Question

Scenario 2

Nurse M. is caring for a 73 year old male Patient Joe. Joe was admitted for observation for an acute epileptic seizure. His medical history also includes Parkinson’s disease and Schizophrenia.

When reconciling his medications Nurse M. notes that Patient Joe is taking the following medications:

carbamazepine (tegretol) 600 mg by mouth twice a day (BID)

carbidopa/levodopa (sinemet) 25/100 by mouth twice a day (BID)

haloperidolo (haldol) 1mg by mouth twice a day (BID)

The patient has been depressed due to the development of abnormal movements-chewing motion, lip smacking, tongue protrusion and twisting movements of upper and lower extremities.

1. a) What do you interpret to be the main issue? b) How could this contribute to his seizure?

2. What can be done for the extrapyramidal symptoms (EPS) that Patient Joe is experiencing?

3. What patient teaching could enhance life for patient Joe?

Answer 1

1. Extrapyramidal symptoms happened because of adverse effect of Haldol . Tardive dyskinesia is the terminology.

One more extra pyramidal symptoms includes Neuromalignant syndrome which includes seizures. Carbamazepine adverse effect also presents Neuromalignant syndrome. Usage of carbamazepine in this case need to be investigated whether it is really needed or not.

2. Exyrapyramidal system is a neural network involved in motor function and coordination. They are located in basal ganglia. they need dopamine for their function. First generation antiphyshotics block dopamine by binding to dopamine receptors and cause the above symptoms. Switching on to 2nd generation antiphychotics doesnot block the dopamine receptors and provide dopamine to basal ganglia to function. Any dosage correction need to be made. or any change of medicines need to done .

3. Referring to neurologist for further assesment. Educating the patient on the side effects of the drugs and when to report to doctor. Clozapine can help this case. Anticholinergics and Dopamine agonists can be prescribed to improve the patient life.

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