PSYCHIATRIC NURSING

NURSE CLIENT RELATIONSHIP → SELF AWARENESS

→ Series of interaction between the nurse and the client II. Orientation/Interaction
→ GOAL: Positive behavioral change → There is already contact with the patient
• If the patient previously had mood changes, the proper assessment → proper diagnosis → proper
goal should be patient will go back to normal management → proper results
• The patient should be able to perform ADL’s → Trust, assess the client
• The patient will change for the better → Mutual contract/agreement (inform about
→ Two-way termination)
• Both patient and nurse should work III. Working
→ Longest phase
Common Question on Nurse Client Relationship? → Achieving goals and sharing facts
1. When does the therapeutic relationship begin? → Resolving the problem
• As early as the orientation phase (where the nurse IV. Termination
meets the patient), there should be a therapeutic → Express the feelings about termination (dapat
relationship magsalita si patient if masaya or malungkot siya)
2. What is the only tool available for the nurse? → Explore feelings of the patient: observe “regressive
• SELF – self-awareness should be developed first behaviors” (return to a developmental stage)
because traumatic experiences may reoccur → Moving towards independence
3. When is a trust established?
• When the patient starts sharing details of his/her life THERAPEUTIC COMMUNICATION
4. What phase is self-awareness developed? → The dynamic process of exchanging information
• Pre-orientation phase (depends on the client’s response)
5. Exceptions on asking why? → Verbal and non-verbal (speaking and action) 🡪 effective
• Suicidal patients when both used
6. Most dangerous of DABDA?
• Depression Elements of Therapeutic Communication
→ Sender/Encoder
Elements of Nurse Client Relationship • Source of message
→ T – rust → Message
→ R – apport • Information
→ U – nconditional positive regard (accept the patient for → Receiver/Decoder
who they are) • Recipient of message
• Acceptance regardless of age, race, gender → Feedback
→ S – et limits • Receiver’s response
→ T – herapeutic use of self
• Therapeutic communication Barriers of Communication
→ Factors that inhibit the communication process
Therapeutic Behaviors → Noise, age, environment
1. Genuineness
• Sincerity and honesty Therapeutic Techniques
2. Concreteness
• Ability to identify one’s feelings Non-Verbal Communication
• Kung kailan iniiwasan ng patient yung feelings 1. Proxemics
• Shows the devotion and commitment to solving the • “Physical space”
client’s problems • One arm and half / 3-6 ft
3. Respect 2. Kinetics
• Shown through consideration of the patient as a • Body movements
unique being • Gestures, facial expressions, mannerisms
• Each and every patient is unique 3. Touch
• Intimate
Phases of Therapeutic Relationship • Needs consent before performing to do so
I. Pre-orientation/Pre-interaction 4. Silence
→ No contact with the client • Agreeing/listening/encouraging the patient to talk
→ Data is secondary sources (chart, journals, books, • Silence encourages the patient to talk
internet)
→ Form of preparation
5. Paralanguage Reflecting
• Voice quality (tone, inflection) how the message is → The patient would ask the question back to the nurse
delivered → The nurse should ask it back to the patient because the
• Improves the quality of your message, to see the patient should be able to answer it themselves–
genuineness of your communication stimulate independent decision making
→ E.g., “iiwan ko ba dapat asawa ko?”
Verbal Communication “Sa tingin mo ba makakabuti ang pagiwan mo sa asawa
→ Therapeutic, appropriate, simple, adaptive, concise, mo?”
credible
Non-Therapeutic Communication
Types of Verbal Communication 1. Giving advice
