Nursing Process Focus: Patients Receiving Haloperidol (Haldol) Assessment Potential Nursing Diagnoses Prior to administration: Anxiety, related

d to disease process Assess for hallucinations and the level of Risk for Injury, related to drug effects consciousness both initially and throughout Deficient Knowledge, related to drug action drug therapy. and side effects Obtain a complete health and psychological Ineffective Therapeutic Regimen history especially in regards to Management cardiovascular and neurological disorders. Include blood studies such as CBC, liver enzymes, and electrolytes and obtain an EKG. Obtain the patients drug history to determine possible drug interactions and allergies. Planning: Patient Goals and Expected Outcomes Patient will: Report decreased symptoms of psychosis. Demonstrate an understanding of the drugs action by accurately describing drug side effects and precautions, and measures to take to decrease any side effects. Immediately report side effects and adverse reactions. Adhere to a medication regimen. Implementation Interventions and (Rationales) Patient Education/Discharge Planning *Monitor for EPS and NMS. Medications may Teach patient and family: be available to treat EPS. (Presence of EPS To recognize tardive dyskinesia, dystonia, may be sufficient reason for patient to akathesia, pseudoparkinsonism. discontinue medication; NMS is life To recognize and seek treatment threatening and must be reported and treated immediately for elevated temperature, unstable immediately.) blood pressure, profuse sweating, dyspnea, muscle rigidity, and incontinence. *Observe for seizures. Use with caution in Teach patient/family: patients with pre-existing seizure disorders. That seizures may occur. (Haloperidol decreases seizure threshold.) Safety precautions in case a seizure does occur. *Observe for side effects such as severe Instruct the patient: drowsiness, dizziness, lethargy, headaches, To report side effects. blurred vision, skin rash, diaphoresis, Do not drive or operate dangerous machinery nausea/vomiting, anorexia, diarrhea, and when taking the medication. menstrual irregularities. *Monitor for anticholinergic side effects such Teach patient and family: as dry mouth, constipation, and urinary Measures to relieve symptoms such as retention. sugarless hard candy or gum and frequent drinks of water for dry mouth; increased

*Monitor for adverse reactions, including hypotension (use of anti-psychotics causes lowering of blood pressure) OR hypertension (occurs with overdosage), EKG changes, leukopenia, jaundice, altered liver function tests. *Monitor patients lab tests, observing for leukopenia. *Monitor for alcohol/illegal drug use. (Patients may decide to drink alcohol, so will stop taking the haloperidol. These substances will have an additive CNS depressant effect.) *Discourage caffeine use.

fluids, fruits and vegetables for constipation; To notify the health care provider if urinary retention occurs. Inform patient/family: That routine lab studies (haloperidol levels, CBC, liver function tests, etc.) and other exams must be done. To change position slowly, in case hypotension occurs, to prevent injury.

*Caution the patient to refrain from taking illegal drugs and alcohol.

*Caution the patient that combining caffeine with haloperidol will decrease the effectiveness of the drug and likely increase anxiety. *Monitor for cardiovascular changes, Teach patient: including hypotension, tachycardia, and EKG That dizziness and falls, especially upon changes. (Haloperidol has fewer cardiotoxic sudden position changes, may indicate CV effects than other antipsychotics, and may be changes. preferred for patient with existing CV Safety measures. problems.) To have regular medical follow-up. *Use with caution in elderly patients. (Older Teach patient/family: patient may have unusual adverse reactions. To observe for unusual reactions such as They need lower doses and a more gradual confusion, depression and hallucinations and dosage increase. Elderly women are at greater to report them immediately. risk for developing tardive dyskinesia.) To observe for symptoms of tardive dyskinesia and report them as soon as they occur. *Encourage smoking cessation. (Heavy *Advise patient to decrease or discontinue smoking causes decreased metabolism of smoking; refer to smoking cessation classes if haloperidol, and therefore decreased efficacy.) desired. Evaluation of Outcome Criteria Evaluate the effectiveness of drug therapy by confirming that patient goals and expected outcomes have been met (see Planning).