A patient diagnosed with schizophrenia is very disturbed and ...

[Sufayan.ah]

A patient diagnosed with schizophrenia is very disturbed and violent. After several doses of haloperidol (Haldol), the patient is calm.
 
  Two hours later the nurse sees the patient's head rotated to one side in a stiff position, the lower jaw thrust forward, and drooling. Which problem is most likely?
 
  a. An acute dystonic reaction
  b. Tardive dyskinesia
  c. Waxy flexibility
  d. Akathisia

Question 2

An acutely violent patient diagnosed with schizophrenia receives several doses of haloperidol (Haldol). Two hours later the nurse notices the patient's head rotated to one side in a stiffly fixed position, the lower jaw thrust forward, and drooling.
 
  Which intervention by the nurse is indicated?
 
  a. Administer diphenhydramine (Benadryl) 50 mg IM from the PRN medication administration record.
  b. Reassure the patient that the symptoms will subside. Practice relaxation exercises with the patient.
  c. Give trihexyphenidyl (Artane) 5 mg orally at the next regularly scheduled medication administration time.
  d. Administer atropine sulfate 2 mg subcut from the PRN medication administration record.

[bigsis44]

Answer to Question 1

ANS: A
Acute dystonic reactions involve painful contractions of the tongue, face, neck, and back. Opisthotonos and oculogyric crisis may be observed. Dystonic reactions are considered emergencies requiring immediate intervention. Tardive dyskinesia involves involuntary spasmodic muscular contractions that involve the tongue, fingers, toes, neck, trunk, or pelvis. It appears after prolonged treatment. Waxy flexibility is a symptom seen in catatonic schizophrenia. Internal and external restlessness, pacing, and fidgeting are characteristics of akathisia.

Answer to Question 2

ANS: A
Diphenhydramine, trihexyphenidyl, benztropine, and other anticholinergic medications may be used to treat dystonias. Swallowing will be difficult or impossible; therefore, oral medication is not an option. Medication should be administered immediately, so the intramuscular route is best. In this case, the best option given is diphenhydramine.