1. Offering Self 2. Talking about self
• Let me sit here with you for 5 minutes 3. Telling the client is wrong
2. Active listening 4. False reassurance
• Uh-huh, yes, no, nodding of the head 5. Asking why: demands an answer
3. Exploring • pressure (deep-seated feelings)
• “You said Hannah was the best, can you describe • Exceptions: Suicidal patients: Direct questioning.
her?”
4. Broad opening SPHERES
• Where would you like to begin? → ID
5. Making Observation • Pleasure, irrational
• I noticed you have combed your hair today • Too much → Antisocial personality disorder (no
6. Summarizing remorse)
• In the past 15 mins, we have talked about… → EGO
7. Encouraging description of perception • Reality-based
• Commonly used in hallucinations and illusions → SUPEREGO
8. Presenting reality • Conscience
• Commonly used in hallucinations and illusions • Obsessive-Compulsive Personality Disorder
9. Seeking clarification
• Do you mean? DEFENSE MECHANISMS
• Pwede mo bang ulitin? → Repression (di sadyang limot)
10. Reflecting • UNCONSCIOUSLY forgetting
• Returning the question to the patient so the patient • A traumatic event that causes forgetfulness (you
will decide cannot remember it even if you want to)
11. Restating • E.g., traumatic childhood
• Pt: I am down → Suppression (sadyang limot)
• Nurse: Are you depressed? • CONSCIOUSLY forgetting
12. General leads → Reaction Formation (plastic/orocan)
• Go on… • Actions are not congruent to their feelings
13. Focusing • Fighting their own demons
• Let us look at it more closely → Rationalization
• Reasoning out
Difference between hallucinations and illusions → Projection
→ Hallucinations – without stimulus • Blaming other people
→ Illusions (with stimulus) → Introjection
• Blaming self
Hallucinations • Personalities of others are copied (ALL FEATURES)
→ Visual – seeing → Compensation
→ Auditory – hearing; most dangerous because there is a • Overachieving in a different area of expertise to
command compensate for the weak aspect
• E.g., “I can hear voices...” → Denial
• Nursing Rx- EDP (Encouraging description of • Ignoring or unacceptance the reality or existence of
perception): “What are the voices telling you? a truth
o It will give you an idea of what the voices are → Displacement
saying • Channeling of anxiety from a more threatening to
• Nursing Rx- Presenting Reality. “I know that the less threatening object, animal, person
voices are frightening to you but there are no voices • E.g., kicking a trash can because of anger felt for
here” the mother
→ Tactile – feeling
→ Regression ● The patient may become suicidal
• Going back to a previous developmental stage V. ACCEPTANCE
• E.g., thumb sucking has subsided but returned d/t ● There is the tendency to move forward
anxiety
→ Undoing DISEASE CONDITIONS ON PSYCHIATRIC NURSING
• Doing something to relieve the feelings of guilt
• Giving gifts to a person who s/he just hurt Disturbances in Appearance
→ Conversion 1. Automatisms
• Anxiety turns into physical symptoms ● Abnormal neurotransmitter vs neuromuscular
→ Intellectualization fibers (ticks)
• Reasoning in a detailed, scientific manner to block ● Repeated purposeless behaviors
confrontation with an unconscious conflict ● Shoulder shrug with eye winking
→ Substitution 2. Psychomotor retardation
• Unavailable into available ● Slowed movement in depressed patients
• Replacing unachievable goals to something ● E.g., very slow movements and speaking
achievable 3. Waxy Flexibility
• E.g., a person who wanted to be a doctor has ● Maintenance of an awkward posture
changed his/her dream to be an artist 4. Catatonia
→ Sublimation ● Maintenance of an awkward posture
• Conversion of unacceptable behavior to 5. Echopraxia
acceptable behavior ● Purposeless imitation of movements
