Question

Schizophrenia

Mrs. Maine, age 56, is brought to the emergency department (ED) by her son, who is very concerned. The son tells Stephen, the ED nurse, that he found his mother wandering in the house, aimlessly talking to the furniture. She apparently had not eaten in days. Envelopes covered the kitchen table, along with reams of paper with unintelligible writings. An unopened bottle of Clozaril was found in the kitchen. The son states that his mother was diagnosed with undifferentiated schizophrenia 2 years after her husband died, 20 years ago. She usually suffers one occurrence every year related to discontinuation of her medication. She lives at home and is assessed by a home aide daily. Apparently, her home aide left for vacation without informing Mrs. Maine’s son. Mrs. Maine has no contact with her neighbors.

She displays no eye contact and speaks in a singsong voice. She asks, “Why am I here? There’s nothing wrong with me. I don’t know why that man brought me here; he’s obviously a prison guard and wants to put me in jail.” She states that she is hearing “four or five” voices. “They tell me I’m a bad person, and they plan to beat me and take my shoes,” she says, adding, “Sometimes they turn my mother parts around.” At this she pats her abdomen and giggles. Otherwise her affect is flat, and she demands to be discharged.

Discuss Clozaril. Discuss name, dosage, major side-effects, patient teaching, any pertinent labs.

Assessment

Objective Data: Identify 5 items.

1.

2.

3.

4.

5.

Subjective Data: Identify 5 items.

1.

2.

3.

4.

5.

Answer 1

Clozaril is an atypical antipsychotic medication belongs to Dibenzodiazepine category.Clozaril is mainly used for schizophrenia that does not improve following the use of other antipsychotic medications. In those with schizophrenia and schizoaffective disorder it may decrease the rate of suicidal behavior.

Name- Clozapine.

Dosage - 12.5 mg orally once daily or every 12 hours initially; increased daily in increments of 25-50 mg/day, if well tolerated, to achieve target dosage of 300-450 mg/day by end of 2 weeks.

Side-effect include-

• hypotension
• Fast heart rate
• Increased Appetite
• Constipation
• Heartburn
• Nausea
• Excess salivation/drooling
• Vomiting
• Weight gain
• Sleep problems
• Increased sweating
• Dry mouth
• Blurred vision
• Drowsiness
• HeadHeadache

Patient teaching:

1. If doctor has prescribed one-half of an orally-disintegrating tablet, then break the tablet in half. Throw the other half away. Do not save it for later use.

2. Take as per doctors direction. Do not take more of this medicine than recommended.As Clozapine can cause severe dizziness, slow heartbeats, fainting, or seizures.

3. Teach patient to call doctor right away if she has chest pain, trouble breathing, fluttering in your chest, signs of infection (weakness, fever, sore throat, cold or flu symptoms), or if she feel like she might pass out.

4. Advice patient to avoid getting up too fast from a sitting or lying position, or she may feel dizzy.

pertinent labs:

1.Assessment prior to treatment with clozapine should include evaluation of the patient’s general and cardiovascular health status.

2.Complete blood count that includes an absolute neutrophil count (ANC).

3.Weight and height (BMI), waist circumference, fasting blood sugar and fasting lipids.

4.Drug levels for patients on anticonvulsant drugs.

5.Vital signs.

6.ECG.

7.Pregnancy test in women of childbearing age.

Objective data:

1. Inability to trust.

2. Disorientation on to place and time.

3. Impaired ability to make decisions and solve problems.

4. Disoriented thought sequencing and incorrect speech.

5. Presence of auditory hallucination .

Subjective Data:

1.She said "Why am I here? There’s nothing wrong with me. "

2. She said "don’t know why that man brought me here; he’s obviously a prison guard and wants to put me in jail.”

3. She states that she is hearing “four or five” voices.

4. She said "They tell me I’m a bad person, and they plan to beat me and take my shoes,”

5. She also added "Sometimes they turn my mother parts around.”