Nursing Diagnoses in Psychiatric Nursing Care Plans and Psychotropic Medications

(^498) 10. 11. *Hypersalivationatypicals, with the exception of clozapine) Agranulocytosis It usually occurs within the fi A signifi●A complete blood count should be monitored if these EXCEPTION: symptoms appear.(Clozaril) therapy experience extreme salivation. Offer cytosis with clozapine (Clozaril). Agranulocytosis is a potentially fatal blood disorder in which the client’s white blood cell (WBC) count can drop to extremely low Observe for symptoms of sore throat, fever, malaise. count (ANC) must be taken before initiation of treatment with clozapine and weekly for the fiWBC counts are continued for an additional 4 weeks.ment. Only a 1-week’s supply of medication is dispensed at a time. If the counts remain within the acceptablelevels (i.e., WBC at least 3,500/mmthereafter. When the medication is discontinued, weekly period, counts may then be monitored every 4 weeks 2,000/mmcounts remain within the acceptable level for the biweekly cation may then be dispensed. If for a 6-month period the may be monitored biweekly, and a 2-week supply of medi-levels. A baseline WBC count and absolute neutrophil^ PSYCHOTROPIC MEDICATIONS cant number of clients receiving clozapine (^3) ) during the 6-month period, blood counts (most common with clozapine) (more common with typicals than the There is a signifi rst 3 months of treatment. cant risk of agranulo- rst 6 months of treat- (^3) and the ANC at least
2 2506_Ch28_472-501.indd 1498 506 Ch 28 472 - 501 .ind^ 12.^ a. d c. b. 14 Extrapyramidal symptoms 9 ferences between typicals and atypicals) 8 such as an anticholinergic (e.g., scopolamine patch) or alphasupport to the client, as this may be an embarrassing piration), if the problem is very severe. Management has included the use of sugar-free gum to increase the swal-situation. It may even be a safety issue (e.g., risk of as-lowing rate, as well as the prescription of medications AkinesiaPseudoparkinsonism*Akathisia***rigidity) Symptoms may appear 1 to 5 days following initia- Observe for symptoms and report; administer an- Same as pseudoparkinsonism. This occurs most f requent ly in women; sy mptoms may tion of antipsychotic medication; occurs most often in tiparkinsonian drugs, as ordered (see Chapter 29)occur 50 to 60 days following initiation of therapy. women, the elderly, and dehydrated clients.^2 -adrenoceptor agonist (e.g., clonidine). (muscular weakness) (continuous restlessness and fi (t remor, shuf fl (EPS) (see Table 28-1 for dif- ing gait, drooling, dgeting) 1 10/1/10 9:40:14 AM 0 / 1 / 10 9 : 40 : 14 AM