Psych Med Teaching PDF

NUR 239 Clinical Simulation: Patient Teaching, psychotropic medication In this clinical simulation, the instructor pretends to be a patient, known as a “standardized patient” to whom the student teaches about a psychotropic medication. The student enters the simulation prep room with only t...

NUR 239 Clinical Simulation: Patient Teaching, psychotropic medication In this clinical simulation, the instructor pretends to be a patient, known as a “standardized patient” to whom the student teaches about a psychotropic medication. The student enters the simulation prep room with only their rubric. Students must leave all personal belongings, books, handbags, bookbags, keys, cell phones, smart watches, extra garments, hats, etc. outside of the simulation room. Once in, students are allowed no talking. The student will draw one cards. The card contains the name of a psychotropic medication, its classification, and sub-classification (if pertinent). Students will receive a blank scratch paper, a pencil, and a calculator. Student takes these, along with their rubric, to a table in the room. Student may make notes on the teaching points for the medication they drew. The student must explain all of the critical points to the “client”. Medication Classification: ANTIANXIETY AGENT Sub-Classification: BENZODIAZEPINE IWIPE How does this medication works in the body? (Mechanism of action) moderates GABA to sedate the CNS What symptoms of anxiety disorder would a client have that improve with this medication? (Indications for use) reduces symptoms of anxiety (short-term management) o Improve quality of sleep, o lessen distractibility o reduced feelings of dread, o reduce physical symptoms of anxiety & frequency (can also be used for EtOH WD, pre-op sedation, and mgt of convulsions) How long does it take for this medication to take effect? 30 minutes CRITICAL Client EDUCATION ADVERSE REACTIONS ASSESSMENT (What the client should know & how the of benzodiazepines (what the RN should do, client should respond/manage if certain labs, assessments) reactions occur) do not abruptly stop taking, seizures/ physically addictive note that VS are WNL coma/death can result, potentially fatal withdrawal contact prescriber to supervise a taper take only as prescribed abuse-prone will feel euphoria at first, will go away don’t increase dose Potentially fatal respiratory depression if combined Monitor respirations Do not drink alcohol or take any other with alcohol or other CNS CNS depressing medications depressants  CRITICAL CLIENT EDUCATION SIDE EFFECTS of ASSESSMENT (What the client should know, & how the benzodiazepines (what the RN should client should respond/manage, if certain do, labs, assessments) effects occur) CNS depression = sedation/ assess to assure avoid hazardous activities until you lowered LOC, respirations adjust to medication uncoordinated gait/ataxia, assess alertness and contact prescriber to adjust dose if reduced respirations steadiness continues Caution w/ elderly: assess alertness and low doses if prescribed, watch for sedation or paradoxical steadiness accumulation excitement orthostatic BPs if orthostatic hypotension client has client Caution to change positions slowly symptoms ask client if this is Caution client to notify prescriber but Sexual dysfunction happening do not abruptly stop medications Important food and drug interactions No alcohol – use with alcohol can cause fatal respiratory depression No other CNS depressing medications Avoid grapefruit juice and caffeine Any other special precautions, contraindications, or other teaching points that should be included Treats client’s symptoms only, does not cure anxiety, only temporarily halts the feelings, is essential to participate in therapy to learn to manage anxiety and hopefully, won’t need medication avoid hazardous activity until adjust to effects do not abruptly stop taking – potentially fatal withdrawal do not give to others or run out unexpectedly If pregnant, drug may affect fetus, notify MD as may not be appropriate to prescribe If child bearing-aged female, advise to plan healthy pregnancy with MD after clinical condition is stable Medication Classification: ANTIANXIETY AGENT Sub-Classification: NON-BENZODIAZEPINE, buspirone IWIPE How does this medication work in the body? (Mechanism of action) Makes serotonin more available What symptoms of anxiety disorder would a client have that improve with this medication? (Indications for use) long-term management of anxiety symptoms, Less frequent and less intense symptoms of anxiety lessens feelings of dread improves distractibility and concentration improves sleep and promotes sense of calm and well-being How long does it take for this medication to take effect? About two weeks of routine dosing before is effective ADVERSE CLIENT EDUCATION CRITICAL ASSESSMENT REACTIONS (What the client should know, & how (what the RN should do, labs, non-benzodiazepine, the client should respond/manage, if assessments) buspirone certain reactions occur) Assess for symptoms of Self-monitor for symptoms Serotonin Syndrome: URGENT, potential fatal = Hold o diaphoresis next dose & get to MD/ urgent care/ ED right away Serotonin syndrome (or o  temp & pulse,  BP serotonin toxicity) Warn not to take other serotonin- o muscle rigidity/ boosting agents – always ask MD/ o hyperreflexia RN/ pharmacist before taking any other med, OTC agent, o agitation supplement, etc.… CLIENT EDUCATION SIDE EFFECTS CRITICAL ASSESSMENT (What the client should know, & non-benzodiazepine, (what the RN should do, labs, how the client should respond/ buspirone assessments) manage, if certain effects occur) dizziness, take w/ food Assess for symptoms and degree nausea, take at night of impairment headache move slowly until adjust Important food and drug interactions no caffeine, alcohol, or grapefruit products no other serotonin-boosting substances Any other special precautions, contraindications, or other teaching points that should be included Will not feel euphoria like initially with benzos, but med is working. Does not cause any cognitive impairment or withdrawal symptoms still need to work on managing anxiety through behavioral programs not addictive As with all meds that work on neurotransmission, do not abruptly stop taking - work with prescriber for taper to avoid feeling discontinuation syndrome. If child bearing-aged female, advise to plan healthy pregnancy after clinical condition is stable Medication Classification: ANTIANXIETY AGENT Sub-Classification: NON-BENZODIAZEPINE, hydroxyzine IWIPE How does this medication work in the body? (Mechanism of action) a histamine that suppresses some brain activity and produces skeletal muscle relaxation, bronchodilation, analgesia, & antiemetic effects What symptoms of anxiety disorder would a client have that improve with this medication? (Indications for use) prn use for less frequent and less intense physical feelings of anxiety temporary/ prn relief of mild anxiety symptoms, itching, allergic rx, as a hypnotic How long it takes for this medication to take effect? About 30 minutes ADVERSE CLIENT EDUCATION CRITICAL ASSESSMENT REACTIONS (What the client should know, & how (what the RN should do, labs, non-benzodiazepine, the client should respond/manage, if assessments) hydroxyzine certain reactions occur) For childbearing age For childbearing age females: females: o Warn of harm to fetus teratogenic o Assess for likelihood o Birth control is required/ of pregnancy recommended for child- o BHCG test bearing aged females CLIENT EDUCATION SIDE EFFECTS CRITICAL ASSESSMENT (What the client should know, & how the non-benzodiazepine, (what the RN should do, labs, client should respond/manage, if certain hydroxyzine assessments) effects occur) Frequent sips of water strict oral hygiene BID dry mouth, Assess for dry mouth, take at night if sedating sedation steadiness avoid hazardous activities and move slowly until adjust Important food and drug interactions? no caffeine, alcohol, grapefruit juice/products don’t take with other sedating medications What other precautions, contraindications, or teaching points should be included? Does not cure anxiety, only reduces the physical symtpoms of anxiety  Contraindicated in pregnancy Medication Classification: ANTIDEPRESSANT Sub-Classification: SELECTIVE SEROTONIN RE-UCLIENTAKE INHIBITOR, sertraline IWIPE How this medication works in the body (mechanism of action) Inhibits re-uptake of serotonin Used for mild