chlorproMAZINE (Rx)

Assessment - Assess mental status: orientation, mood, behavior, presence of hallucinations, and type before initial administration and monthly; this product should significantly reduce psychotic behavior - Assess any potentially reversible cause of behavior problems in geriatric before, during therapy - Check for swallowing of PO medication; check for hoarding or giving of medication to other patients - Monitor • I&O ratio; palpate bladder if low urinary output occurs, especially in geriatric; urinalysis recommended before, during prolonged therapy - Monitor bilirubin, CBC, liver function studies, ocular exam; agranulocytosis, glaucoma, cholestatic jaundice may occur - Assess respirations q4 hr during initial treatment; establish baseline before starting treatment; report drops of 30 mm Hg; obtain baseline ECG, Q wave, and T wave changes - Check for dizziness, faintness, palpitations, tachycardia on rising; severe orthostatic hypotension is common - Identify for neuroleptic malignant syndrome: hyperpyrexia, muscle rigidity, increased CPK, altered mental status; product should be discontinued - Assess for EPS including akathisia (inability to sit still, no pattern to movements), tardive dyskinesia (bizarre movements of the jaw, mouth, tongue, extremities), pseudoparkinsonism (rigidity, tremors, pill rolling, shuffling gate); an antiparkinsonian product should be prescribed - Assess for constipation, urinary retention daily; if these occur, increase bulk, water in diet

Patient/family education - Teach patient to use good oral hygiene; frequent rinsing of mouth, sugarless gum, candy, or ice chips for dry mouth - Caution patient to avoid hazardous activities until product response is determined; dizziness, blurred vision may occur - Inform patient that orthostatic hypotension occurs often and to rise from sitting or lying position gradually, to remain lying down after IM inj for at least 30 min; tell patient to avoid hot tubs, hot showers, tub baths, since hypotension may occur; tell patient that in hot weather heat stroke may occur; take extra precautions to stay cool - Advise patient to avoid abrupt withdrawal of this product, or extrapyramidal symptoms may result; product should be withdrawn slowly - Teach patient to avoid OTC preparations (cough, hay fever, cold) unless approved by prescriber, since serious product interactions may occur; avoid use with alcohol, CNS depressants, since increased drowsiness may occur - Caution patient to use sunscreen and sunglasses to prevent burns - Teach patient about extrapyramidal symptoms and necessity of meticulous oral hygiene, since oral candidiasis may occur - Instruct patient to take antacids 2 hr before or after taking this product - Instruct patient to report sore throat, malaise, fever, bleeding, mouth sores; if these occur, CBC should be drawn and product discontinued - Teach that urine may turn pink or reddish-brown - Teach patient to use contraceptive measures

Evaluation

Positive therapeutic outcome: Decrease in emotional excitement, hallucinations, delusions, paranoia; Reorganization of patterns of thought, speech; Increase in target behaviors