Nursing Considerations for Clients Receiving MAOIs
MAOI使用者的护理考虑
A. Assessment: History and Examination 评估：病史与检查
• Assess for any known allergies to these drugs to avoid hypersensitivity reactions; impaired liver or kidney function that could alter the metabolism and excretion of the drug; cardiac dysfunction; GI or GU obstruction, which could be exacerbated by the drug; surgery, including elective surgery, because the effects of changes in NE levels are unpredictable following surgery; seizure disorders; psychiatric conditions or suicidality; and occurrence of myelography within the past 24 hours or in the next 48 hours to avoid the possibility of severe reactions.
• Determine whether female patients are pregnant or breast-feeding because these drugs should not be used during pregnancy or lactation.
确定女性患者是否怀孕或哺乳，因为怀孕或哺乳期间不应使用这些药物。
• Assess temperature and weight; skin color and lesions; affect, orientation, and reflexes; vision; blood pressure, including orthostatic blood pressure; pulse and perfusion; respiratory rate and adventitious sounds; and bowel sounds on abdominal examination to determine baseline status and for any potential adverse effects before beginning therapy. Also obtain an electrocardiogram and renal and liver function tests.
• Limit drug access to a potentially suicidal patient to decrease the risk of overdose.
限制潜在自杀性患者的药物获取途径，降低服药过量危险
• Monitor the patient for 2 to 4 weeks to ascertain the onset of the full therapeutic effect.
监测患者2-4周，确定疗效完全发挥
• Monitor blood pressure and orthostatic blood pressure carefully to arrange for a slower increase in dose as needed for patients who show a tendency toward hypotension.
仔细监测血压和体位性血压，安排慢慢增加有低血压倾向患者所需要的用药剂量
• Monitor liver function before and periodically during therapy and arrange to discontinue the drug at the first sign of liver toxicity.
治疗前及治疗期间定期监测患者肝功能，一旦出现肝毒性症状就立即停药
• Discontinue drug and monitor the patient carefully at any complaint of severe headache to decrease the risk of severe hypertension and cerebrovascular effects.
患者表示剧烈头痛时应停药，仔细监测患者，以减少严重高血压和脑血管效应危险
• Have phentolamine or another adrenergic blocker on standby as treatment in case of hypertensive crisis.
备好酚妥拉明或别的肾上腺素阻断剂，以便一旦出现高血压危象时进行治疗
• Provide comfort measures to help the patient tolerate drug effects. These include voiding before dosing, instituting a bowel program as needed, taking food with the drug if GI upset is severe, and environmental control (lighting, temperature, decreased stimulation).
提供舒适性措施，帮助患者耐受药物效应。措施包括用药前排便、必要时制定排便计划、GI不适严重时可药物、食物同服、环境控制（照明、温度、减少刺激）等。
• Provide a list of potential drug–food interactions that can cause severe toxicity to decrease the risk of a serious drug–food interaction. Provide a diet that is low in tyramine-containing foods.
提供潜在的可能引起严重毒性的药物-食物相互作用清单，减少严重的药物-食物相互作用危险。提供酪胺含量较低的食物饮食
• Provide thorough patient teaching, including drug name, prescribed dosage, measures for avoidance of adverse effects, and warning signs that may indicate possible problems. Instruct the patient about the need for periodic monitoring and evaluation to enhance patient knowledge about drug therapy and to promote compliance.
提供彻底的患者宣教，包括药物名称、处方剂量、避免不良效应的措施、提示可能问题的警示标志。指导患者了解定期监测和评价的必要性，增加患者药物疗法知识，促进治疗依从性
• Offer support and encouragement to help the patient cope with the disease and the drug regimen.
提供支持与鼓励，帮助患者应对疾病和药物治疗
★Vocabulary for Today ★
elective surgery – 选择性手术
phentolamine – n. 酚妥拉明
adrenergic blocker – 肾上腺素阻断剂
standby – n. 备用
tyramine – n. 酪胺
1. The client diagnosed with depression is prescribed phenelzine (Nardil), a monoamine oxidase (MAO) inhibitor. Which statement by the client indicates to the nurse the medication teaching is effective?
A. “I am taking the herb ginseng to help my attention span.”
B. “I drink extra fluids, especially coffee and iced tea.”
C. “I am eating three well-balanced meals a day.”
D. “At a family cookout I had chicken instead of a hotdog.” 2. The client diagnosed with panic disorder is taking a phenelzine (Nardil), an MAO inhibitor. Which statement by the client warrants immediate intervention?
A. “I am very careful about what I eat.”
B. “I have been taking Robitussin for my cough.”
C. “I took two Tylenol for my headache.”
D. “I only drink one cup of coffee a day.”
答案 Key to Questions 1. D. “At a family cookout I had chicken instead of a hotdog.”
Rationale: Taking MAO inhibitors requires adherence to strict dietary restrictions concerning tyramine-containing foods, such as processed meat (hot dogs, bologna, and salami), yeast products, beer, and red wines. Eating these foods can cause a life-threatening hypertensive crisis. 2. B. “I have been taking Robitussin for my cough.”
Rationale: Dextromethorphan (Robitussin) interacts with MAOIs to produce hypertension, fever, and coma. This statement warrants intervention.
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