• Instead of punching someone the person joined ● Mirrored movements
boxing as a sport ● If you move your hands up, the patient will copy it
→ Identification
• Idolization (copy of CERTAIN FEATURES) Disturbances in Communication
→ Splitting 1. Mutism
• They see others as either all good or all bad ● The patient is mute, unable to speak
2. Negativism
• A person may have been allowing her to borrow
● Persistent resistance to the suggestion of others
pens for the longest time but then there comes a
3. Circumstantiality
time where the other person tells the girl that she
● Beating around the bush (with answer)
no longer has an extra pen, the girl's response
4. Tangentiality
would be “that’s who you really are! you are selfish
● Beating around the bush (without the answer)
to me!”
5. Stilted Language
● Communication is characterized by situationally-
CRISIS
inappropriate formality
1. Maturational/Developmental
6. Flight of ideas
● Expected crisis, normal part of life
● Slightly related, with meaning
● E.g., monthly bills, marriage, graduation,
● There are words similar for every sentence
pregnancy
7. Loose Association
2. Situational
● Without meaning, not related
● Unexpected, not common, sudden
● Word salad- different words in one sentence
● E.g., teenage pregnancy, accidents
8. Perseveration
3. Adventitious/social
● Going back to the same topic
● Problems in the community
● The topic has already changed but the patient goes
● Acts of God, the force of nature
back to the previous topic
● E.g., fire, thunder, earthquake, flood, election,
9. Echolalia
rape, abuse
● Parrot-like
● Repetition of words
Stages of Death and Dying
● Nurse says come here, px also says come here
I. DENIAL
10. Palilalia
● Unacceptance of the truth
● Stereotyped words/last syllable
II. ANGER
● Involuntary repetition of syllables
● Ability to project anger to others
11. Verbigeration
● May blame others
● Continual repetition of stereotyped phrases
III. BARGAINING
12. Coprolalia
● Bargain
● Copro (feces) – lali (speech)
● “Sana ako nalang, gagawin ko lahat”
● Coprolalia tends to curse
IV. DEPRESSION
● Shit talk
● The most dangerous part of DABDA
13. Neologisms → The common characteristic of anxiety is said to be
● Creation of new words contagious and repetitive
● Only the patient can understand • Nervousness can be passed from one person to
● Shekelemi uskaratata, pash pash another
14. Jargons → Initial nursing action is introspection or self-awareness
● Specific words used by certain professions or (knowing one’s self-thoughts, beliefs, and values) to
groups which makes it difficult to understand by avoid getting yourself involved in the situation of your
other people patient and avoid prejudices toward your patient
● BID, TID, OD • To not let your emotions overcome the clearness
● Toxic of your judgment
● Benign • Determine your own level of anxiety, to avoid
15. Blocking having a panic attack that is similar to your patient’s
● Sudden cessation of thought → Priority will always be the safety of both you and the
● Mental block patient
16. Word Salad • If the patient is suffering from anxiety you have to
● A mixture of unrelated words stay with the patient
● Ant, picture, cup → Drug of choice are benzodiazepines (-lam and -pam)
● Words only while loose association have phrases • Alprazolam
already • Diazepam
17. Clang Association → If a patient takes anxiolytics, always instruct the patient
● Groupings of words, usually rhyming words, that to avoid any form of alcohol because benzodiazepines
are based on similar-sounding sounds, even are already respiratory depressants
though the words themselves don't have any logical • Alcohol is also a respiratory depressant, these two
reason to be grouped together combined will lead to respiratory arrest

