A patient on treatment for Schizophrenia complains of persistent feelings of restlessness and says, "I have to move all the time." What should a nurse do first?

Appeared in: KGMU 2023

Explanation

The patient's report of restlessness and a constant need to move are hallmark signs of akathisia, a type of extrapyramidal symptom (EPS).
According to the nursing process (ADPIE), the first step is always assessment. The nurse must gather more data before intervening.
Assessing for other EPS (like dystonia, pseudoparkinsonism) provides a complete clinical picture to accurately report to the physician for appropriate management.
Differentiating between a medication side effect (akathisia) and a symptom of the illness (psychomotor agitation) is critical for correct treatment and patient safety.

Option A: A patient with akathisia has a compelling, uncontrollable internal urge to move. Asking them to rest is ineffective and can increase their anxiety and distress.
Option B: While walking might temporarily satisfy the urge to move, it is a coping mechanism, not a therapeutic nursing intervention. It fails to address the underlying cause and bypasses the essential first step of assessment.
Option D: This is incorrect because it misattributes the cause. The symptoms are highly indicative of a medication side effect (akathisia), not a primary symptom of schizophrenia. Educating the patient with wrong information is a clinical error and could lead to worsening of the condition if the antipsychotic dose were increased.

Visual 1: Infographic: Chart showing the four main types of Extrapyramidal Symptoms (Akathisia, Acute Dystonia, Pseudoparkinsonism, Tardive Dyskinesia) with their key signs and symptoms.
Visual 2: Illustration: A visual comparison between a person experiencing akathisia (pacing, unable to sit still) and a person with pseudoparkinsonism (shuffling gait, tremors).

Clinical Relevance

Nursing practice connection: Use the key finding related to Management of Extrapyramidal Symptoms (EPS) to guide bedside assessment, documentation, and the next nursing action.
Nurses must be vigilant in monitoring for EPS in patients on antipsychotics, as these side effects are common, distressing, and can lead to non-adherence with treatment.
Prompt identification and reporting of EPS are crucial for patient safety. Severe forms, like acute dystonia involving the larynx, can be life-threatening.
What if the patient was newly admitted and not yet on medication? In that case, the restlessness would more likely be psychomotor agitation related to their psychosis, and the priority would be ensuring safety and preparing for prescribed treatment, rather than assessing for medication side effects.

How to Approach the Question

Identify the question type: This is a priority-setting question asking for the 'first' nursing action.
Analyze the patient's clinical presentation: The patient is on treatment for schizophrenia and complains of restlessness and a constant need to move.
Connect the symptoms to potential causes: These symptoms are classic for akathisia, a medication side effect (EPS).
Apply the Nursing Process (ADPIE): The first step in the nursing process is always Assessment. Look for the option that involves gathering more data.
Evaluate the options: 'Assess the patient for other extrapyramidal symptoms' is the only option that reflects the assessment step. The other options are interventions (implementation) or education, which should only occur after a thorough assessment.

Concept Tested & Keywords

Concept Tested: Management of Extrapyramidal Symptoms (EPS)
Stem keywords: Schizophrenia, restlessness, move all the time
Lead-in keywords: first
Clinical cues: Patient on treatment for Schizophrenia presenting with new motor symptoms, suggesting a medication side effect.

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Practise the full KGMU 2023

Attempt every question from this paper in a timed mock, then review the full solution for each one.