A nurse is teaching a client who has major depressive disorder about electroconvulsive therapy. Which of the following information should the nurse include?

a. Methadone 40 mg PO daily: This is contraindicated. Methadone is primarily used for opioid withdrawal and maintenance, not for alcohol withdrawal.

b. Nutritional consult: This is anticipated. Nutritional therapy can help balance out the loss of nutrients due to heavy drinking.

c. Perform Alcohol Use Disorders Identification Test (AUDIT): This is contraindicated. AUDIT is a screening tool for assessing alcohol consumption and related problems, but it’s not typically used once a diagnosis of alcohol use disorder has been established and the patient is in withdrawal.

d. Complete blood count and basic metabolic profile: This is anticipated. These tests can help assess the patient’s overall health status and identify any potential complications related to alcohol withdrawal67.

e. Group therapy: This is anticipated. Group therapy can provide peer support and is often beneficial in the treatment of alcohol use disorder.

f. Schedule electroconvulsive therapy (ECT): This is contraindicated. ECT is typically used for severe depression and other psychiatric disorders, not for alcohol withdrawal.

g. Diazepam 10 mg PO three times a day: This is anticipated. Diazepam, a benzodiazepine, is commonly used in the management of alcohol withdrawal to reduce symptoms and prevent complications.

h. Propranolol 40 mg PO twice a day: This is contraindicated. Propranolol, a beta-blocker, is not typically used as a first-line treatment for alcohol withdrawal. It may be used to manage some symptoms such as tremors or high blood pressure, but it does not prevent seizures, a potential complication of alcohol withdrawal.

When educating the client about their medication, the nurse should teach the client that there is a risk for hypertensive crisis due to ingestion of tyramine.

Choice A: Hypertensive Crisis

Reason: Selegiline is a monoamine oxidase inhibitor (MAOI), which can cause a hypertensive crisis if the client ingests foods high in tyramine. Tyramine is found in aged cheeses, smoked meats, and certain alcoholic beverages. When MAOIs inhibit the breakdown of tyramine, it can lead to a sudden and dangerous increase in blood pressure. Normal blood pressure ranges are less than 120/80 mmHg.

Choice B: Tardive Dyskinesia

Reason: Tardive dyskinesia is a movement disorder characterized by involuntary, repetitive body movements. It is typically associated with long-term use of antipsychotic medications, not with MAOIs like selegiline. Therefore, this condition is not relevant to the client’s current medication.

Choice C: Rhabdomyolysis

Reason: Rhabdomyolysis is a serious condition involving muscle breakdown and release of muscle fiber contents into the bloodstream, which can lead to kidney damage. It is not a known side effect of selegiline. This condition is more commonly associated with severe physical exertion, trauma, or certain medications like statins.

Choice D: Infection

Reason: Infection is not a direct risk associated with selegiline. While some medications can suppress the immune system and increase infection risk, selegiline does not have this effect. Therefore, this condition is not applicable to the client’s medication education.

Choice E: Nervous System Instability

Reason: Nervous system instability can refer to a range of symptoms including dizziness, confusion, or seizures. While selegiline can cause some central nervous system side effects, it is not typically associated with a broad category of nervous system instability. The primary concern with selegiline remains the risk of hypertensive crisis due to tyramine ingestion.

Choice A: Hypertensive Crisis

Reason: Selegiline is a monoamine oxidase inhibitor (MAOI), which can cause a hypertensive crisis if the client ingests foods high in tyramine. Tyramine is found in aged cheeses, smoked meats, and certain alcoholic beverages. When MAOIs inhibit the breakdown of tyramine, it can lead to a sudden and dangerous increase in blood pressure. Normal blood pressure ranges are less than 120/80 mmHg.

Choice B: Tardive Dyskinesia

Reason: Tardive dyskinesia is a movement disorder characterized by involuntary, repetitive body movements. It is typically associated with long-term use of antipsychotic medications, not with MAOIs like selegiline. Therefore, this condition is not relevant to the client’s current medication.

Choice C: Rhabdomyolysis

Reason: Rhabdomyolysis is a serious condition involving muscle breakdown and release of muscle fiber contents into the bloodstream, which can lead to kidney damage. It is not a known side effect of selegiline. This condition is more commonly associated with severe physical exertion, trauma, or certain medications like statins.

Choice D: Infection

Reason: Infection is not a direct risk associated with selegiline. While some medications can suppress the immune system and increase infection risk, selegiline does not have this effect. Therefore, this condition is not applicable to the client’s medication education.

Choice E: Nervous System Instability

Reason: Nervous system instability can refer to a range of symptoms including dizziness, confusion, or seizures. While selegiline can cause some central nervous system side effects, it is not typically associated with a broad category of nervous system instability. The primary concern with selegiline remains the risk of hypertensive crisis due to tyramine ingestion.