How to write a nursing clinical Journal Reflection (Answered)
The benefits of antipsychotics are sometimes obscured by their adverse effects that range from minor tolerable issues to unpleasant and life-threatening issues. Examples include minor issues like dry mouth or mild sedation to unpleasant issues like akathisia and sexual dysfunction (Balon, 2019). Primary Mental Health Nurse Practitioners (PMHNP) should perform risk-benefit analysis before prescription of drugs. In this discussion, I reflect on some of the side effects observed in my patients and the strategies used to address the side effects.
Akathisia/Tremors
Akathisia is a common side effect characterized by subjective and objective psychomotor restlessness. I have observed many patients develop this side effect, especially during the early days of treatment with antipsychotics like clozapine and aripiprazole. The primary intervention for such patients involves the prescription of centrally acting beta-adrenergic antagonists like propranolol (Stroup & Gray, 2018). In all patients that I have managed, the use of this medication helps. However, I have observed some patients develop hypotension and bradycardia when using beta-blockers.
EPS/TD
Extrapyramidal symptoms refer to drug-induced movement disorders that result from the use of dopamine-receptor blocking agents (Stroup & Gray, 2018). Examples include dystonia, akathisia, parkinsonism, and tardive dyskinesia. During my clinical practice, I have observed patients with schizophrenia develop these symptoms, especially those using risperidone. In patients with dystonia, switching medication from typical first-generation antipsychotic to atypical antipsychotic usually helps (Goldberg & Ernst, 2018). I have also provided prophylaxis benztropine for high potency antipsychotics like haloperidol.
Weight Gain
Many antipsychotic medications are associated with weight gain that can be managed using pharmacologic and nonpharmacologic interventions. I have observed weight gain issues mostly in adolescent patients with schizophrenia. Medications like clozapine, olanzapine, and aripiprazole are observed to cause weight gain in patients (Balon, 2019). My primary intervention includes encouraging patients to exercise and use dietary modification. Secondly, switching between medications like olanzapine to aripiprazole has greatly produced results in many patients. For those with chronic weight gain issues, I have used medications like metformin to improve insulin resistance that prevents metabolic conditions like diabetes.
Metabolic Syndrome
Antipsychotic use can be associated with weight gain, lipid disturbance, and glucose dysregulation that contribute to the development of the metabolic syndrome (Balon, 2019). The first strategy that I have used to manage metabolic syndrome is switching medications with a lower risk of metabolic problems (Goldberg & Ernst, 2018). Metformin is a common drug that I use for those with weight gain issues while statins help to treat dyslipidemias.
Sexual Dysfunction
Sexual dysfunctions I have observed during treatment of patients include reduced libido and anorgasmia with a few complaining of erectile dysfunction. For patients on medications like olanzapine, switching to prolactin-sparing antipsychotics like quetiapine and aripiprazole is observed to help (Stroup & Gray, 2018). Another strategy used is lowering the dosage of medications like clozapine to minimize sexual dysfunction issues.
Blunted Affect
Blunted affect is a symptom that is commonly observed in patients with schizophrenia where the patient experiences difficulty in expressing emotions. I have observed medications like antidepressants cause blunted affect and although lowering doses does not seem to help, using group therapy sessions is a good strategy.
Agranulocytosis
Agranulocytosis is common with medications like clozapine and in the severe form, it can cause death. Although I have not observed this symptom, evidence-based practice suggests that discontinuation of medication is the definitive solution (Stroup & Gray, 2018). Switching to another medication and using agents like lithium can help to increase the neutrophil counts.
References
Balon, R. (2019). Managing the Side Effects of Psychotropic Medications. Journal of Psychiatric Practice, 25(5), 411-413.
http://dx.doi.org/10.1097/PRA.0000000000000406
Goldberg, J. F., & Ernst, C. L. (2018). Managing the side effects of psychotropic medications. American Psychiatric Pub: ISBN 978-1-58562-488-1.
Stroup, T. S., & Gray, N. (2018). Management of common adverse effects of antipsychotic medications. World psychiatry : Official Journal of the World Psychiatric Association (WPA), 17(3), 341–356.
https://doi.org/10.1002/wps.20567
Related Posts:
- Pediatric patient evaluations must involve a combination of patient input, parent input, and your own observations from physical exams and diagnostics. As you read the following the case study, consider the source (i.e., patient, parent, or practitioner) of the provided patient information.
- Module 08 Discussion – Gas Exchange
- The Affordable Care Act was signed into law by President Barack Obama in March 2010. Many of the provisions of the law directly affect health care providers. Review the following topic materials
- What Is The Difference Between Service-Based And Population-Based Applications For Information Systems In Public Health Organizations
- What Spiritual Considerations Surrounding A Disaster Can Arise For Individuals, Communities, And Health Care Providers
- What Do You Think Are Some Effective Tactics For APN Strategic Positioning Regarding Pay Equality? Should APNs Position Themselves As Lower-Cost Providers Who Provide Better Care Or Push For Comparable Worth, Same Service And Same Pay?
- What Do You Think Are Some Effective Tactics For APN Strategic Positioning Regarding Pay Equality? Should APNs Position Themselves As Lower-Cost Providers Who Provide Better Care Or Push For Comparable Worth, Same Service And Same Pay?
- What Do You Think Are Some Effective Tactics For APN Strategic Positioning Regarding Pay Equality? Should APNs Position Themselves As Lower-Cost Providers Who Provide Better Care Or Push For Comparable Worth, Same Service And Same Pay?
- What spiritual issues surrounding a disaster can arise for individuals, communities, and health care providers?
- Post an explanation of the women’s health issue you selected, including the impact of political, social, and sociocultural factors on this issue. Explain how personal perceptions of providers might influence their ability or willingness to care for women in relation to this issue.
- How would you describe the issues addressed by Polit and Beck (2012) regarding the implementation potential of an innovation in a particular setting?
- Write a 1,050- to 1,400-word strategic objectives summary. Include your balanced scorecard and its impact on all stakeholders, and the communication plan.
- 1.Research and describe a product ideation model or methodology. Describe the ideation approach and how you might use it in your collaboration assignment for this module. 2.Explain the importance of using a structured innovation process in your organization to enable innovation.
- In Silent Spring, Rachel Carson uses a very powerful narrative framework to describe the world as it exists in harmony and bliss before the fall into the massive use of poisons in the environment. In 1,000-1,250-words, summarize the key issues addressed in this publication; discuss how this publication has contributed to current knowledge and understanding of the dynamic between the environment and health; and explain the relationship between the environment and health
- Define the process of planning,Implementation and evaluation in the role of the RN in planning,Implementation and role of the LPN/LVN
- Select an ethical dilemma related to health policy from the categories of moral values, professional regulation, health of individuals in society, or distributive justice. What are the controversies surrounding this issue? What are the opposing ethical principles? How has past or current health policy addressed this dilemma? Support your reasoning with reference citations.
- Identify a potential data base you can imagine emerging from data within the healthcare electronic systems within your organization and describe its’ potential to improve nursing practice and patient outcomes.
- Implementation Stage Issues
- Unemployment in the United States in October 2012
- Dark Shadows the 2012 horror-comedy movie