Preadministration Assessment

A patient receiving an antipsychotic drug may be treated in the hospital or in an outpatient setting. The nurse assesses the patient's mental status before and periodically throughout therapy. The nurse must note the presence of hallucinations or delusions and document them accurately in the patient's record.

Before starting therapy for the hospitalized patient, the nurse obtains a complete psychiatric and medical history. In the case of psychosis, patients often are unable to give a reliable history of their illness. When a psychosis is present, the nurse obtains the psychiatric history from a family member or friend. During the time the history is taken, the nurse observes the patient for any behavior patterns that appear to be deviations from normal. Examples of deviations include poor eye contact, failure to answer questions completely, inappropriate answers to questions, a monotone speech pattern, and inappropriate laughter, sadness, or crying.

Physical assessments include obtaining blood pressure measurements on both arms with the patient in a sitting position, pulse, respiratory rate, and weight. The hospitalized patient may ultimately be discharged from the psychiatric setting. Some patients, such as those with mild schizophrenia, do not require inpatient care. The nurse usually sees these patients at periodic intervals in the psychiatric outpatient setting.

The initial assessments of the outpatient are basically the same as those for the hospitalized patient. The nurse obtains a complete medical history and a history of the symptoms of the mental disorder from the patient, a family member, or the patient's hospital records. During the initial interview, the nurse observes the patient for what appear to be deviations from a normal behavior pattern. The nurse also should assess the patient's vital signs and body weight.

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