A nurse is teaching a client who has an ileostomy about the care of their stoma site. Which of the following statements made by the client indicates the teaching was effective?

Rationale for Correct Choices:

• Serotonin syndrome: The client’s symptoms recent SSRI dose increase indicate possible serotonin toxicity. Serotonin syndrome occurs when excessive serotonin accumulates in the body, typically following dose escalation or interaction between serotonergic medications. It is a medical emergency that can progress to seizures or death if not promptly identified and treated.

• Adverse effects of paroxetine: The increase in paroxetine dosage one week prior likely triggered excessive serotonergic activity. Paroxetine, an SSRI, elevates serotonin levels, and dose escalation can precipitate serotonin syndrome.

Rationale for Incorrect Choices:

• Generalized anxiety disorder: Although the client has a history of anxiety, the acute onset of fever, disorientation, and autonomic instability points to a physiological reaction rather than worsening anxiety. Anxiety may cause restlessness but does not produce hyperthermia or confusion.

• Neuroleptic malignant syndrome: This condition is associated with antipsychotic drugs, not SSRIs like paroxetine. While both syndromes can present with fever and altered mental status, the client’s medication profile and timing support serotonin toxicity instead.

• Feelings of hopelessness: Although ongoing hopelessness is part of the client’s depression, it does not explain the acute physical manifestations. Emotional symptoms may persist with depression, but fever and disorientation indicate a pharmacologic rather than psychological cause.

• Anxiety: Anxiety alone cannot account for the client’s fever, disorientation, or abdominal pain. These findings suggest a systemic reaction consistent with serotonin excess, not a purely psychological state.

Rationale:
A. "Placement of the catheter is confirmed by a CT scan.": Catheter placement is not routinely confirmed by CT scan. Instead, correct placement of a central venous catheter is verified by a chest X-ray immediately after insertion to ensure proper tip location.

B. "You will be under general anesthesia for this procedure.": General anesthesia is not required for placement of a nontunneled percutaneous central venous catheter. The procedure is typically performed using local anesthesia and aseptic technique at the bedside.

C. "The provider will wear a mask while performing the procedure.": The provider wears a mask, sterile gown, gloves, and cap as part of strict sterile technique during insertion to prevent catheter-related bloodstream infections.

D. "Your head will be elevated as high as possible while the catheter is inserted.": The client’s head is not elevated during insertion. Instead, a flat or slight Trendelenburg position is used to distend neck veins and reduce the risk of air embolism.