A nurse on a mental health unit is caring for a client.
Nurses’ Notes
Day 1, 1300:
Client admitted following a suicide attempt. Client’s family reports client has not left bedroom in 1 week. Client previously. diagnosed with bipolar disorder.
Client reports feeling excessively tired and light-headed. Allergies: Client’s family reports allergy to SSRIS (angioedema) and penicillin (anaphylaxis).
1600:
Client has been sleeping in their room since admission. Flat affect noted.
For each potential provider’s prescription, click to specify if the potential prescription is anticipated or contraindicated for the client.
A.
Low-sodium diet
B.
Potassium 40 mEq PO daily
C.
Initiate suicide precautions
D.
Fluoxetine 20 mg PO daily
The correct answer and Explanation is :
Here’s a breakdown of each prescription for the client, considering their condition and history:
A. Low-sodium diet
Anticipated
This prescription may be anticipated, as it can be beneficial for clients with bipolar disorder who may be prescribed lithium for mood stabilization. Lithium treatment requires careful monitoring of sodium levels because low sodium can lead to increased lithium levels in the blood, potentially causing toxicity. However, if this patient is on or may be started on lithium therapy, a low-sodium diet should be avoided unless otherwise indicated and should be tailored according to their individual needs.
B. Potassium 40 mEq PO daily
Contraindicated
There is no direct evidence in the notes suggesting that the client needs potassium supplementation. Prescribing potassium without a known deficiency could lead to hyperkalemia, which may have serious cardiac effects. Since the client hasn’t been reported to have any issues with potassium, and no laboratory results are provided, this prescription would generally be contraindicated unless bloodwork indicates a need.
C. Initiate suicide precautions
Anticipated
This prescription is anticipated. Given the client’s recent suicide attempt, it is critical to implement suicide precautions immediately to ensure their safety. Clients with bipolar disorder, particularly in depressive or mixed states, are at an elevated risk for suicide. Suicide precautions might include constant observation, limiting access to dangerous items, and creating a safe environment, which are standard in mental health units for clients at risk.
D. Fluoxetine 20 mg PO daily
Contraindicated
Fluoxetine is a selective serotonin reuptake inhibitor (SSRI). According to the family report, the client has an allergy to SSRIs, causing angioedema, a potentially life-threatening condition. Administering fluoxetine would be contraindicated in this case due to the risk of a severe allergic reaction. An alternative mood stabilizer or antidepressant that does not belong to the SSRI class would be more appropriate.
These considerations are essential in ensuring safe, personalized care for this client.