to moderate depressions Symptoms of depression a client would have that improve with this medication (indications for use) Elevates mood Reduces preoccupation with negative, morbid or guilty thoughts Eventually reduces thoughts of self-harm stimulate renewed interest in ADLs / personal responsibilities, Improves concentration Promotes feeling of well-being and renewed interest in things formerly enjoyed Increases appetite, Reduces preoccupation with somatic complaints & pain, Promotes healthy sleep-wake cycle How long it takes for this medication to take effect? Weeks to see symptom relief, months for full effect CLIENT EDUCATION ADVERSE CRITICAL ASSESSMENT (What the client should know, and how REACTIONS (what the RN should do, labs, client should respond/manage, if certain SSRIs assessments) reactions occur) Assess for symptoms of Self-monitor for these symptoms Serotonin Syndrome: o diaphoresis URGENT, potential fatal = Hold next dose & get to MD/ urgent care/ ED right away Serotonin syndrome o  temp & pulse,  BP Warn not to take other serotonin-boosting o muscle rigidity/ agents – always ask MD/RN/ pharmacist o hyperreflexia before taking any other med, OTC agent, supplement, etc.… o agitation  CLIENT EDUCATION CRITICAL ASSESSMENT SIDE EFFECTS (What the client should know, and how the (what the RN should do, lab SSRI client should respond/manage, if certain tests, assessments) effects occur)  suicidality Assess suicidality (clients are Self-monitor suicidal ideation, is URGENT (especially with at greater risk when starting = report right away to prescriber or get to adolescent/young to feel better) MD/ ED adult) Assess for symptoms: Frequent sips of water, o dry eyes/blurred vision strict oral hygiene, anticholinergic o dry mouth empty bladder before meds & on schedule (can’t give if o urinary retention, throughout day glaucoma, BPH) o constipation,  fiber + daily exercise, o orthostatic hypotension, change positions slowly o sexual dysfunction report  libido to prescriber to fix Anorexia or GI Assess for symptoms Take with food upset Other laboratory tests, diagnostic procedures, and follow-up visits that may be required? Usually there is no routine monitoring unless there is a concern (may do liver/renal function tests to assure can metabolize/clear med) Important food and drug interactions No other meds or products that boost serotonin No alcohol or grapefruit products, avoid caffeine Any other special precautions or other teaching points that should be included? Typically, mood elevating Not a cure As with all meds that work on neurotransmission, do not abruptly stop taking - work with prescriber for taper to avoid feeling discontinuation syndrome. If child bearing-aged female, advise to plan healthy pregnancy with MD after clinical condition is stable Medication Classification: ANTIDEPRESSANT Sub-Classification: TRICYCLIC IWIPE How this medication works in the body (mechanism of action) blocks re-uptake of norepinephrine and some serotonin Used for moderate to more severe depressions (not for suicidal clients) Symptoms of depression a client would have that improve with this medication Elevates mood increases appetite, Reduces preoccupation with negative, stimulate renewed interest in ADLs / morbid or guilty thoughts personal responsibilities, Eventually reduces thoughts of self- reduces preoccupation with somatic harm complaints & pain Improves concentration promotes healthy sleep-wake cycle Promotes feeling of well-being and renewed interest in things formerly enjoyed How long does it take for this medication to take effect? Weeks to see symptom relief, months for full effect CLIENT EDUCATION ADVERSE CRITICAL ASSESSMENT (What the client should know, and how REACTIONS (what the RN should do, labs, client should respond/manage, if TCA assessment) certain reactions occur)  suicidality Assess suicidal ideation teach client self-monitor for  (MD won’t prescribe if fatal on overdose won’t suicidal ideation, treat as URGENT = concerned that client prescribe to suicidal clients report right away to prescriber/ is suicidal) urgent care/ ED  HR – dysrhythmias Assess VS Teach to self-monitor pulse & report (make TCAs fatal on Baseline and periodic EKGs irregularities to prescriber overdose) Self-monitor