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Thought Disorders

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Title: Thought Disorders


1
Thought Disorders
  • Adrianne Maltese

2
Etiology of schizophrenia
  • Most likely caused by a convergence/interaction
    of genetic and environmental factors
  • GENETIC factors
  • Neurodevelopmental brain abnormalities
  • Enlarged ventricles
  • Cortex-left localized
  • Temporal lobe dysfunction
  • Phospholipid metabolism
  • Frontal lobe dysfunction
  • Brain circuitry dysfunction
  • Neuronal density
  • NEUROTRANSMITTER SYSTEM
  • D

3
Schizophenria
  • BLEULERS four As
  • Ambivalenceholding two different
    attitudes/emotions/feelings at the same time
  • Autistic thinkingdisturbances in thoughts
    private fantasy world/abnormal responses to
    people/events of the real world

4
Bleulers 4 As(cont)
  • Loosening of Associations-rapid shift of ideas-
    unrelated manner
  • Affective disturbance - may be blunt,
    flat,inappropriate/labile

5
Positive Symptoms
  • DELUSIONS(paranoid/reference)
  • HALLUCINATIONS(auditory/visual)
  • DISORANIZED SPEECH/THINKING(tangential/loa/incoher
    ent/neologisms
  • GROSSLY DISORGANIZED BEHAVIOR(difficulty with
    goal setting/ADLsunpredictable
    agitation/silliness/social disinhibition/bizarre
    behaviors
  • CATATONIC BEHAVIORS(decrease reaction to
    environment/bizarre postures/aimless motor
    activity)

6
Negative symptoms
  • AFFECTIVE FLATTENING
  • ALOGIA (poverty of speech/slowed speech/decrease
    fluency/content)
  • AVOLITION(inability to initiate goal directed
    behavior)

7
  • TYPES OF SCHIZOPHRENIA
  • Disorganized
  • Paranoid
  • Catatonic
  • Undifferentiated
  • Residual
  • Related Psychotic Disorders
  • Schizoaffective Disorder
  • Schizophreniform disorder
  • Delusional disorder
  • Brief Psychotic disorder

8
Paranoid Type
  • Persistent delusions/persecuatory nature
  • Auditory hallucinations-single or associated
    theme
  • Guarded,suspicious,hostile,angry,
  • possibly violent
  • Pervasive anxiety
  • Intensive,reserved,controlled social interactions
  • Onset- later in life
  • Generally more favorable dx. re independent
    living/occupational functioning.

9
Disorganized type
  • Grossly inappropriate/flat affect
  • Primitive / uninhibited behaivor
  • Unusual mannerisms-giggle/cry out loud/distort
    facial expressions
  • Hypochondriasis (multiple physical complaints)
  • Socially inept/withdrawn
  • Onset early- prepsychotic period- marked
    adjustment problems
  • Hallucinations/delusions more fragmented

10
Catatonic Type
  • Marked disturbance of psychomotor activity
  • May be immobile/or with psychomotor excitation
  • Displays negativism/mutism
  • Posturing
  • Bizarre positions-waxy flexibility

11
Undifferentiated type
  • Florid psychotic symptoms
  • delusions/hallucinations
  • incoherence
  • disorganized speech/behavior
  • do not clearly fit into other categories

12
Scenario Client with Thought Disorder
  • R.T.is a 28 y/o male is brought to the ER by
    police. R.T. barricaded himself in his single
    room apartment with a gun and called 911 saying
    that he needed to protect himself from aliens who
    were invading the planet. He was admitted to the
    in-patient unit on a 5150 hold as DTO. He was
    fearful on approach, appearance was disheveled,
    speech disorganized. He reports hearing voices
    telling him that he would be next. R.T. reports
    that he hitch-hiked across the country and has no
    family here. He ran out of meds 4 weeks ago. He
    is admitted with the dx. of Schizophrenia,
    paranoid type is started on Haldol 5 mg BID
    Cogentin 1 mg BID.
  • 1.Prioritize TWO nursing Dx./outcomes/intervention
    s
  • 2. How would the nurse evaluate the effectiveness
    of the medication?
  • 3. Why is Cogentin being given?

13
Schizophreniform Disorder
  • Meets criteria for schizophrenia except
  • 1) duration-at least 1 month but lt 6 mos.
  • 2)Social/ Occupational functioning may or may
    not be impaired vs. schizophrenia where
    functional disturbances ierelationships,
    school,self care are present.

