Schizophrenia Q 46
Yesterday, a client with schizophrenia began treatment with haloperidol (Haldol). Today, the nurse notices that the client is holding his head to one side and complaining of neck and jaw spasms. What should the nurse do?
A. Assume that the client is posturing.
B. Tell the client to lie down and relax.
C. Evaluate the client for adverse reactions to haloperidol.
D. Put the client on the list for the physician to see tomorrow.
Correct Answer: C. Evaluate the client for adverse reactions to haloperidol.
An antipsychotic agent, such as haloperidol, can cause muscle spasms in the neck, face, tongue, back, and sometimes legs as well as torticollis (twisted neck position). The nurse should be aware of these adverse reactions and assess for related reactions promptly. The extrapyramidal symptoms are muscular weakness or rigidity, a generalized or localized tremor that may be characterized by the akinetic or agitation types of movements, respectively. Due to the blockade of the dopamine pathway in the brain, typical antipsychotic medications such as haloperidol have correlations with extrapyramidal side effects.
Option A: Although posturing may occur in clients with schizophrenia, it isn’t the same as neck and jaw spasms. Due to potential side effects development, patients receiving haloperidol require monitoring, especially when receiving the intramuscular form. It can be easily monitored by taking blood levels. It has a therapeutic range of 2 to 15 ng/ml in serum. Blood levels should be monitored at 12-hour or 24-hour intervals or after the last dose of haloperidol use in a patient.
Option B: Having the client relax can reduce tension-induced muscle stiffness but not drug-induced muscle spasms. Since there is no specific antidote, supportive treatment is the mainstay of haloperidol toxicity. If a patient develops sign symptoms of toxicities, the clinician should consider gastric lavage or induction of emesis as soon as possible, followed by the administration of activated charcoal.
Option D: When a client develops a new sign or symptom, the nurse should consider an adverse drug reaction as the possible cause and obtain treatment immediately, rather than have the client wait. Since the drug can cause several side effects and related to several toxicities after initiation, the healthcare workers must be familiar with its pharmacology, signs symptoms of toxicity, and management of adverse effects. They must monitor their side effects and toxicities. A proper history and physical examination are necessary before the initiation of haloperidol in any patient.