation may -
review results of lab be the result of a
tests and diagnostic decline in physical
studies well-being or
progression of
chronic condition, or
physical symptoms
may be associated with
- Note behaviors effects of depression.
indicative of
hopelessness based - Identifies problem
on subjective data areas to be addressed in
presented developing an effective
plan of care and
suggests possible
- Evaluate and discuss resources needed
the use of defense
and coping - Identifying behaviors
mechanisms such as
increased/decreased
sleep, forgetfulness,
ineffective efforts and
such can provide
accurate information
- Evaluate the degree for client to begin
of hopelessness changing behavior.
using Beck’s
Depression Scale - Identifying the degree
- Assist client to of hopelessness and
identify feelings to possible suicidal
cope with problems thoughts is crucial to
as perceived instituting appropriate
- Answer questions treatment to protect
truthfully while client.
establishing a -
positive therapeutic - Enhances trust so
relationship client feels safe to
disclose feelings, talk
The client do not
have any problem
physically as stated
by the patient
a (physical pain all
over the body)
- Client is mostly
worried about her
jobless husband and
how it affects their
family
- Client needs sleep
consistently in same
hours, taking 45
minute walk atleast 3
times a week, and
visiting her loved
ones.
- Client scored 15.
Indicates that she is
mild-moderate
depression.
Client has a lot of
questions about
taking antidepressant
and its overall effect
 openly, and feel that may influence
- Express hope to understood and listened her family.
client and encourage to.
health-team
members to do so as - Client may not identify - Endorsed client to a
well. Avoid positives in own social worker to help
expressions of false situation and may find her condition as well
hope. it difficult to accept as to help her
them from others, but husband to get work.
will hear them. False
reassurances will
- Encourage client to undermine sense of
identify and list security
short-term goals that - The client listed
can be taken - Dealing with situation interventions that
in manageable steps may help her to get
enhances chances for through her condition
success, promotes without taking any
sense of control, and medications.
encourages belief that
there is hope for
resolution of
situation/moving
forward and
encourages use of own
actions, validates
- Encourage risk- reality, and promotes
taking in situations sense of control of the
in which the client situation - Client wants to try
can succeed the listed
- Succeeding in new interventions though
ventures can improve she stated that it’s
self-esteem and hope difficult as he doesn’t
- Discuss safe use of for more successful have the energy to do
- Promote wellness prescribed
and encourage actions it.
antidepressants
follow-up check
ups and feedback - Client is still hesitant
progress. - May require short-term to take medication
use to elevate mood
 - Provide positive while client pursues
feedback for actions other therapeutic
made to overcome measures to regain
feelings of sense of hope
hopelessness - Praised the client as
- Encourages changes in she is doing great to
thinking patterns and recover with simple
- Encourage continuation of desired steps.
client/family to behaviors
develop support
systems in the - Client stated that she
immediate - Having support nearby has travelled to see
community. provides individuals her family and now
with assistance and enjoys visiting
advocacy for moving neighbors in the
- Introduce the client forward, enabling them community.
into a support group to look toward future
before the individual with hope
therapy - Introduce client to a
- Provides for a smooth support group or let
transition so client feels client to pick her
- Emphasize need for accepted and support group before
continued comfortable in the therapy.
monitoring of presence of others
medication regimen - Client stated that she
by healthcare - Necessary to evaluate wants to discontinue
provider effectiveness and medication as she is
prevent or minimize feeling well lately.
possible side effects.
Antidepressant agents
are not to be
discontinued abruptly
without consulting
healthcare provider
Reference/s:
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2018). Nursing diagnosis manual: Planning, individualizing, and documenting client care. Philadelphia, PA: F.A. Davis.
In Herdman, T. H., In Kamitsuru, S., & North American Nursing Diagnosis Association,. (2018). NANDA International, Inc. nursing diagnoses: Definitions & classification 2018-
2020.
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nursing care plans: Guidelines for individualizing client care across the life span. Philadelphia: F.A. Davis Co.
 Page 4 of 7
Drug Study

