Reference no: EM133882905

Assignment:

Nick is a 22-year-old man with a history of schizophrenia who is admitted to the inpatient psychiatric unit for psychosis. He has been nonadherent with his outpatient medication regimen and has developed auditory hallucinations of voices talking about "demons stalking him" and delusions that helicopters are following him. He smashed all the televisions in the house because he believed that the local news anchorwoman was broadcasting his location to the authorities. His mother, with whom he lives, called the police.

Nick has no past medical history other than schizophrenia. Basic metabolic panel, complete blood cell count, thyroid function tests, and urine analysis are normal. Urine toxicology is negative. When he arrives on the unit, he is started on risperidone 4 mg daily. Within the next 24 hours, nursing calls to request an urgent evaluation of the patient. He is circling the nursing station, appears anxious, and is having trouble speaking. Through clenched teeth he calls out, "My jaw is stuck!" His lower mandible is clenched, locked into position, and resists passive movement. His neck is slightly extended, and his eyes appear to be forcefully rolled in the direction of the upper right quadrant. He lacks rigidity in his upper or lower extremities.

Vital signs are taken for this patient. Nick's temperature is 98 °F, blood pressure is 125/82 mm Hg, pulse rate 88/min, respiratory rate is 18/min, and oxygen saturation is 98% on room air. Although it is difficult for him to speak, he is awake, alert, and oriented to person, place, time, and current situation. He is not diaphoretic. Diphenhydramine 50 mg is given intramuscularly. Within 20 minutes, Nick regains voluntary movement of his extraocular muscles and mandible. "Doctor, you are my hero!" he exclaims down the hallway.

Two days later, Nick is seen pacing the hallways. When brought into the interview room, he sits down momentarily and then quickly stands back up. He marches in place for the duration of the interview. He comments, "I'm so uncomfortable. I can't stay still."

1. What is the primary diagnosis for Nick?
2. What are the different medication-induced movement disorders that occur in a client on antipsychotics?
3. What is acute dystonia? What is the treatment modality for acute dystonia?
4. What is akathisia? Explain the possible symptom presentation for a client exhibiting akathisia.
5. What is the treatment recommendation for akathisia?
6. What is tardive dyskinesia? How will you treat tardive dyskinesia?
7. What are the possible risks and benefits of long-acting injectable antipsychotic medications?
8. As a PMHNP, how will you promote the client's medication compliance?