Disturbances in Perception Levels of Anxiety

1. Delusions
● Fixed false beliefs Level Manifestations Management
● “I believe that aliens will come to me at night and
Mild ● A normal level of ● Allow the patient to
get me” anxiety, and can be verbalize the
felt on a daily basis anxiety
Types of Delusions ● Promotes optimal ○ You are not
→ Delusion of Persecution functioning and allowed to give
→ Delusion of Grandeur safety advice, agree or
● Increased alertness disagree with the
2. Magical Thinking ● Learning is more patient, or give
effective your own opinions
● A belief that one's ideas, thoughts, actions, words,
● Wide perception about the patient’s
or use of symbols can influence the course of
and heightened concern
events in the material world senses ○ Never ask “why”
● “I believe I can summon nine tails sa Naruto” / “Ako always stimulate
po ay isang sangre” the independent
3. Paranoia decision making of
● Extreme suspiciousness the patient
● “You’re talking about me, aren’t you?” ○ Do not ask close-
4. Religiosity questions
○ Use supportive
● Obsession in religious ideas
confrontation-
● Exaggerated zeal to religion, obsessed with religion
acknowledge the
5. Phobia feelings, then
● Irrational fear motivate

ANXIETY AND ANXIETY-RELATED DISORDERS Modera ● Selective ● Redirect the

te attention patient to keep the
Anxiety ● The patient can still patient safe
→ Anxiety is the fear in the uncertainty of the unknown be redirected ● Oral anxiolytics
● Parasympathetic are given
→ GABA is responsible for the development of anxiety
stimulation
• ↓GABA will result in anxiety (this is an inhibitory (diarrhea, urinary
neurotransmitter) frequency, and
• Has a sedating effect on the brain salivation may
 occur)
• Gradually limit the performance of the ritual
● Perception o E.g., for the first week, you can check the door
becomes narrow 30 times then gradually reduce it per week until
and senses it can be removed
become decreased o Do not strictly stop it because it will cause a
panic attack
Severe ● Can no longer ● IM anxiolytics is • Cognitive-behavioral management
solve problems given o Cognition is your thoughts, your thoughts will
● Can no longer
always affect your behavior
complete tasks
● Cannot be
o Correction of the thoughts of the patients to
redirected promote a positive change in the behavior of
● Somatic the patient
manifestation- the o To manage the repetitive thoughts that will also
patient is already result in the management of the repetitive
experiencing actions
physical
manifestations of Phobic Disorder
anxiety- headache,
→ Social phobia- an irrational fear of socializing/
inability to walk
(this will subside interacting with other people or strangers
once anxiety also → Agoraphobia- an irrational fear of inescapable places
subsides, or if the • Avoid places or situations that might cause panic
patient has and make the person feel trapped, helpless, or
verbalized anxiety) embarrassed
● The manifestation → Specific phobia- all other phobias are under this type
the patient feels are • Claustrophobia (fear of closed spaces)
real
• Necrophobia (fear of dead people)
Panic ● Delusions (false ● Take control • Thanatophobia (fear of death/ dying)
beliefs) and ● Restraints if • Acrophobia (fear of heights)
hallucinations are needed → The defense mechanism is displacement
experienced at this • Releasing anger on a different person or object
level • E.g., a person who experienced something bad on
● Violence and top of a building can displace the intense feelings
suicide may occur to the location→ acrophobia (fear of heights)
here
→ Management
• Systematic desensitization- gradual exposure to
Generalized Anxiety Disorder the feared object
→ (+) Anxiety for more than six months that causes • The first step is to let the patient talk frequently
physical manifestations already about the fear
• The first day- show the patient an image with the
Anxiety-Related Disorders feared object
• On the second day- let the patient see the real
Obsessive-Compulsive Disorder object but at a distance
→ Obsessive- repetitive thoughts • Should gradually decrease in the distance until the
• The repetitive thoughts will result in the repetitive patient can hold the feared object
actions
→ Compulsive- repetitive actions Eating Disorders
• Ritualistic behaviors → Psychodynamics
• Ritualistic behavior is done to relieve the anxiety or • Mental harassment, antagonism
guilt • They think that they can obtain love from other
→ The defense mechanism is undoing people by being “physically attractive”
• Doing something to relieve the feelings of guilt → Sociocultural factors
→ Management • Developmental pressure (common in adolescent
• Allow the patients to perform the ritualistic group age)
behaviors (this will relieve the anxiety of the → Neurotransmitter
patient→ preventing anxiety attacks) • ↓Serotonin and epinephrine (also same with major
• Adjust the schedule of the patient, to give ample depression)
amount of time for the patient to perform his/her • Underlying depression may also manifest
ritualistic behaviors → Age group
 • Adolescents become more conscious of their body • If the patient requests to go to the bathroom,
image accompany the patient to the bathroom
• Tell the patient “do not close the door, I’ll be
Anorexia Nervosa Bulimia Nervosa
outside”

