Nursing management
1. Psychopharmacology:
Drug class and names.
(Typical / Traditional)
- Acetophenazine (Tindal)
- Chlorpromazine (Thorazine)
- Fluphenazin (Prolixin)
- Haloperidol (Haldol)
- Loxapine (Loxitane)
- Mesoridazine (Trilafon)
- Thioridazine (Mellaril)
- Thiothixene (Navane)
- Trifluoperazine (Stelazine)
- Triflupromazine (Vesprin)
(Atypical / Second Generation)
- Aripiprazole (Abilify)
- Clozapine (Clozaril)
- Olanzapine (Zyprexa)
- Olanzapine / fluoxetine (Symbyax)
- Quetiapine (Seroquel)
- Risperidone (Risperdal)
- Sertindole (Serlect)
- Ziprasidone (Geodon)
(Antiparkinsonism / Anticholinergic) to treat extrapyramidal side effects
- Benztropine (Cogentin)
- Biperiden (Akineton)
- Ethopropazine (Parsidol)
- Procyclidine (Kemadrin)
- Trihexyphenidyl (Artane)
(Dopamine Agonnist)
- Amantadine (Symmetrel)
(Beta Adrenergic Blocker)
- Propranolol (Inderal)
(Benzodiazepines)
- Lorazepam (Activan)
(Antihistamine)
- Diphenhydramine (Benadryl)
Nursing considerations and interventions:
- Assess patient's response towards the medication and for any possible drug interaction
- Monitor patient on antipsychotic medications for extapyramidal side effects (EPS) and other adverse effects
- Administer the abnormal and involuntary movement scale (AIMS) to assess the client on psychotic medication for the signs of tardive dyskinesia
- Assess for signs of neuroleptic malignant syndrome (NMS) and access emergency care for the client if NMS suspected
- Monitor the patient's vital signs for hypotension, orthostatic hypotension, and tachycardia
- Monitor the patient's body weight
- Monitor the blood glucose and lipids
- Monitor the client for any seizure activity
- Instruct the patient to prevent getting overheated in the sun by using sunblock or avoiding taking hot baths
- Perform weekly WBC count with clozapine because of the risk of agranulocytosis
Nursing Measures for Side Effects (Anticholinergic Syndrome)
- Suggest chewing sugarless gum or hard candy to offset effect of dry mouth
- Suggest rinsing mouth frequently to decrease side effect of dry mouth
- Encourage use of stool softeners by increasing water intake and dietary fiber to decrease the side effect of constipation
- Suggest use of saline nasal spray to decrease side effect of nasal congestion
- Instruct patient to use caution due temporary side effect of blurred vision. Vision will return to previous condition in a few weeks
- Instruct patient to acknowledge the nurses if any eye pain happened immediately
- Instruct patient on need to use caution in the sun , wear sunscreen, sunglasses, and avoid becoming overheated because of side effects of photophobia and photosensitivity
- Instruct patient to use caution with sudden changes in body positions due to possible orthostatic hypotension
- Monitor patient for signs of urinary retention and hesitation
Extrapyramidal Side Effects from Antipsychotic Medications
Akathisia: Motor restlessness , inability to remain still, can also occur as subjective feeling
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| https://images.app.goo.gl/qT5zGxZQNnEfemK87 |
Akinesia: Absence of movement or difficulty with movement
Dystonias: Muscle spasm, spastic movements of the neck and back, can be painful and frightening for the client
Pseudoparkinsonism: Shuffling and slow gait, masklike facial expression, tremors, pill-rolling movements of the hands, stooping posture, rigid
Tardive dyskinesia: Involuntary and abnormal movements of the mouth, tongue, face, and jaw. May progress to the limbs, irreversible condition, may occur in months after using antipsychotic drug
Neuroleptic malignant syndrome: A potientially lethal side effect of antipsychotic medicaation that requires emergency treatment, manifested symptoms include hyperthermia, muscle rigid, tremors, altered consciousness, tachycardia, hypertension, incontinence
2. Encourages patient express their feelings and thought
3. Avoid arguing with the patient with their client about delusion and hallucination
1. Assess of self-destructive behaviors, provide needed precautions
2. Provide opportunities for the client to promote socialization and prevent or decrease isolation
3. Encourage patient to express feelings by verbalize their thought openly
1. Provide for the clients’ safety and the safety of others in the milieu
2. Provide a supportive environment that structured and predictable
3. Assist client with ADL needed and encourage client progresses
1. Educate family about chronic illness of schizophrenia.
- Implications
- Early signs
- Symptoms of relapse
- Disease management
- Medication management
- Community support systems available
2. Provide outlet for family discus patient’s feelings and fear, explore healthy and helpful, effective coping skills
3. Educate family stress within family (expressed emotion) to decrease the patient relapsing.
 |
| https://images.app.goo.gl/aHAsYQgQfHbtgYni6 |
Dystonias: Muscle spasm, spastic movements of the neck and back, can be painful and frightening for the client
| https://images.app.goo.gl/83iu8dsFKJYwF2yM8 |
Pseudoparkinsonism: Shuffling and slow gait, masklike facial expression, tremors, pill-rolling movements of the hands, stooping posture, rigid
 |
| https://images.app.goo.gl/2A4SF9PEPkMJy1jR6 |
Tardive dyskinesia: Involuntary and abnormal movements of the mouth, tongue, face, and jaw. May progress to the limbs, irreversible condition, may occur in months after using antipsychotic drug
 |
| https://images.app.goo.gl/FotiqhsvzCpdmiMt8 |
Neuroleptic malignant syndrome: A potientially lethal side effect of antipsychotic medicaation that requires emergency treatment, manifested symptoms include hyperthermia, muscle rigid, tremors, altered consciousness, tachycardia, hypertension, incontinence
2. Individual and group intervention:
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| https://images.app.goo.gl/AQSMU6opAxiE483z7 |
Management of delusions and hallucinations
1. Established trusting and therapeutic relationship for the clients by being honest supportive and consistent.2. Encourages patient express their feelings and thought
3. Avoid arguing with the patient with their client about delusion and hallucination
General nursing considerations and interventions
2. Provide opportunities for the client to promote socialization and prevent or decrease isolation
3. Encourage patient to express feelings by verbalize their thought openly
3. Milieu Therapy: Method psychotherapy by controlling the environment client provide interpersonal contact to enhance trust, assurance and personal autonomy.
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| https://images.app.goo.gl/Ku7N8xDzsEWfAUzF7 |
2. Provide a supportive environment that structured and predictable
3. Assist client with ADL needed and encourage client progresses
4. Family therapy:
 |
| https://images.app.goo.gl/Ac5zjXLQQeEMmomS9 |
1. Educate family about chronic illness of schizophrenia.
- Implications
- Early signs
- Symptoms of relapse
- Disease management
- Medication management
- Community support systems available
2. Provide outlet for family discus patient’s feelings and fear, explore healthy and helpful, effective coping skills
3. Educate family stress within family (expressed emotion) to decrease the patient relapsing.
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