14
Schizoaffective Disorder
  • Symptoms of both Schizophrenia and
  • affective (mood)disorders
  • delusions/hallucinations/disorganized speech
  • Major depression, mania, mixed
  • At least a two week period of psychotic symptoms
    only
  • Onset is later than schizophrenia
  • Prognosis is better than schizophrenia,but worse
    than Affective Disorder.

15
Residual Type
  • Client has had at least one acute episode
  • Free of psychotic symptoms
  • Continues to exhibit persistent social
    withdrawal/emotional blunting/illogical
  • thinking/eccentric behavior

16
Delusional Disorder
  • Presence of one or more nonbizarre delusions
    persist for ONE month or more
  • Bizarre delusion iebrain removed by
    aliens-replaced with computer
  • vs. nonbizarre delusion- more believable
    iebelieves the IRS is going to prosecute his
    family for his wrongdoings.

17
Subtypes of Delusional Disorder
  • Erotomanicmay involve stalking/spying
  • Jealousefforts made to follow Catch
  • Grandiosehas extraodinary talent/knowledge
  • Persecutoy-victim of a conspiracy/poisining/spying
  • Somatic-bodily sensations/believes body has a
    foul odor/insects or parasites on/in body/body
    part is nonfunctional

18
SHARED PSYCHOTIC DISORDER
  • Delusional disorder also known as
  • folie a deux
  • develops in a person who is involved in a
    relationship with another person who already has
    a psychotic d/o with prominent delusions.

19
Psychotic Disorder due to medical conditions
  • Characterized by prominent hallucinations and
    /or delusions due to physiologic effect of
    medical condition

20
Substance Induced Psychotic Disorder
  • Characterized by prominent hallucinations and
    /or delusions produced by the physiological
    effects of a substance ie
  • Drugs of abuse,medications or toxins
  • The disorder first occurs during intoxication or
    withdrawal stages, but can last for weeks
    thereafter.

21
Human Needs AssessmentMaslow
  • Biologic Physiologic Integrity
  • (Air, Fluids , Comfort, Activity, Nutrition,
    Elimination, Skin Integrity)
  • Overall Decline in health maintenance
  • Poor grooming/hygiene/ADL functions
  • Increased risk for communicable diseases r/t i.e.
    TB, PNA, Infection homelessness poor hygiene,
    poor judgment

22
Oxygen Fluids Assessment
  • Note hx. of cigarette smoking second hand in
    smoke filled facilities, Respiratory diseases
  • Poor posture shallow breathing patterns
  • May drink too little or too much water due to
    delusional beliefs
  • May be dehydrated upon admission
  • Check Chem panel and electrolytes(hypo-hyper
    nutremia hypo-hyper kalemia)

23
Mental Status Assessment
  • Altered mood/depressive symptoms
  • Anxiety/agitation
  • Social withdrawal/isolation
  • Perceptual distortions
  • Hallucinations, illusions,altered internal
    sensations,Agnosia,distorted body image,negative
    self-perception

24
Comfort, Activity
  • Assess Pain, discomfort ,injuries
  • Activity level normal vs. Psychomotor
    retardation, psychomotor agitation

25
Mental Status Assessment
  • Cognitive Distortions
  • Delusions,derealizations,ideas of
    reference,errors in memory recall,problems with
    attention/concentration
  • Incorrect use of language which interferes with
    socialization (neologosisms/clanging)
  • Flight of ideas

26
Nutrition, Elimination, Skin Integrity
  • Assess food intake ?mal-nourishment where does
    client get food supply? meals daily, usual
    diet, eaten while on unit?
  • B12 Folate levels, Liver Panel, CBC w/diff ,
    Protein levels
  • Assess constipation/loose stools r/t S/Es of
    psychotropic meds.
  • Assess Skin Integrity- condition of skin- dry,
    cracked, sun-burned
  • Foot care may walk barefoot on surface streets

27
Safety Security Assessment
  • Assess suicidal ideation(50 suicide rate)
  • Assess potential for violence/aggression
  • Maintain safe/secure environment
  • Assess orthostatic B/P changes
  • Assess Mental Status changes

28
Belonging AttachmentAssessment (Psychosocial)
  • Assess support system (effective or not?)
  • Family attachments, friends, clergy, 12 step
    groups)
  • Affect- may be labile, emotionless
  • Coping ability
  • Ability to form trusting reciprocal
    relationships

29
Other Psychotic disorders
  • BRIEF PSYCHOTIC DISORDER
  • At least one of the following sxs
  • Hallucinations,delusions,
  • disorganized speech,
  • behavior disturbance,(disorganized or catatonic)
  • Sxz last at least one daybut less than one
    month.returns to premorbid level.