Perfectionist Hunger-anger cycle Psychotherapeutic Management

→ Self-monitoring
Hungry people tend to be • Allow the patient to keep a diary or journal
angry→ anger will lead to • Diary- more on record of events
binge-eating→ guilt o Diary of food intake
feelings→ purging- induce • Journal- a record of reflections and emotions
vomiting (binge-purge
o Relate the diary to the journal, let the client do
syndrome)
it by themselves
Self-restricted diet Hypokalemia (common o Allow the patient to identify a pattern to be able
complication d/t vomiting) to identify and relate their emotions to their
eating patterns
Compulsive exercising Vomitus (+) HCl→ tooth • E.g., on February 1, the patient only ate sky flakes
Invite the client for a walk if decay (the dominant feeling is sadness; therefore, food
they are having vigorous ● The HCl will destroy intake is few)
push-ups (distract the the tooth enamel o February 14, the patient ate 3 full meals with a
client) ● The dentist will be
midnight snack (the dominant feeling is
Do not let the client finish the the first to suspect
routine, the patient has not the presence of happiness)
been eating, and exercising bulimia nervosa, but o if they can control emotions, they can control
can cause the demise the psychiatrist will eating pattern
still do the
diagnosing Evaluation
→ Weight gain of 1-2 lbs./ wk. (not accurate criteria
Alopecia Can maintain normal body because weight gain of tall and short people differ)
weight
→ BMI (N: 18.5 - 24.9/25)- more accurate criteria
Anemia They may use enema or
laxatives in place of purging Medical Treatment
→ Antidepressant medications
Life-threatening- can cause Russel’s sign: teeth scarring • SSRIs- inhibits reabsorption of serotonin to
electrolyte imbalance on the knuckle/back of the maintain levels and prevent depression
(vigorous exercising and not hands because they put their
eating) hands in their mouth when PERSONALITY DISORDER
they induce purging → A pattern of behavior
• If these patterns of behaviors cause problems with
Nursing Diagnosis interpersonal relationships, they will not be called
→ Altered body image personality disorders
• Only used for people who underwent surgeries that
have affected their bodies e.g., mastectomy, Diagnosis
amputations → Adolescent (improve by the age 40-50 years old)
→ Body image disturbance Cluster A Cluster B Cluster C
• The problem is how a person perceives themselves
• Altered nutrition P-paranoid B- borderline A- avoidant
→ Electrolyte imbalance ● People who ● People with ● Avoids
• Life-threatening d/t hypokalemia→ cardiac arrest are very unpredictable responsibilities
• Short term goal suspicious mood
● Defense D- dependent
Priority should be the life-threatening and short-term goals– S- schizoid mechanism: ● Depend on
easily corrected ● People who splitting others for
are always ● Has a high decision-
aloof/alone tendency for making even
Interventions ● Low self- suicide or self- for very simple
→ Involve the patient in planning for them to know that confidence mutilation decisions
what they’re eating does not cause them to get fat ● They let others
→ Set time limit during meals for them to finish their food S- schizotypal A- antisocial decide for
→ Supervise client after eating ● Superstitious; ● Rule/lawbreak them
 Assessment
believes in ers
supernatural ● Defiant O- obsessive- → Assess the perception of the client to the event
powers compulsive • E.g., the death of a parent can lead to a crisis
● Wears a lot of H- histrionic personality → Presence of support system
ornaments and ● Attention- disorder → Coping mechanisms
jewelry (bric-a- seekers ● Perfectionist
brac) ● Use their body SCHIZOPHRENIA
to attract
→ Splitting of the mind or soul
attention
● Big,
→ Came for the Greek words schizein (splitting) and phren
exaggerated (diaphragm)
movements
(flamboyant) Criteria in Diagnosis of Schizophrenia (DSM-V)
→ DSM-V is the basis of psychiatrists basing on the past
N- narcissistic reports, behaviors of the patient to diagnose
● People who → Two or more of the following for at least one month
are self- • Hallucination
entitled
• Delusion
● Deny any
form of • Disorganized thinking
weakness/fai o Circumstantiality- the patient is providing too
lure many details and retains the original topic but
still answer the questions
Odd group Bad group Fearful group o Tangentiality- the patient is providing too many
● The strange ● Erratic group ● Fear rejection, details but not answering the question
and eccentric criticisms, and o Looseness of association- fragmented
group failure
thoughts
o Flight of ideas- rapid speech with the patient
jumping from one topic to another (there are
OCD- have rituals to relieve anxiety
OCPD- perfectionism
words similar in the sentences)
Antisocial- law breakers • Catatonic- induced immobility
Asocial- always alone and may be manifested in schizoid • Negative symptoms