for symptoms Assess for symptoms of URGENT, potential fatal = Hold next serotonin syndrome: dose & get med care now Serotonin syndrome (not o agitation Warn not to take other serotonin- as frequent occurrence boosting agents, ask MD/RN/ RPh o diaphoresis w/ TCAs as it is with before taking other prescribed, OTC other antidepressants) o  T & HR, BP agents, supplements, etc., especially o muscle rigidity/ other antidepressants hyperreflexia  CLIENT EDUCATION CRITICAL ASSESSMENT SIDE EFFECTS (What the client should know, and (what the RN should do, lab TCA how the client should respond/ tests, assessments) manage, if certain effects occur) non-medicated, lubricating eye Assess for symptoms: drops Frequent sips of water, o dry eyes/blurred vision strict oral hygiene, anticholinergic o dry mouth (significant with TCAs - empty bladder before med & on o urinary retention, can’t give if glaucoma, schedule throughout day BPH) o constipation,  fiber + daily exercise, o orthostatic hypotension, change positions slowly o sexual dysfunction report  libido to prescriber to fix – don’t stop taking meds weight gain (reason many stop taking monitor BMI diet & exercise it) Important food and drug interactions No alcohol or grapefruit products, avoid caffeine & other stimulants (too much norepinephrine available) No other serotonin-boosting meds or products, especially other antidepressants unless cleared through prescriber Any other special precautions or other teaching points that should be included As with all meds that work on neurotransmission, do not abruptly stop taking - work with prescriber for taper to avoid discontinuation syndrome. take in AM if energizing, take @ HS if sedating If child bearing-aged female, advise to plan healthy pregnancy with MD after clinical condition is stable Not a cure Medication Classification: ANTIDEPRESSANT Sub-Classification: MONOAMINE OXIDASE INHIBITOR, selegiline IWIPE How this medication works in the body (mechanism of action) Inhibits monoamine oxidase (MAO) – prevents this enzyme from burning up residual norepinephrine, serotonin, and dopamine making these neurotransmitters more readily available Improves cell-to-cell neurotransmission MAO also metabolizes tyramine. When MAO is inhibited, tyramine builds up and causes hypertensive crisis. (Tyramine is an amino acid found in aged, processed, preserved, pickled, smoked, fermented, and cured foods) Used for moderate to severe depressions Symptoms this client has that should improve with this medication Elevates mood Reduces preoccupation with negative, morbid or guilty thoughts Eventually reduces thoughts of self-harm Promotes feeling of well-being and renewed interest in things formerly enjoyed increases appetite, stimulate renewed interest in ADLs / personal responsibilities, reduces preoccupation with somatic complaints & pain Improves concentration & promotes healthy sleep-wake cycle How long it takes for this medication to take effect Weeks to see depression symptom relief, months for full effect – must be patient CLIENT EDUCATION ADVERSE CRITICAL ASSESSMENT (What the client should know, and how REACTIONS (what the RN should do, labs, client should respond/manage, if certain MAOI assessments) reactions occur) Potential fatal Self-monitor BP, if  = hold med & get hypertensive crisis VS to prescriber, urgent care or MD (from tyramine Teach what tyramine is, how to avoid it build-up) & why (see food/drug interactions) Assess for symptoms: o agitation Self-monitor for symptoms o diaphoresis URGENT, potential fatal = Hold next Serotonin o  T,  HR, BP dose & get to MD, urgent care, ED right syndrome o muscle rigidity/ away hyperreflexia Warn not to take other serotonin- 5 week “wash-out” period boosting agents. before & after an MAOI  CLIENT EDUCATION SIDE EFFECTS CRITICAL ASSESSMENT (What the client should know, and how (what the RN should do, lab MAOI the client should respond/manage, if tests, assessments) certain effects occur) non-med, lubricating eye drops Assess for symptoms: Frequent sips of water, o dry eyes/blurred vision strict oral hygiene, o dry mouth empty bladder before meds & on anticholinergic o urinary retention, schedule throughout the day o constipation,  fiber + daily exercise o orthostatic