ATI flashcards set 2

The nurse knows that the physician has ordered the liquid form of the drug chlorpromazine (Thorazine) rather than the tablet form because the liquid: A. has a more predictable onset of action. B. produces fewer anticholinergic effects. C. produces fewer drug interactions. D. has a longer duration of action.

A. Rationale: A liquid phenothiazine preparation will produce effects in 2 to 4 hours. The onset with tablets is unpredictable.

side effects of Thoraxine and Haldol

Antipsychotic agents can produce a range of distressing side effects, from involuntary movements to increased risk of diabetes. Some side effects are treatable; others may diminsh over time or can be compensated for via behavioral changes. ADRESS SIDE EFFECTS IS ESSENTIAL TO PREVENTING NON-ADHERENCE AND TO MAXIMIZE QUALITY OF LIFE.

Contraindications/Precautions

Coma, severe depression, parkinson's disease, prolactin-dependent cancer of the breast ,and severe hyptension use cautiously in clients with glaucoma, parlytic ileus, prostate enlargement, heart disorders, liver or kidney disease, and seizure disorders.

Anticholinergic effects

Dry mouth, blurred vision, photophobia, urinary hesitancy or retention, constipation, tachycardia Suggest the following strategies to decrease anticholinergic effects: chewing sugarless gum sipping of water avoiding hazardous activities wearing sunglasses when outdoors eating foods high in fiber participating in regular exercise Maintaining fluid intake of 2 to 3 L/day from beverages and food sources Voiding just before taking medication

Acute Dystonia

Severe spasm of the tongue, neck, face, and back. Crisis that requires rapid treatment. Begin to monitor for side effects anywhere between 5 hrs to 5 days after administration of first dose. Treat these side effects with antichlinergic agents, such as benxtropine (cogentin) or diphenhydramine (benadryl)

Neuroleptic malignant syndrome

Sudden high fever, blood pressure fluctuations, dysrhythmias, muscle rigidity, changes in level of consciousness, coma

Late extrapyramidal effects

Tardive dyskinesia - involuntary movements of the tongue and face, such as lip smacking. Involuntary movements of the arms, legs, and trunk. Administer lowest dosage possible to control symptoms. Evaluate the client after 12 months of therapy and then every 2 months. Manifestation may occur months to years after the initiation of therapy. If signs of TD appear, dosage should be lowered, or the client should be switched to an atypical agent.

sexual dysfunction

common in both males and females, advise the client of possible side effects encourage that the client report side effects to the provider. the client may need dosage lowered or be switched to a high-potency agent.

skin effects

photosensitivity that can result in severe sunburn, contact dermatitis from handling medicatins advise clients to avoid excessive exposure to sunlight, to use sunscreen, and to wear protective clothing. advise the client to avoid direct contact with the medication

A client begins taking haloperidol (Haldol). After a few days, he experiences severe tonic contractures of muscles in the neck, mouth, and tongue. The nurse should recognize this as: a.psychotic symptoms b.parkinsonism. c.akathisia. d.dystonia.

Answer: D Rationale: These symptoms describe dystonia, which commonly occurs after a few days of treatment with haloperidol. The symptoms may be confused with psychotic symptoms and misdiagnosed. Parkinsonism results in muscle rigidity, shuffling gait, stooped posture, flat- faced affect, tremors, and drooling. Signs and symptoms of akathisia are restlessness, pacing, and inability to sit still.

A client receiving haloperidol (Haldol) complains of a stiff jaw and difficulty swallowing. The nurse's first action is to: A. reassure the client and administer as needed lorazepam (Ativan) I.M. B. administer as needed dose of benztropine (Cogentin) I.M. as ordered. C. administer as needed dose of benztropine (Cogentin) by mouth as ordered. D. administer as needed dose of haloperidol (Haldol) by mouth.

B. Rationale: The client is most likely suffering from muscle rigidity due to haloperidol. I.M. benztropine should be administered to prevent asphyxia or aspiration. Lorazepam treats anxiety, not extrapyramidal effects. Another dose of haloperidol would increase the severity of the reaction.

A client is receiving haloperidol (Haldol) to reduce psychotic symptoms. As he watches television with other clients, the nurse notes that he has trouble sitting still. He seems restless, constantly moving his hands and feet and changing position. When the nurse asks what is wrong, he says he feels jittery. How should the nurse manage this situation? A. Ask the client to sit still or leave the room because he is distracting the other clients. B. Ask the client if he is nervous or anxious about something. C. Give an as needed dose of a prescribed anticholinergic agent to control akathisia. D. Administer an as needed dose of haloperidol to decrease agitation

C. Rationale: Akathisia, characterized by restlessness, is a common but often overlooked adverse reaction to haloperidol and other antipsychotic agents; it may be confused with psychotic agitation. To control akathisia, the nurse should give an as needed dose of a prescribed anticholinergic agent. The client can't control the movements, so asking him to sit still would be pointless. Asking him to leave the room wouldn't address the underlying cause of the problem. Encouraging him to talk about the symptoms wouldn't stop them from occurring. Giving more antipsychotic medication would worsen akathisia.