Biologic Theory
Management: Behavioral management → Genetics: 1 parent diagnosed with schizophrenia
→ Roleplaying (15%); 2 parents (35%)
→ E.g., “Patient X, please dress up for an interview” the → Neuroanatomy: there is a decrease or less amount of
patient should be able to dress appropriately for the cerebrospinal fluid and brain tissue
situation and the patient should be able to react and act → Immunovirology: exposure to influenza in the 2nd
appropriately trimester of pregnancy will predispose the fetus to
→ Show how to respond without getting angry or how to schizophrenia
behave properly in front of other people → Neurochemistry:↑serotonin and ↑dopamine
Goal of Management Social Causation Hypothesis
→ Help the patient return to the community and establish → Low socioeconomic status
meaningful relationships • Low access to healthcare
• Nutrition is not adequate
Crisis intervention
→ The focus should be the present (here and now) Four As of Schizophrenia
• Gestalt therapy- focusing on the immediate → Autism- the absence of contact with reality
problems, needs, and feelings of the patient
• Alternate worlds are manifested in schizophrenia
• Allow the patient to grieve, give time for the patient
→ Ambivalence- two opposing feelings
to grieve
• Id- evil component
• If the patient denies help, still offer yourself “I will
• Superego- guilt feeling
leave you for a while but you can call me if you need
• Ego- balancer
anything”
• In schizophrenia, there is a splitting of the mind→
→ Not all people who undergo adventitious events develop
ego is not functioning well→ imbalance of the ID
a crisis. A crisis becomes a crisis when coping
and superego
mechanisms become ineffective
→ Associative looseness- fragmented thought
→ Abnormal affect
 • Schizophrenia usually manifests inappropriate Third Generation Depot Injection
affect
• Emotions are incongruent with the context of the Dopamine System Stabilizer Indication:
situation ● Balances the ● Patient is non-
• E.g., the patient is telling you something that is dopamine levels compliant
happy but is crying ● If dopamine is ● Memory lapses
increased it will ● Limited access to
Positive Signs decrease it, vice healthcare facilities
versa
→ Increase in the dopamine level→ Disturbances in the
Decanoate
thought process -Zole ● Given IM twice or
→ Hallucination Aripiprazole once a month
→ Delusion Brexpiprazole ● For the long-term
→ Disorganized thinking effect of a drug

