Page 2354 - Saunders Comprehensive Review For NCLEX-RN

e. Myoclonus (muscle spasms), increased
motor activity

C. Interventions

1. Monitor vital signs, because SSRIs can potentially
lower or elevate blood pressure.
2. May cause sexual dysfunction or lack of sex drive.
Inform health care provider if this occurs.
3. Initiate safety precautions and contact the PHCP if
dizziness occurs.
4. Instruct the client to avoid alcohol.
5. Administer with a snack or meal to reduce the risk of
dizziness and lightheadedness.
6. Monitor the suicidal client, especially during
improved mood and increased energy levels.
7. Instruct the client that taking ibuprofen with SSRIs
increases the risk of an upper GI bleed.
8. For the client on long-term therapy, monitor liver and
renal function test results; altered values may occur,
requiring dosage adjustments.
9. Monitor white blood cell and neutrophil counts; the
medication may be discontinued if levels decrease
below normal.
10. Instruct to change positions slowly if experiencing a
hypotensive effect.
11. Educate the client to not discontinue medication
abruptly. Abrupt cessation can lead to serotonin
withdrawal characterized by gastrointestinal distress,
movement disorders, insomnia, and sensory
disturbances.
12. Be aware of the potential for serotonin syndrome,
characterized by hyperactivity or restlessness,
tachycardia, fever, elevated blood pressure, altered
mental status (delirium), mood swings, seizures,
muscle rigidity, and abdominal pain; this risk is
greatly increased when SSRIs are given with MAOIs.
This medication combination needs to be avoided.
13. Instruct that over-the-counter (OTC) cold medicines
may increase the likelihood of serotonin syndrome.
14. In pregnancy, consultation with an obstetrician is
recommended regarding taking these medications.
15. Monitor the medication response in children,
adolescents, and older adults closely, because the
response may be different than in an adult client.
16. Encourage psychotherapy.
17. Serotonin-norepinephrine reuptake inhibitors (SNRI)
are similar to SSRIs, but they also work by blocking
the effects of norepinephrine in addition to serotonin.

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