hypotension, change positions slowly o sexual dysfunction report  libido to prescriber to fix – don’t stop taking meds Always is potential Assess suicidality Self-monitor suicidal ideation = report for suicidality (b/c right away to prescriber/ MD/ ED clients are at greater risk when starting to feel better) monitor baseline and periodic May depress thyroid TSH (may not do routinely – inform function only if clinically indicated) Important food and drug interactions tyramine-free diet no other serotonin-boosting agents No alcohol, grapefruit products Other laboratory tests, diagnostic procedures, and follow-up visits that may be required Liver & renal function may not be routinely monitored unless there is a concern Any other special precautions or other teaching points that should be included Not a cure If sedating, take at night As with all meds that work on neurotransmission, do not abruptly stop taking - work with prescriber for taper to avoid feeling discontinuation syndrome. If child bearing-aged female, advise to plan healthy pregnancy with MD after clinical condition is stable Medication Classification: MOOD STABILIZER Sub-Classification: LITHIUM OR LITHOBID IWIPE How this medication works in the body (mechanism of action) A salt that works on transport channels in and out of all cells to stabilize / improve neurotransmission. Influences serotonin, norepinephrine, acetylcholine, & dopamine. Symptoms of bipolar disorder, mania, a client would have that improve with this medication Treats manic episodes of BPAD; inhibits extremes of mood seen in mania, reduces racing thoughts, extremes of emotion, pressured speech, intrusiveness, irritability, impulsivity Improves the ability to concentrate, communicate, and process information Promotes feeling more in control and better able to express self; promotes healthy sleep pattern How long it takes for this medication to take effect takes a few weeks to adjust to right dose to start to see symptoms relief, months before can evaluate full effectiveness, doses are established over first few weeks factoring in client’s daily fluid and salt intake + watching for symptom control without untoward effects, must be patient to achieve & maintain thx serum level before knowing if dose is appropriate. ADVERSE CRITICAL ASSESSMENT (what CLIENT EDUCATION REACTIONS the RN should do, labs, (What the client should know, and how Lithium assessments) client should respond, if reactions occur) monitor lithium level: take doses same time QD lithium toxicity o thx level = 0.5 to 1.5 mEq/L Explain relationship between lithium: o draw 12 hours after last dose, body water: sodium = to avoid concentrating/diluting lithium levels o frequently at first, up to Q 3-6 Don’t change habits for I & O of sodium months once stabilized or fluids assess symptoms toxicity: No laxatives or diuretics o V/D Self-monitor toxicity symptoms = o Drowsiness URGENT! = permanent kidney damage & can be fatal. STOP dose, get to MD/ o Muscle weakness/  urgent care/ ED stat coordination Self-monitor consistent urine output o Slurred speech (drug excreted exclusively thru kidneys) I & O while titrating dose UOP must average ____/hour to clear Renal function tests, routinely medication electrolytes routinely Keep consistent sodium intake  ADVERSE CRITICAL ASSESSMENT (what CLIENT EDUCATION REACTIONS the RN should do, labs, (What the client should know, and how Lithium assessments) client should respond, if reactions occur) For child-bearing age women: Assess for likelihood of For child-bearing age women: teratogenic Warn of harm to fetus pregnancy Birth control is usually mandatory BHCG at baseline & prn Unmasks Self-monitor for any noticeable Brugada EKG baseline and periodically dysrhythmia, report to prescriber Syndrome CRITICAL CLIENT EDUCATION SIDE EFFECTS ASSESSMENT (RN should do, lab (What the client should know, how client should Lithium tests, assessments) respond/manage, if certain effects occur) often diminishes over time Fine hand tremor assess may prescribe propranolol often diminishes over time acne assess vigilant skin care often diminishes over time Nausea/metallic taste assess take dose with food sugar-free mints, sips of water, strict oral hygiene often diminishes over time