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

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