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Difficulty: HardChemical and Other Dependencies / Substance Use Disorders

Following a total knee arthroplasty, a 68-year-old client is recovering on the surgical unit. Review of the electronic health record reveals a home regimen of high-dose clonazepam that was inadvertently not continued postoperatively. At 48 hours post-admission, the client develops profound disorientation, coarse bilateral tremors, profuse diaphoresis, and a resting heart rate of 124 beats/min. Which action should the nurse take first?

  1. A
    Provide the prescribed as-needed intravenous haloperidol to manage the acute agitation.
  2. B
    Ask a nursing assistant to remain continuously at the bedside to prevent falls.
  3. C
    Explain to the family that transient cognitive changes are a normal response to anesthesia in older adults.
  4. Implement strict seizure precautions and urgently contact the healthcare provider.Answer

Answer

Implement strict seizure precautions and urgently contact the healthcare provider.
The client is exhibiting classic signs of acute benzodiazepine withdrawal, including profound disorientation, coarse tremors, diaphoresis, and tachycardia. Because clonazepam is a benzodiazepine, its abrupt cessation places the client at high risk for life-threatening withdrawal seizures. The nurse's immediate priority is to ensure client safety by implementing seizure precautions and contacting the healthcare provider to obtain a prescription for a benzodiazepine replacement or taper.

Step-by-Step Solution

1
Analyze the client's medication history and current clinical presentation.
The client has abruptly stopped taking high-dose clonazepam (a long-acting benzodiazepine) and is exhibiting profound autonomic hyperactivity and disorientation 48 hours later.
Identifying the timeline of medication cessation is critical to determining the underlying etiology of the new-onset symptoms.
2
Recognize the specific withdrawal syndrome.
The hyperadrenergic symptoms and altered mental status indicate severe acute benzodiazepine withdrawal.
Abrupt discontinuation of long-acting benzodiazepines classically produces severe withdrawal symptoms that peak 2 to 4 days after the last dose.
3
Determine the highest priority complication and the required nursing intervention.
The client is at imminent risk for status epilepticus, making safety and medical intervention the immediate priorities.
Life-threatening seizures are the most severe complication of benzodiazepine withdrawal, requiring immediate environmental safety measures (seizure precautions) and medical intervention (resumption of a benzodiazepine or equivalent taper).

Key Concept

Clients abruptly discontinuing benzodiazepines are at high risk for life-threatening withdrawal seizures, necessitating immediate seizure precautions and prompt medical management.
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Topics

Chemical and Other Dependencies / Substance Use Disorders

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