McKenna's Pharmacology for Nursing, 2e

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P A R T 4  Drugs acting on the central and peripheral nervous systems

Care considerations for people receiving antipsychotic/neuroleptic drugs

■ ■ Encourage person to void before taking a dose if urinary hesitancy or retention is a problem. ■ ■ Provide safety measures such as side rails and assistance with ambulation if CNS effects or orthostatic hypotension occurs to prevent injury. ■ ■ Provide for vision examinations to determine ocular changes and arrange appropriate dose change. ■ ■ Provide thorough teaching, including drug name, prescribed dosage, measures for avoidance of adverse effects, cautions that it may take weeks to see the desired clinical effects, warning signs that may indicate possible problems and the need for monitoring and evaluation to enhance knowledge about drug therapy and to promote compliance. (Refer to Critical thinking scenario.) Warn person that urine may have a pink to reddish-brown colour. ■ ■ Offer support and encouragement to help the person to cope with the drug regimen. Evaluation ■ ■ Monitor response to the drug (decrease in signs and symptoms of psychotic disorder). ■ ■ Monitor for adverse effects (sedation, anticholinergic effects, hypotension, extrapyramidal effects, bone marrow suppression). ■ ■ Evaluate the effectiveness of the teaching plan (person can give the drug name and dosage, possible adverse effects to watch for, specific measures to prevent adverse effects and warning signs to report). ■ ■ Monitor the effectiveness of comfort measures and compliance with the regimen.

Assessment: History and examination

■ ■ Assess for contraindications or cautions for the use of the drug including any known allergies to these drugs, severe CNS depression, circulatory collapse, coronary disease including prolonged QT c interval, brain damage, severe hypotension, glaucoma, respiratory depression, urinary or intestinal obstruction, thyrotoxicosis, seizure disorder, bone marrow suppression, pregnancy or breastfeeding and myelography within the last 24 hours or scheduled in the next 48 hours. In children younger than 12 years of age, screen for CNS infections. ■ ■ Assess temperature; skin colour and lesions; CNS orientation, affect, reflexes and bilateral grip strength; bowel sounds and reported output; pulse, auscultation and blood pressure, including orthostatic blood pressure; respiration rate and adventitious sounds; and urinary output to determine baseline status before beginning therapy and for any potential adverse effects. Also obtain liver and renal function tests, thyroid function tests, ECG if appropriate and full blood count (FBC). Refer to the Critical thinking scenario for a full discussion of care for a person who is prescribed antipsychotic drugs. Implementation with rationale ■ ■ Do not allow the person to crush or chew sustained-release capsules, which will speed up their absorption and may cause toxicity. ■ ■ If administering parenteral forms, keep person recumbent for 30 minutes to reduce the risk of orthostatic hypotension. ■ ■ Consider warning the person or their guardians ■ ■ Monitor FBC to arrange to discontinue the drug at signs of bone marrow suppression. ■ ■ Monitor blood glucose levels with long-term use to detect the development of glucose intolerance. ■ ■ Arrange for gradual dose reduction after long-term use. Abrupt withdrawal has been associated with gastritis, nausea, vomiting, dizziness, arrhythmias and insomnia. ■ ■ Provide positioning of legs and arms to decrease the discomfort of dyskinesias. ■ ■ Provide sugarless lozenges and ice chips to increase secretions and frequent mouth care to prevent dry mouth from becoming a problem. about the risk of development of tardive dyskinesias with continued use so they are prepared for that neurological change.

KEY POINTS

■■ Mental disorders are thought-process disorders that may be caused by some inherent dysfunction within the brain. A psychosis is a thought disorder and schizophrenia is the most common psychosis in which delusions and hallucinations are hallmarks. ■■ Antipsychotic drugs are dopamine-receptor blockers that are effective in helping people to organise thought patterns and to respond appropriately to stimuli. ■■ Antipsychotics can cause hypotension, anticholinergic effects, sedation and extrapyramidal effects, including parkinsonism, ataxia, tremors and neuroleptic malignant syndrome.