GENERIC NAME: MECHANISM OF ACTION: SIDE EFFECTS/ADVERSE

alprazolam
BRAND NAME:
Xanax
DRUG ILLUSTRATION:
CLASSIFICATION:
Benzodiazepine (Schedule IV);
Antianxiety
DOSAGE/FREQUENCY/ROUTE:
PO (Immediate-Release, Oral
Concentrate, ODT): Initially, 0.5 mg 3
times/day. May increase at 3- to 4-day
intervals in increments of 1 mg or less a
day. Range: 5–6 mg/day.
Enhances the inhibitory effects of the
neurotransmitter gamma-aminobutyric acid in the
brain.
Therapeutic Effect: Produces anxiolytic effect due
to CNS depressant action.
INDICATION:
Management of generalized anxiety disorders
(GAD). Short-term relief of symptoms of anxiety,
panic disorder, with or without agoraphobia.
Anxiety associated with depression.
OFF-LABEL: Anxiety in children. Preoperative
anxiety.
CONTRAINDICATION:
Contraindications: Hypersensitivity to alprazolam.
Acute narrow angle-closure glaucoma, concurrent
use with ketoconazole or itraconazole or other
potent CYP3A4 inhibitors.
Cautions: Renal/hepatic impairment, predisposition
to urate nephropathy, obese pts. Concurrent use of
CYP3A4 inhibitors/inducers and major CYP3A4
substrates; debilitated pts, respiratory disease,
depression (especially suicidal risk), elderly
(increased risk of severe toxicity). History of
REACTION
SIDE EFFECTS:
Frequent (41%–20%): Ataxia, light-
headedness, drowsiness, slurred speech
(particularly in elderly or debilitated
patients).
Occasional (15%–5%): Confusion,
depression, blurred vision, constipation,
diarrhea, dry mouth, headache, nausea.
Rare (4% or less): Behavioral
problems such as anger, impaired
memory; paradoxical reactions
(insomnia, nervousness, irritability).
ADVERSE EFFECTS/
TOXIC REACTIONS:
Abrupt or too-rapid withdrawal may
result in restlessness, irritability,
insomnia, hand tremors,
abdominal/muscle cramps, diaphoresis,
vomiting, seizures. Overdose results in
drowsiness, confusion, diminished
reflexes, or coma. Blood dyscrasias
noted rarely.
Antidote: Flumazenil
NURSING RESPONSIBILITY
Baseline assessment:
 Assess degree of anxiety; assess for
drowsiness, dizziness, light-
headedness.
 Assess motor responses (agitation,
trembling, tension), autonomic
responses (cold/clammy hands,
diaphoresis).
 Initiate fall precautions.
Intervention/evaluation:
 For patients on long-term therapy,
perform hepatic/renal function
tests, CBC periodically.
 Assess for paradoxical reaction,
particularly during early therapy.
 Evaluate for therapeutic response:
calm facial expression, decreased
restlessness, insomnia.
 Monitor respiratory and
cardiovascular status.
Patient/family teaching:
 Drowsiness usually disappears
during continued therapy.
 If dizziness occurs, change
positions slowly from recumbent to
 substance abuse. sitting position before standing.
 Avoid tasks that require alertness,
motor skills until response to drug
is established.
 Smoking reduces drug
effectiveness.
 Sour hard candy, gum, sips of water
may relieve dry mouth.
 Do not abruptly withdraw
medication after long-term therapy.
 Avoid alcohol.
 Do not take other medications
without consulting physician.

GENERIC NAME: MECHANISM OF ACTION: SIDE EFFECTS/ADVERSE NURSING RESPONSIBILITY

fluoxetine hydrochloride Acts as an antidepressant by inhibiting CNS neuronal
uptake of serotonin; blocks uptake of serotonin with
little effect on norepinephrine
BRAND NAME: INDICATION:
 Treatment of depression; most effective in
Prozac patients with major depressive disorder
 Treatment of obsessive-compulsive disorder
 Treatment of bulimia
DRUG ILLUSTRATION:  Treatment of panic disorder with or without
agoraphobia
REACTION
Side effects
Dizziness, drowsiness, nervousness,
insomnia (avoid driving or performing
hazardous tasks); nausea, vomiting,
weight loss (eat frequent small meals;
monitor your weight loss); sexual
dysfunction; flulike symptoms.
Adverse reaction
 CNS: Headache, nervousness,
insomnia, drowsiness, anxiety,
tremor, dizziness, light-headedness,
agitation, sedation, abnormal gait,
seizures
 CV: Hot flashes, palpitations
 Dermatologic: Sweating, rash,
Nursing responsibilities
1. Review the order for the
appropriateness of prescribed
therapy for the patient’s age and
condition, access device, dose, rate,
and route of administration, and note
to follow the rights of medication
administration
2. Review facility policy for the list of
approved parenteral medications and
solutions for each type of
administration method and route
3. Be knowledgeable of indications for
therapy, side effects, potential
adverse reactions, and appropriate
interventions
4. Evaluate and monitor the