maintain habitual I & O & sodium intake - same as Polyuria/polydipsia assess when dose was established, know  or  could influence serum lithium levels Weight gain assess monitor Kcal/nutritional intake, daily exercise Suppresses thyroid TSH monitoring keep client’s appointment for lab work function Important food and drug interactions no laxatives or diuretics avoid alcohol, grapefruit products Any other special precautions or other teaching points that should be included pay attention to daily I & O and keep as stable as possible not a cure take w/ food to reduce nausea As with all meds that work on neurotransmission, do not abruptly stop taking - work with prescriber to discontinue Contraindicated in pregnancy. Birth control required for women of child-bearing age. Medication Classification: MOOD STABILIZER Sub-Classification: ANTICONVULSANT – valproic acid IWIPE How this medication works in the body (mechanism of action) Depresses CNS and inhibits “kindling” process. (Kindling is phenomenon where hypersensitive areas of the brain erupt in erratic activity without any provocation like seizures or, in our application for psychiatric disease, extreme emotional states like mania seen in BPAD). Some anticonvulsants commonly used for mood stabilization (valproic acid and topiramate) increase levels of inhibitory neurotransmitter GABA. Symptoms of mania a client with BPAD would have that improve with this medication Inhibits impulsivity, extremes of mood (like mania) and flights into extreme emotional states (like rages) reduces racing thoughts, pressured speech, intrusiveness, irritability, impulsivity Improves the ability to concentrate, communicate, and process information Promotes feeling more in control and better able to express self Promotes healthy sleep pattern How long it takes for this medication to take effect Sedative effects felt within 30 minutes, but weeks to achieve mood stabilization ADVERSE CLIENT EDUCATION REACTIONS (What the client should know, CRITICAL ASSESSMENT (what the Anticonvulsants and how client should respond/ RN should do, labs, assessments) used as mood manage, if certain reactions stabilizers occur) Self-monitor for skin rash. Stevens-Johnson Assess for skin rash IMPORTANT = hold med and syndrome get to MD soon Liver function tests at baseline and Teach importance to keep hepatotoxicity periodically appointments for tests Some are Child-bearing age women: Child bearing age women: teratogenic BHCG at baseline and periodic Inform & take birth control Serum drug levels (may not obtain Teach importance to keep Drug toxicity levels for each one of these appointments for tests anticonvulsants)  ADVERSE CLIENT EDUCATION REACTIONS (What the client should know, CRITICAL ASSESSMENT (what the Anticonvulsants and how client should respond/ RN should do, labs, assessments) used as mood manage, if certain reactions stabilizers occur) CBC at baseline and periodic & assess lab values and symptoms:  WBC = 4,000 to 11,000, assess s/s Self-monitor for symptoms of Blood dyscrasias of infection blood dyscrasias, hold med and ( WBC,  RBC = 4.5 to 5.7, assess  contact prescriber quickly if  RBC, & oxygenation (SOB, dizzy, chest pain, symptomatic.  plts) anemia)  platelets = 150,000 to 400,000, assess for signs/symptoms of bleeding. SIDE EFFECTS CRITICAL ASSESSMENT CLIENT EDUCATION Anticonvulsants (what the RN (What the client should know, and how used as mood should do, lab tests, the client should respond/manage, if stabilizers assessments) certain effects occur) Sedation Take at night, safety precautions Assure blood components dizziness May diminish with time, use caution aren’t low N/V Take with food Depletes vitamin B12 May monitor levels Educate vitamin B-rich foods. & folate Vitamin supplementation indirectly increases Teach measures for cardiac health homocysteine levels Important food and drug interactions No grapefruit products or alcohol No anti-coagulant meds or aspirin Any other special precautions or other teaching points that should be included Do not abruptly stop, will feel very ill Not a cure If sedating, take at HS Contraindicated in pregnancy. Birth control required for women of child-bearing age. Medication Classification: ANTIPSYCHOTICS IWIPE How this medication