Negative Signs
→ Increase in the level of serotonin→ problems with The patient is taking clozapine, which of the following is a
emotions positive sign of improvement?
→ Asociality- absence or lack of relationships a. Increased WBCs
b. Decreased platelets
(relationships with friends, family, romantic
c. Increased participation in activities
relationships)
→ Avolition- lack of motivation Rationale: clozapine is a second-generation antipsychotic
→ Anhedonia- lack of pleasure that manages the negative symptoms, asociality may
→ Alogia- lack of speech present→ if the patient starts to join activities, this is already
→ Abnormal affect- inappropriate affect/ incongruence a positive sign of improvement
between the emotion of the patient and the situation
→ Catatonia- induced immobility/ stuporous/ waxy Antipsychotic Medications Side Effects
flexibility → Photosensitivity
• Scaly skin presents d/t exposure to UV rays
Treatment Modality (Antipsychotics/ Neuroleptics) • Avoid direct sunlight
1st Generation 2nd Generation • Use umbrella, sunglasses, SPF 25 lotion
(Conventional) (Atypical) → Sedation
• Avoid driving or operating pieces of machinery
MOA: decrease the level of MOA: decrease the level of
dopamine dopamine but more
Anticholinergic Side Effects
serotonin
Manage the positive signs → Adrenergic effects→ SNS activation
Manage the negative signs → Constipation
-Zine • Instruct the client to increase fiber in the diet and
Chlorpromazine -Pine fluid intake
Thorazine Clozapine → Agranulocytosis (clozapine)
Fluphenazine Olanzapine • Monitor the WBCs of the patient
Haloperidol (Haldol)- high • Instruct the patient to report signs of infection–
potency antipsychotic -Done
fever or sore throat
medication Risperidone
● Used when there → Tooth decay and;
are command Two exemptions (these are → Dry mouth
hallucinations still first-generation • Hard sugarless candy to stimulate salivation and
already antipsychotics) prevent decay of the tooth
M- molindone → Orthostatic hypotension
If dopamine is decreased→ L- loxapine • Avoid sudden changes in position to prevent
pseudoparkinsonism may dizziness
present
→ Galactorrhea
Contraindicated to elderly • Secretions from the breast
(>65 years old) • Use cotton underwear to absorb these secretions
● The second Nursing instructions should be based on the side effects of
generation is given the medications.
to the elderly
Extrapyramidal Syndrome (EPS) Missed dose
→ Decrease in the level of dopamine → If <4 hours, take it ASAP
→ Common in first-generation antipsychotic medications → If >4 hours, skip the dose just take the medications the
(-zine, ML) day after
→ Dystonia- abnormal muscle contractions, → Make sure to take the drug at the same time to prevent
uncontrollable jerking side effects
• Dysphagia, drooling of saliva • E.g., the patient took the dose at 3 pm because
• Oculogyric crisis (upward deviation of the eyes) s/he forgot, then took the medication at 8 am the
• Torticollis (wry/ stiff neck) day after→ a severe decrease of dopamine→ EPS

• Drugs to Manage Acute Dystonia Prevention

○ Akineton (Biperidine) → Pillbox
○ Benadryl (diphenhydramine)
○ Cogentin (Benztropine) Suicide
→ Akathisia- the inability of the client to sit still; → 6% of those diagnosed with schizophrenia commit
restlessness suicide d/t hallucinations (command hallucinations)
• Propranolol is used to manage this
→ Pseudoparkinsonism- Parkinson-like symptoms: fine
tremors, unstable gait
• Amantadine (Symmetrel) is used for the
management of pseudoparkinsonism
→ Notify the physician if these symptoms show, but do not
discontinue the medication to avoid relapse
→ Antipsychotic medications should be taken regularly to
prevent relapse of symptoms
→ The physician will decide on how to manage EPS
(decrease the dose or shift to a second-generation
antipsychotic medication, or order medications to
counteract EPS)

Neuroleptic Malignant Syndrome (NMS)

→ Fever
→ Hypertension
→ Muscle rigidity
• Can lead to laryngospasm→ airway obstruction→
death
→ The most fatal side effect of antipsychotic medications
→ Nursing action: discontinue immediately to prevent
death
→ Management: muscle relaxant to counteract muscle
rigidity (Baclofen)
→ Prevention: hydrate the patient to avoid the SNS
stimulation that causes drying

Tardive Dyskinesia
→ Last side effect of antipsychotic medication
• Tardive- late
→ Only appears after months of taking the drug
• Irreversible once it appears
→ Tongue protrusion
→ Tongue twisting
→ Teeth grinding
→ Lip-smacking
→ Nursing action
• Notify the physician
• only discontinue medication if it leads to NMS
because it can lead to death
→ Management: valbenazine (ingrezza)