A patient has not come out of her room for breakfast. The nurse finds the patient moving restlessly about her room in a disorganized manner

Question

The patient is talking to herself, and her verbal responses to the nurse are nonsensical and suggest disorientation. The nurse notices that the patient's skin is hot and dry, and her pupils are somewhat dilated. All these symptoms are significant departures from the patient's recent presentation. The patient is likely experiencing ________ , and the nurse should ___________. a. anticholinergic toxicity…check vital signs and prepare to use a cooling blanket stat
b. relapse of her psychosis…administer PRN antipsychotic drugs and notify her physician
c. neuroleptic malignant syndrome…contact her physician for a transfer to intensive care
d. agranulocytosis…hold her antipsychotic and draw blood for a complete blood count

Answer 1

A
Anticholinergic toxicity is due to excessive anticholinergic activity, typically from the use of multiple anticholinergic medications and/or sensitivity to anticholinergic medications. Symptoms include but are not limited to hyperpyrexia, elevated and unstable vital signs, a worsening of psychotic symptoms, hallucinations, delirium, hot and dry skin, erythema, and dilated pupils. Emergency cooling measures are indicated for hyperpyrexia. A simple relapse would not include the physical changes noted here. Neuroleptic malignant syndrome would include hyperpyrexia and marked motor stiffness (the patient would not be moving about her room) but would not include pupillary dilation. Agranulocytosis would present with symptoms suggesting infection, not the symptoms noted here.