works in the body (mechanism of action) Dopamine antagonists older (“conventional” or “1st generation” medications have broad effect and more adverse effects, than the newer - “atypical” or “2nd” & “3rd” generation- medications which are more precise with fewer adverse effects) Symptoms of schizophrenia a client has that improve with this medication (indications for use) Makes thinking clearer and reduces delusions Promotes reasoning and more rational interpretation of sensory input and reduces hallucinations Improves ability to express self and to understand others Improves concentration, judgment, & insight Decreases tension, anger, and feelings of fear/ suspiciousness Helps control unusual behaviors and irrational/odd mood responses How long it takes for this medication to take effect Some conventionals, like haloperidol, have sedative effects w/in 30 min For psychotic symptoms relief, takes a couple of weeks to start to see symptom relieve but up to a few months to evaluate full effectiveness CLIENT EDUCATION ADVERSE CRITICAL ASSESSMENT (What the client should know, and REACTIONS (what the RN should do, labs, how client should respond/manage, Antipsychotics assessments) if certain reactions occur) assess VS Assess symptoms: Self-monitor symptoms = Neuroleptic o diaphoresis EMERGENCY (can be fatal): STOP malignant syndrome o  temp,  pulse,  BP med & get to MD, Urgent Care, ED (can be fatal) o muscle rigidity/ stiffness right away o confusion/delirium Use AIMS to assess abnormal, tardive dyskinesia uncontrollable movement of face, Self-monitor symptoms. URGENT mouth (chewing movements), (can be permanent) = hold dose (is irreversible) tongue (thrusting), neck (twisting) and contact prescriber right away muscles. Self-monitor symptoms of CBC: WBC @ 4,000 to 11,000 infection. URGENT (can be fatal) = agranulocytosis baseline and periodic if symptoms, no more doses until Assess symptoms infection get to MD, Urgent Care, ED right away  dysrhythmias EKG monitoring inform CLIENT EDUCATION ADVERSE CRITICAL ASSESSMENT (What the client should know, and how REACTIONS (what the RN should do, labs, client should respond/manage, if certain Antipsychotics assessments) reactions occur) Metabolic monitoring every 3 months: nutrition (low fat, low carb, high fiber) Metabolic syndrome o Lipid panel (cholesterol, HDL, daily exercise (prediabetes & LDL, triglycerides) watch weight cardiovascular disease) o Blood sugar (BG, Hgb A1c) o BMI & waist circumference CRITICAL ASSESSMENT (what CLIENT EDUCATION SIDE EFFECTS the RN should do, lab tests, (What client should know, how client should Antipsychotics assessments) respond/manage if effects occur) extra pyramidal symptoms Assess symptoms: Self-monitor for symptoms & contact o dystonia Akathisia prescriber (May add benztropine for o akathisia Pseudoparkinsonism – pseudoparkinsonism, may add propranolol o pseudo- Acute dystonia – for akathisia, or change dose or med) parkinsonism non-med, lubricating eye drops Assess for symptoms: Frequent sips of water, o dry eyes/blurred vision strict oral hygiene BID, o dry mouth empty bladder before meds & on schedule Anticholinergic o urinary retention, thereafter o constipation,  fiber + daily exercise, o orthostatic hypertension, change positions slowly o sexual dysfunction report  libido to prescriber to fix – don’t stop taking meds  prolactin levels ✓ prolactin levels if symptomatic: Self-monitor & report to prescriber gynecomastia, lactation, discomfort, Important food and drug interactions no alcohol or grapefruit products check w/ prescriber or pharmacist before taking any other meds or OTC remedies Other laboratory tests, diagnostic procedures, and follow-up visits that may be required liver function tests are often monitored, renal may be monitored if clinically indicated Any other special precautions or other teaching points that should be included Photosensitivity Can lower seizure threshold Not a cure Long acting injectable forms available for some antipsychotics - improve compliance For all meds that work on neurotransmission, do not abruptly stop - work with prescriber for taper to avoid feeling discontinuation syndrome.  If child bearing-aged female, work with MD to plan healthy pregnancy after condition is stable