Page 2356 - Saunders Comprehensive Review For NCLEX-RN

6. Weight gain or weight loss
7. Anxiety, restlessness, irritability, confusion
8. Decreased or increased libido with ejaculatory and
erection disturbances
9. Symptoms of tricyclic antidepressant (TCA) toxicity
a. Tardive dyskinesia: involuntary
movement of the face and jaw
b. Akinesia: loss of voluntary muscle
movement
c. Akathisia: state of agitation, distress,
and restlessness
d. Pseudoparkinsonism

C. Interventions

1. Monitor the suicidal client, especially during
improved mood and increased energy levels.
2. Instruct the client to change positions slowly to avoid
a hypotensive effect.
3. Monitor pattern of daily bowel activity.
4. Assess for urinary retention.
5. For the client on long-term therapy, monitor liver and
renal function test results.
6. Administer with food or milk if gastrointestinal
distress occurs.
7. Administer the entire daily oral dose preferably at
bedtime because of the sedative effect. Do not split
doses, such as taking half in the morning and half in
the evening.
8. Instruct the client to avoid alcohol and
nonprescription medications to prevent adverse
medication interactions.
9. Instruct the client to avoid driving and other activities
requiring alertness until the response is known;
sedation is expected in early therapy and may subside
with time.
10. When the medication is discontinued by the primary
health care provider (PHCP), it should be tapered
gradually.
11. The potential for medication interactions with OTC
cold medications exists.
12. Encourage oral hygiene and the use of hard candies
and mouth rinses to relieve dry mouth.
13. Encourage psychotherapy.

Inform the client that antidepressant medication may take

several weeks to produce the desired effect (client response may not

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