New to Psych nursing and stumped

  1. 20 years of nursing experience, but brand new to psych. Will try to shorten this confusing pt. 28 year old, no previous problems until one week ago when she developed severe debilitating exhaustion. Had been on Reglan for one month to increase breast milk, breastfeeding her seven month old. Saw her obstetrician two days after exhaustion began who ran some lab tests. Two days later got results of tests, they were normal. She started crying on phone, devestated to have no clue what was going on, she was barely able to get energy to get out of bed. Zoloft 50mg QD ordered and she was warned it would take two weeks to help. In desparation she took three, hoping to get her bloodlevel up then began having all kinds of new symptoms, could not eat, severe anxiety, urinary hestitancy, panic attacks. Could not sleep. Husband brought her to our psych hospital and she was admitted for Postpartal depression. She took 150 zoloft first day, 100 second day and 25 third day. The evening of admission she said she felt normal and symptoms were only severe in morning. In my inexperienced assessment, she was honest, appropriate, scared. After discovering the reglan i was certain that it was the cause of initial symptoms, and then Zoloft side effects kicked in. I felt confident that she would feel better after a night of sleep. MD ordered trazadone for sleep.

    Next morning, she woke up after a poor night of sleep, she felt anxious but only mildly. I drew her lab work and did her tb skin test, and she had increasing agitation, syncope and nausea. I put her head down thinking it was just a reaction to having bloodwork, but it did not resolve quickly. She remained alert and oriented but was scared and anxious. I checked bp, it was 60/24 and pulse was 40! Her admission vs had been normal. I sat with her about 10 minutes with no real improvement. VS stayed about same. She was also sweating. She then had an epidode where her eyes rolled back and deviated up and left , mouth pulled down and to left in a horrid grimace, left arm contracted, and left leg pulled up, some brief jerking then as I spoke she "came out of it" and was really scared, asking what had happened to her. That episode lasted less than 30 secs, no incontinence. Her pulse and bp still very low. They were normal about 10 minutes later when ambulance arrived, to take her to ER. She had no further problems, and was sent back to the unit and sent home that evening because her insurance did not cover psych.

    Okay all you smart psych nurses. help!! What do you think was going on with her? Thanks in advance )
    Last edit by LibbyK on Jun 25, '03
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  2. 6 Comments

  3. by   Murt
    Zoloft can cause such heart fluctuations, seems the most likely seeing the size of the initial dose, 150mg!!
  4. by   rola
    DO YOU THINK IS THERE ANY PERSONALITY DISORDER ?
  5. by   maureeno
    poor woman
    already under stress trying to increase milk production....
    I don't know what happened that morning
    some reports of tics/strange movements with SSRIs
    [hope she is not pregnant again!]

    here is an interesting site
    alternative non-medical point of view
    regards meds
    http://www.prozactruth.com/index.html
    hope you enjoy psych nursing
    always lots to ponder
  6. by   sanakruz
    Ive seen EPRs with Reglan- the individual in question had mixed it with marijuana. Still, could be.

    Ive met many folks with personality disorders that deserved Oscars, but never anyone that could drop their blood pressure like that-
    How's her thyroid?
  7. by   sanakruz
    HMMM Zoloft causes perfuse sweating in some individuals-So does hyperthyroidism.She actually has several symptoms of hyperthyroism-Anxiety,poor sleep,sweating,cardiac changes (altho I seem to recall increase in pulse/bp...) I'm curious LibbyK- What happened?
  8. by   ainz
    Probably a combination of things. Zoloft, post-partal hormone effects, thyroid issues, perhaps some history of depression or other behavioral issues prior to pregnancy. Does she have a history like this?

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