A patient with schizophrenia is admitted to the psychiatric unit in an acutely disturbed, violent state. He is given several doses of haloperidol (Haldol) and becomes calm and approachable
During rounds the nurse notices the patient has his head rotated to one side in a stiffly fixed position. His lower jaw is thrust forward and he appears severely anxious. The patient has _________ , and the nurse should _________. a. a dystonic reaction…administer PRN IM benztropine (Cogentin)
b. tardive dyskinesia…seek a change in the drug or its dosage
c. waxy flexibility…continue treatment with antipsychotic drugs
d. akathisia…administer PRN diphenhydramine (Benadryl) PO
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, and the primary intervention is administration of an antiparkinsonian agent IM (due to impaired swallowing). Tardive dyskinesia involves involuntary rhythmic muscular contractions that involve the tongue, fingers, toes, neck, trunk, or pelvis that usually appear after extended treatment and do not respond to antiparkinsonian drugs. Waxy flexibility is a form of catatonia wherein the patient will remain in whatever position he is placed in for extended periods. Akathisia is psychomotor restlessness, often presenting as pacing and an inability to remain at rest.
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