Yesterday, a client with schizophrenia began treatment with haloperidol (Haldol). Today, the nurse notices that the client is holding his head to one side and complaining of neck and jaw spasms. What should the nurse do? A. Assume that the client is posturing. B. Tell the client to lie down and relax. C. Evaluate the client for adverse reactions to haloperidol. D. Put the client on the list for the physician to see tomorrow

C. Rationale: An antipsychotic agent, such as haloperidol, can cause muscle spasms in the neck, face, tongue, back, and sometimes legs as well as torticollis (twisted neck position). The nurse should be aware of these adverse reactions and assess for related reactions promptly. Although posturing may occur in clients with schizophrenia, it isn't the same as neck and jaw spasms. Having the client relax can reduce tension-induced muscle stiffness but not drug-induced muscle spasms. When a client develops a new sign or symptom, the nurse should consider an adverse drug reaction as the possible cause and obtain treatment immediately, rather than have the client wait.

A client has been receiving chlorpromazine (Thorazine), an antipsychotic, to treat his psychosis. Which findings should alert the nurse that the client is experiencing pseudoparkinsonism? A. Restlessness, difficulty sitting still, and pacing B. Involuntary rolling of the eyes C. Tremors, shuffling gait, and masklike face D. Extremity and neck spasms, facial grimacing, and jerky movements

C. Rationale: Pseudoparkinsonism may appear 1 to 5 days after starting an antipsychotic and may also include drooling, rigidity, and "pill rolling." Akathisia may occur several weeks after starting antipsychotic therapy and consists of restlessness, difficulty sitting still, and fidgeting. An oculogyric crisis is recognized by uncontrollable rolling back of the eyes and, along with dystonia, should be considered an emergency. Dystonia may occur minutes to hours after receiving an antipsychotic and may include extremity and neck spasms, jerky muscle movements, and facial grimacing.

seizures

Greatest risk in those clients who have an existing seizure disorder. advise the client to report seizure activity to the provider an increase in antiseizure medication may be necessary

neuroendocrine effects

Gynecomastia, Galactorrhea, menstrual irregularities advise the client to observe for these manifestations and to notify the provider if they occur.

How soon after chlorpromazine (Thorazine) administration should the nurse expect to see a client's delusional thoughts and hallucinations eliminated A. Several minutes B. Several hours C. Several days D. Several weeks

D. Rationale: Although most phenothiazines produce some effects within minutes to hours, their antipsychotic effects may take several weeks to appear.

agranulocytosis

advise the client to observe for signs of infection (fever, sore throat), and to notify the provider if these occur. if signs of infection appear, obtain the client's baseline WBC. Medication should be discontinued if laboratory test indicates the presents of infection.

What medication would probably be ordered for the acutely aggressive schizophrenic client? A. chlorpromazine (Thorazine) B. haloperidol (Haldol) C. lithium carbonate (Lithonate) D. amitriptyline (Elavil)

Rationale: Haloperidol administered I.M. or I.V. is the drug of choice for acute aggressive psychotic behavior. Chlorpromazine is also an antipsychotic drug; however, it causes more pronounced sedation than haloperidol. Lithium carbonate is useful in bipolar or manic disorder, and amitriptyline is used for depression.

Severe dysrhythias

are associated with some of the conventional antipsychotic agents Obtain the client's baseline ECG and potassium level prior to treatment, and periodically throughout the treatment period. Avoid concurrent use with other medications that prolong QT interval

Parkinsonism

bradykinesia, rigidity, shuffling gait, drooling, tremors. Observe for signs and symptoms for the first month after the initiation of therapy. Treat these side effects with benztropine, diphenhydramine, or amantadine (Symmetrel)

Akathisia

inability to sit or stand still, continual pacing and agitation. Observe for signs and symptoms for the first 2 months after the initiation of treatment. Manage symptoms with beta-blockers, benzodiazepines, or anticholergic medications.

Sedation

inform the client that the effects should diminish within a few weeks. instruct the client to take the medication at bedtime to avoid daytime sleepiness advise the client not to drive until sedation has subsided.

Orthostatic Hypotension

the client should develop tolerance in 2 to 3 months. monitor the clients blood pressure and heart rate for orthostatic changes. instruct clients about the signs of postural hypotesion (lightheadedness, dizziness). If these occur, advise the client to sit or lie down. Orthostatic hypotension can be minimized by getting up or changing positions slowly.