muscle stiffness (continuous) or cogwheeling rigid-
ity (ratchet-like movements of joints), drooling, and
akinesia (slowness and difficulty initiating move-
ment). These symptoms usually appear in the first
few days after starting or increasing the dosage of
an antipsychotic medication. Treatment of pseudo-
parkinsonism and prevention of further dystonic re-
actions are achieved with the medications listed in
Table 14-3.
Akathisiais characterized by restless move-
ment, pacing, inability to remain still, and the client’s
report of inner restlessness. Akathisia usually devel-
ops when the antipsychotic is started or when the
dose is increased. Clients are very uncomfortable
with these sensations and may stop taking the anti-
psychotic medication to avoid these side effects. Beta-
blockers such as propranolol have been most effective
in treating akathisia, while benzodiazepines have pro-
vided some success as well.
The early detection and successful treatment of
EPS (extrapyramidal side effects) is a very important
in promoting the client’s compliance with medica-
tion. The nurse is most often the person who will ob-
serve these symptoms or the person to whom the
client will report symptoms. To provide consistency
in assessment among nurses working with the client,
a standardized rating scale for EPS symptoms is use-
ful. The Simpson-Angus scale for EPS is one tool that
can be used.Tardive Dyskinesia.Tardive dyskinesia,a late-
appearing side effect of antipsychotic medications, is
characterized by abnormal, involuntary movements
such as lip smacking, tongue protrusion, chewing,
blinking, grimacing, and choreiform movements of
the limbs and feet. These involuntary movements are
embarrassing for clients and may cause them to be-
come more socially isolated. Tardive dyskinesia is ir-
reversible once it has appeared, but decreasing or
discontinuing the medication can arrest the progres-
sion. Clozapine (Clozaril), an atypical antipsychotic
drug, has not been found to cause this side effect, so
it often is recommended for clients who have experi-
enced tardive dyskinesia while taking conventional
antipsychotic drugs.
Screening clients for late-appearing movement
disorders such as tardive dyskinesia is important. The
Abnormal Involuntary Movement Scale(AIMS)304 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS
Table 14-2
SIDEEFFECTS OFANTIPSYCHOTICMEDICATIONS ANDNURSINGINTERVENTIONS
Side Effect Nursing InterventionDystonic reactionsTardive dyskinesiaNeuroleptic malignant syndromeAkathisiaExtrapyramidal side effects or
neuroleptic-induced parkinsonismSeizuresSedationPhotosensitivityWeight gainAnticholinergic symptoms
Dry mouthBlurred visionConstipationUrinary retentionOrthostatic hypotensionAdminister medications as ordered; assess for effectiveness; reassure
client if frightened.
Assess using tool such as AIMS; report occurrence or score increase to
physician.
Stop all antipsychotic medications; notify physician immediately.Administer medications as ordered; assess for effectiveness.Administer medications as ordered; assess for effectiveness.Stop medication; notify physician; protect client from injury during
seizure; provide reassurance and privacy for client after seizure.
Caution about activities requiring client to be fully alert such as driving
a car.
Caution client to avoid sun exposure; advise client when in the sun, to
wear protective clothing and sun-blocking lotion.
Encourage balanced diet with controlled portions and regular exercise;
focus on minimizing gain.Use ice chips or hard candy for relief.Assess side effect, which should improve with time; report to physician
if no improvement.
Increase fluid and dietary fiber intake; client may need a stool softener if
unrelieved.
Instruct client to report any frequency or burning with urination; report
to physician if no improvement over time.
Instruct client to rise slowly from sitting or lying position; wait to
ambulate until no longer dizzy or light-headed.