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Difficulty: HardPharmacological and Parenteral Therapies

An adult client with a history of schizophrenia is brought to the emergency department from a residential care facility. The client exhibits "lead-pipe" muscle rigidity, a core body temperature of 104.2∘F104.2^\circ\text{F} (40.1∘C40.1^\circ\text{C}), profuse diaphoresis, and a fluctuating level of consciousness. The client's daily medication regimen includes haloperidol and fluoxetine. Based on this clinical presentation, which of the following nursing actions should be prioritized? (Select all that apply.)

  1. Withhold all scheduled doses of haloperidol and notify the healthcare provider immediately.Answer
  2. Prepare to administer intravenous dantrolene sodium as prescribed.Answer
  3. Initiate active external cooling measures such as cooling blankets and ice packs.Answer
  4. D
    Delegate the ongoing assessment of the client's vital signs and neurological status to the unlicensed assistive personnel (UAP).
  5. E
    Administer the scheduled dose of haloperidol to rapidly manage the client's altered mental status and severe agitation.
  6. F
    Administer prescribed intravenous emergency medications via secondary piggyback into the client's continuous total parenteral nutrition (TPN) line.

Answer

The correct actions are to withhold all scheduled doses of haloperidol, prepare to administer intravenous dantrolene sodium, and initiate active external cooling measures.
Neuroleptic malignant syndrome (NMS) is a rare but life-threatening pharmacological emergency caused by antipsychotic medications (like haloperidol). It is characterized by severe autonomic instability, extreme hyperpyrexia, altered mental status, and 'lead-pipe' muscle rigidity. The immediate nursing and medical priorities are discontinuing the offending medication, administering specific antidotes such as dantrolene (a muscle relaxant) to halt the muscular hypermetabolism, and aggressively treating the hyperpyrexia with external cooling measures.

Step-by-Step Solution

1
Analyze the client's clinical presentation and medication history.
The combination of haloperidol use, lead-pipe rigidity, extreme hyperpyrexia, and autonomic instability identifies Neuroleptic Malignant Syndrome (NMS).
Recognizing the specific toxidrome is required to implement the correct pharmacological and physiological interventions.
2
Determine the immediate pharmacological priorities.
The offending drug (haloperidol) must be stopped immediately, and specific antidotes/relaxants (dantrolene) must be prepared.
Continuing the causative agent will worsen the life-threatening reaction, while dantrolene directly counteracts the extreme muscle contraction.
3
Identify physiological safety and supportive care needs.
External cooling is required for hyperpyrexia, the RN must maintain direct assessment of the unstable client, and safe IV administration rules (avoiding the TPN line) must be upheld.
Supportive care prevents mortality in NMS, and strict adherence to scope of practice and IV compatibility ensures patient safety during an emergency.

Key Concept

Pharmacological Management of Neuroleptic Malignant Syndrome (NMS) and Intravenous Safety
Estimated Time:1m 30s
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Topics

Pharmacological and Parenteral Therapies

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