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Extrapiramidal signs.
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Extrapiramidal signs.
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TABLE 17-2 EXTRAPYRAMIDAL SIDE EFFECTS (EPSEs) CAUSED BY ANTIPSYCHOTICDRUGS AND THEIR NURSING INTERVENTIONS
EPSE NURSING INTERVENTIONS
Akathisia Be patient and reassure patient who is “jittery” that you understand the need to move and that appropriate drug
interventions can help differentiate akathisia and agitation. Because akathisia is a major cause of noncompliance with
antipsychotic regimens, switching to a different class of antipsychotic drug might be necessary to achieve compliance.
Akinesia/bradykinesia May respond to anticholinergics. May want to reduce dose or change antipsychotics.
Dystonias If a severe reaction (e.g., oculogyric crisis, torticollis) occurs, give antiparkinsonian drug (e.g., benztropine [Cogentin]) or
antihistamine (e.g., diphenhydramine [Benadryl]) immediately, as needed. Offer reassurance. If an order for intramuscu-
lar administration has not been written, call the physician at once to obtain the order. When an order for an antiparkin-
sonian drug is warranted for less severe dystonias, notify the physician.
Drug-induced parkinsonism Assess for major parkinsonism symptoms: tremors, rigidity, and bradykinesia; report to physician. Antiparkinsonian drugs
will probably be indicated.
Tardive dyskinesia Assess for signs by using the abnormal inventory movement scale (AIMS). Drug holidays might help prevent tardive dyski-
nesia. Anticholinergic agents will worsen tardive dyskinesia; therefore, question their indiscriminate prophylactic use.
Neuroleptic malignant syndrome Be alert for this potentially fatal side effect. Routinely take temperatures, and encourage adequate water intake for all
patients on a regimen of antipsychotic drugs; routinely assess for rigidity, tremor, and similar symptoms.
Pisa syndrome Treat with higher doses of antiparkinsonian drugs.
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