A patient who is taking amitriptyline (Elavil) reports constipation and dry mouth. The nurse will give the patient which instruction?

A) Decrease in heart rate and perfusion, and an increase in inflammatory response: These manifestations suggest parasympathetic nervous system activation, not the sympathetic response. The sympathetic system generally increases heart rate and perfusion to support "fight or flight" responses. Additionally, inflammatory responses are more immune-related and are not a direct effect of sympathetic activation.

B) Increase motility and secretion in the GI tract, constriction of bronchi and pupils: This is characteristic of parasympathetic nervous system activity. The parasympathetic system stimulates digestion (increased motility and secretion) and causes bronchoconstriction and pupil constriction (miosis). The sympathetic nervous system, in contrast, inhibits GI motility and causes bronchodilation and pupil dilation.

C) Increase in blood pressure, bronchodilation, and decrease bowel sounds: These are hallmark signs of sympathetic nervous system activation. When the sympathetic system is activated during stress or danger, it leads to vasoconstriction, which increases blood pressure. Bronchodilation occurs to allow more oxygen intake, and GI motility decreases (manifested as reduced bowel sounds) to redirect energy to more vital functions, like increased circulation to muscles.

D) Decrease in sweating, decrease in respiration, and pupil constriction: These signs suggest parasympathetic or a relaxed state. The sympathetic nervous system typically increases sweating, respiration, and causes pupil dilation to prepare the body for increased activity. Decreased sweating and respiration, along with pupil constriction, would not be consistent with the sympathetic response.

A) Stop taking the medication immediately: Abruptly stopping amitriptyline without the guidance of a healthcare provider can cause withdrawal symptoms and other complications. Discontinuing this medication should only be done under medical supervision.

B) Increase fluid intake: Amitriptyline can cause anticholinergic side effects such as dry mouth and constipation. Increasing fluid intake helps manage dry mouth by stimulating salivation and helps alleviate constipation by promoting bowel regularity.

C) Request another antidepressant: While amitriptyline can cause side effects like dry mouth and constipation, switching medications should not be the first step. These side effects are often manageable with lifestyle modifications, such as increasing fluid and fiber intake, and adjustments to the treatment plan can be considered if the symptoms are severe or persistent.

D) Notify the provider: While it is important for the nurse to document and inform the provider about any significant side effects, this instruction alone does not provide immediate relief to the patient. It is more appropriate to first recommend increasing fluid intake, and then the nurse can discuss with the provider if the symptoms persist or worsen.