A patient on treatment for Schizophrenia complains about a persistent feeling of restlessness and says "I feel like I need to move all the time." What should a nurse do?

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2015

Explanation

The patient's complaint of restlessness and a constant need to move is a classic presentation of akathisia, a type of extrapyramidal symptom (EPS) caused by antipsychotic medications.
According to the nursing process, assessment is the critical first step before any intervention can be planned or implemented.
Recognizing one EPS (akathisia) necessitates a full assessment for other EPS, such as dystonia, pseudoparkinsonism, and tardive dyskinesia, as they require different management strategies and can have serious consequences.
Differentiating a medication side effect (akathisia) from a symptom of the illness (psychomotor agitation) is a crucial nursing responsibility to prevent harmful interventions, like increasing the causative medication's dose.

Why Other Options Were Wrong

Option A: Telling a patient with akathisia to rest is futile and dismissive of their experience. The urge to move is a compelling, internal, and uncontrollable sensation, not a matter of willpower.
Option B: While walking may temporarily alleviate the discomfort of akathisia, it is a coping mechanism, not a therapeutic nursing action. It fails to address the underlying cause and skips the essential step of assessment.
Option D: This is a dangerous error in clinical judgment. It misidentifies a medication side effect as a symptom of schizophrenia. This could lead to an increase in the antipsychotic dose, which would worsen the akathisia.

Related Visual

Clinical Relevance

Nursing practice connection: Use the key finding related to Management of extrapyramidal symptoms (EPS) secondary to antipsychotic medication to guide bedside assessment, documentation, and the next nursing action.
A nurse's ability to differentiate between a medication side effect and a symptom of the underlying mental illness is a critical patient safety competency. Misinterpretation can lead to worsening the patient's condition.
Prompt identification and reporting of EPS can lead to medication adjustments (e.g., dose reduction, switching agents) or the administration of counteracting medications (e.g., propranolol for akathisia), significantly improving patient comfort and adherence.
What if? If the patient reported restlessness along with a stiff neck and their eyes rolling upwards, the priority would shift. This indicates acute dystonia, a medical emergency requiring immediate administration of an anticholinergic agent (like benztropine) or an antihistamine (like diphenhydramine).

How to Approach the Question

First, analyze the patient's statement: "persistent feeling of restlessness" and "need to move all the time."
Connect this statement to the patient's context: they are being treated for Schizophrenia, which implies they are likely taking antipsychotic medication.
Recognize these specific symptoms as the hallmark signs of akathisia, a well-known extrapyramidal side effect (EPS) of antipsychotics.
Apply the nursing process (ADPIE: Assessment, Diagnosis, Planning, Implementation, Evaluation). The first and most crucial step is always Assessment.
Evaluate the options through the lens of the nursing process. Option C is the only one that involves assessment. The other options are interventions (A, B) or education (D), which should only follow a thorough assessment.

Concept Tested & Keywords

Concept Tested: Management of extrapyramidal symptoms (EPS) secondary to antipsychotic medication.
Stem keywords: Schizophrenia, restlessness, need to move
Lead-in keywords: What should a nurse do
Clinical cues: Patient on treatment for Schizophrenia presenting with new motor symptoms.

Question ID

QLVG1QA2BXE8DFkV3oeR-M

Reference Book

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) pp. 3901-3903, 5075-5077

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