342
P A R T 4
Drugs acting on the central and peripheral nervous systems
■■
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.
KEY POINTS
■
■
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.
Care considerations for people receiving
antipsychotic/neuroleptic drugs
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
about the risk of development of tardive
dyskinesias with continued use
so they are
prepared for that neurological change.
■
■
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.
