Nursing Pharmacology Chapter 16: Case Study, Antipsychotic Drugs (contributed by Nathan Lavid, M.D.)

Choose the correct answer for each question


You are psychiatry resident on call at an university affiliated tertiary care hospital. Unfortunately, your pager goes off at three in the morning. You are asked to see a patient in the surgical ICU that’s "going crazy". The surgery intern further informs you that the patient is a 21 y/o white male who had an emergency appendectomy earlier that afternoon. The intern reports that the patient has had no complications from the surgery or post-op; except for some insomnia, which he prescribed lorezapam. Nursing staff called the surgical intern after the patient pulled out his Foley catheter and threw the contents. Since the intern arrived at bedside, the patient has also ripped out his antecubital IV access and you can hear, through the phone, background shouting of "you’re trying to kill me...Satan is here".

You rush over to the ICU and quickly review the patient’s chart with the intern. The patient has no significant past psychiatric or medical history. Family history is significant for maternal depression and CAD. The patient’s medication regimen consists of piperacillin/tazobactam (Zosyn) 3.375 g IV q6hrs – s/p 2 doses and acetaminophen 300mg/codeine 60mg (Tylenol #4) q4hrs prn pain – s/p 3 tablets. The patient also received 2mg of the above-mentioned lorezapam (Ativan) at 2:00am. Pre-op serology was WNL, except for an elevated white blood cell count of 19,100 with a left shift on differential. Post-op labs are scheduled for 6:00 am.

You enter the patient’s room and find him surrounded by nursing staff. They have restrained him and have bandaged his arm. The patient is oblivious to your attempts to communicate with him and only shouts "you’re hurting me" over and over again. Nursing staff reveals that the patient’s surgical wound has not been disrupted, that the bleeding from his arm has been stopped and that there appears to be minimal damage to the patient’s penis. Vital signs taken from earlier in the shift (midnight) are stable.

After synthesis of the patient’s information, you make the diagnosis of delirium. You advise the surgical intern of possible medication and behavioral management of the condition and make recommendations concerning the patient’s current medication regimen.