Question

Multiple-choice question: Th e nurse is caring for a hospitalized patient who has been taking haloperidol (Haldol) for 3 days. To assess the patient for NMS, the nurse should assess the patient’s: Exercise 3.41 A. Blood pressure B. Serum sodium level C. Temperature D. Weight

Short answer

C. Temperature

Step-by-step solution

Understanding NMS and its symptoms

Neuroleptic Malignant Syndrome (NMS) is a potentially life-threatening condition that can occur following treatment with antipsychotic drugs. It is characterized by a mixed picture of symptoms including hyperthermia (high body temperature), autonomic dysregulation, altered mental status and generalized muscle rigidity.

Mapping symptoms to the options

Among the options provided(A. Blood pressure, B. Serum sodium level, C. Temperature, D. Weight), the symptom specific to NMS is hyperthermia which relates to the increased body temperature. Therefore, to assess for NMS in a patient taking haloperidol, the patient's temperature should be checked.

Key concepts

Neuroleptic Malignant Syndrome

Neuroleptic Malignant Syndrome (NMS) is a severe reaction to antipsychotic medications, known for its potential to become life-threatening if not promptly recognized and treated. It emerges as an idiosyncratic response—meaning it occurs unpredictably and not as a result of medication dosage.

When assessing for NMS, healthcare providers look for a range of symptoms. These include severe muscle rigidity, fever, fluctuating blood pressure, and changes in mental status such as confusion or agitation. NMS often occurs within the first two weeks of starting an antipsychotic medication, or after a dosage increase. However, it can happen at any time, even after long-term use.

Understanding NMS is crucial in clinical settings, particularly for nurses and doctors who manage patients receiving antipsychotic medications. Prompt detection and intervention can significantly reduce the risks of complications.

Antipsychotic Drugs

Antipsychotic drugs are a class of medication primarily used to manage psychosis, including delusions, hallucinations, or disordered thought that can occur in conditions like schizophrenia and bipolar disorder. However, they're also used for other mental health issues sometimes.

These medications work by affecting neurotransmitters in the brain, such as dopamine, to help stabilize mood and reduce psychotic symptoms. While they can be life-changing in their benefits, antipsychotic drugs carry a risk of side effects, one of the most serious being the induction of Neuroleptic Malignant Syndrome.

Common Antipsychotic Medications:

• First-generation antipsychotics (e.g., haloperidol)
• Second-generation antipsychotics (e.g., risperidone, olanzapine)

Each of these has different risk profiles and mechanisms of action, making patient monitoring a critical component in their administration.

Haloperidol

Haloperidol, sold under the brand name Haldol among others, is a first-generation antipsychotic drug. It's frequently used to treat conditions like schizophrenia, acute psychosis, and to control tics and vocal utterances in Tourette syndrome.

As with other antipsychotic drugs, haloperidol's main action is to block dopamine receptors in the brain, which can help lessen psychotic symptoms. However, due to its potency and dopamine blockade, it carries a higher risk for extrapyramidal side effects and NMS than some other newer antipsychotic medications.

Healthcare providers need to monitor patients closely for early signs of NMS when initiating treatment with haloperidol, especially in the first few days to weeks, or when increasing the dosage. Familiarity with the patient's baseline health status, including their normal body temperature, is essential for early detection of NMS.

Hyperthermia

Hyperthermia refers to an abnormally high body temperature, which is a medical emergency. It's one of the hallmark signs of Neuroleptic Malignant Syndrome, resulting from the body's reaction to antipsychotic medication, and is distinct from fever, which is caused by an infection-triggered immune response.

In the setting of NMS, hyperthermia is often accompanied by muscle rigidity and other autonomic disturbances, which can include alterations in heart rate and blood pressure. Hyperthermia can lead to complications such as dehydration, muscle breakdown (rhabdomyolysis), and organ failure, hence why continuous monitoring of temperature is critical in patients who are at risk for NMS.

Management of hyperthermia involves immediate cessation of the offending drug, supportive care, and sometimes the use of medications that can help relax muscles and reduce fever. Early intervention is key to preventing serious outcomes associated with this condition.