CLASSIFICATION
Antidepressant, Selective serotonin
reuptake inhibitor (SSRI)
DOSAGE/FREQUENCY/ROUTE:
Per Orem Tablets—10, 20 mg;
capsules—10, 20, 40 mg; liquid—20
mg/5 mL; DR capsules—90 mg
10 mg/day PO for the first week,
increase to 20 mg/day if needed.
Maximum dose, 60 mg/day.
GENERIC NAME:
Paroxetine
CONTRAINDICATION:
 Hypersensitivity to fluoxetine, pregnancy.
 Use cautiously with impaired hepatic or renal
function, diabetes mellitus, lactation, seizures,
history of suicide attempts.
MECHANISM OF ACTION:
Selectively blocks uptake of neurotransmitter
serotonin at CNS neuronal presynaptic
membranes, increasing its availability at
postsynaptic receptor sites.
Therapeutic Effect: Relieves depression, reduces
obsessive compulsive behavior, decreases anxiety.
pruritus, acne, alopecia, contact
dermatitis
 GI: Nausea, vomiting, diarrhea, dry
mouth, anorexia, dyspepsia,
constipation, taste changes,
flatulence, gastroenteritis, dysphagia,
gingivitis
 GU: Painful menstruation, sexual
dysfunction, frequency, cystitis,
impotence, urgency, vaginitis
 Respiratory: URIs, pharyngitis,
cough, dyspnea, bronchitis, rhinitis
 Other: Weight loss, asthenia, fever
SIDE EFFECTS/ADVERSE
NURSING RESPONSIBILITY
REACTION
SIDE EFFECTS: Baseline assessment:
Frequent (26%–8%): Nausea,  Obtain baseline LFT
drowsiness, headache, dry mouth,  Assess appearance, behavior,
asthenia, constipation, dizziness, speech behavior, level of interest,
 BRAND NAME:
Paxil
DRUG ILLUSTRATION:
CLASSIFICATION:
PHARMACOTHERAPEUTIC:
Selective serotonin reuptake inhibitor
(SSRI).
CLINICAL: Antidepressant,
antiobsessive-
compulsive, antianxiety.
DOSAGE/FREQUENCY/ROUTE:
PO: (Immediate-Release): ADULTS:
Initially, 20 mg/day. May increase by
10 mg/ day at intervals of more than 1
wk. Maximum: 50 mg/day.
References:
Kizior, R. J. (2021). Saunders nursing drug handbook 2021.
INDICATION: insomnia, diarrhea, diaphoresis,
 MDD Tremor
 OCD Occasional (6%–3%): Decreased
 SAD appetite, respiratory disturbance
 GAD (e.g., increased cough), anxiety,
 PMDD flatulence, paresthesia, yawning,
decreased libido, sexual dysfunction,
 OFF-LABEL: Social anxiety disorder in
abdominal discomfort.
children, self injurious behavior, treatment of
depression and OCD in children. Rare: Palpitations, vomiting, blurred
vision,
altered taste, confusion.
ADVERSE EFFECTS/
TOXIC REACTIONS:
Hyponatremia, seizures have been
CONTRAINDICATION: reported.
 Hypersensitivity to Paroxotine Serotonin syndrome (agitation,
confusion, diaphoresis, hallucinations,
 Concurrent use of MAOIs
hyperreflexia) occurs rarely.
and mood
Intervention/evaluation:
 For patients on long-term therapy,
perform hepatic/renal function
tests, CBC, LFT periodically.
 Assess for paradoxical reaction,
particularly during early therapy.
 Evaluate for therapeutic
response: calm facial expression,
decreased restlessness, insomnia.
 Assess mental status for
depression, suicidal ideation,
appearance
Patient/family teaching:
 Avoid alcohol, St. John’s wort.
 Therapeutic effect may be noted
within 1–4 wks.
 Do not abruptly discontinue
medication.
 Avoid tasks that require
alertness, motor skills until
response to drug is established.
 May impair reproductive
function.
 Report suspected pregnancy.
 Report worsening depression,
suicidal ideation, unusual
changes in behavior.