30
Self-Esteem Self EfficacyAssessment
  • What is clients view of self ?(was education
    interrupted by illness?)
  • Body image (distorted or realistic)
  • What stage of development was effected by onset
    of illness?
  • Decision making capacity
  • Sense of control over life

31
The Nursing Process
  • Assessment Subjective/Objective
  • Use of the Mental status exam
  • Focus on four areasdisturbances in perceptions,
    Language thought Process, affect feelings, and
    Psychomotor behavior.
  • Direct questions towards assessment of these
    areas

32
Self Actualization Self-Transcendence Assessment
  • Ability to maintain health- compliance with med
    regime
  • Ability to seek help when needed keeps Dr.s
    appts for f/u of illness
  • Seeks ways to control stress

33
Psychosocial Assessment
  • Behavioral disturbances
  • Poor impulse control/anger management problems
  • High risk for self harm (50 risk for Suicide)
  • Lack of social support systems
  • Substance abuse/med noncompliance

34
Psychosocial Assessment
  • Poor peer relationships-has few friends
  • Social/occupational areas poor functions
  • Preoccupied/detached
  • Poor achievements-lacks competativeness
  • Avolition- lacks initiative to engage in
    self-initiated, goal directed activity.
  • Social withdrawal/self isolation

35
Developmental Assessment
  • Autistic like behaviors-lacks social skills
  • Delayed development- immature
  • Strikes in late adolescenceearly adulthood
    effecting emotional development.
  • Eriksons stage(identity vs. role confusion)
  • (intimacy vs. isolation)

36
Spiritual Assessment
  • Religiosity- delusional beliefs centered around
    religious beliefs
  • Values and beliefs with which one is raised
  • Impact of these beliefs on delusional system

37
Nursing Diagnosis(Actual or Potential)
  • Communication, Impaired verbal
  • Disturbed personal Identity
  • Coping, Ineffective Individual
  • Family Process, altered
  • Sensory/ perceptual alterations
  • Thought processes, altered
  • Violence, risk for self/other directed
  • Altered nutrition lt body requirements
  • Self care deficit (bathing/hygiene/grooming/
  • bathing/feeding/toileting)

38
Outcome Identification/goals
  • The client will
  • Demonstrate reduction in psychotic symptoms
  • Demonstrate absence of self-mutilating,violent or
    aggressive behaviors
  • Demonstrate reality based thinking behaviors
  • Socialize with peers/staffparticipate in groups
  • Comply with medication regimen
  • Verbalize the role of medications in reduction of
    psychotic symptoms.

39
Nursing Interventions/Rationales
  • Involve client/family in treatment process
    (avoids misunderstandingsresistance from
    client/family/or financial/environmental
    constraints)
  • Establish a therapeutic relationship with client
    first (the client must first feel he can trust
    the nurse-assists with safety and security)
  • Institute measures to maintain/regain physical
    health (the clients safety and physical health
    are priority!)

40
Interventions/rationales
  • Use clear/concrete statements vs. generalizations
    (they may exacerbate misperceptions or
    hallucinations)
  • Determine stressors that may trigger
    sensory-perceptual disturbances (hallucinations
    may be exacerbated by external/environmental
    stressors)
  • Distract client from delusions that exacerbate
    aggressive/potentially violent episodes (engaging
    the client in more functional,less anxiety
    provoking activities increases the reality base
    and decreases risk of violent episodes that may
    be provoked by delusions)

41
Interventions/rationales
  • Begin with one to one interactions, accompany
    client to group activities starting with more
    structured, less threatening groups and
    progressing to more informal spontaneous
    activities(limited contact at first-often better
    tolerated later increase in socialization to
    assist with social skills to expand reality
    base)
  • Focus on meaning behind delusion rather than
    content-recognize as clients perception of the
    environment(meets clients needs,reinforces
    reality,non challenging or threatening)

42
Questions-Thought disorders Schizophrenia
  • A client is a withdrawn catatonic state exhibits
    waxy flexibility. During the initial phase of
    hospitalization for this client the nurses first
    priority is to
  • Watch for edema and cyanosis of the extremities.
  • Encourage the client to discuss concerns that led
    to the catatonic state.
  • Provide warm, nurturing, relationship, with
    therapeutic use of touch.
  • Identifying the predisposing factors to the
    illness.

43
  • 2. A client with schizophrenia, disorganized type
    is admitted to the inpatient unit. He frequently
    giggles and mumbles to himself. He hasnt taken
    a shower in 3 days. His appearance is disheveled
    and unkempt. The nurse would best persuade the
    client to shower by saying
  • Clients on this unit take showers daily.
  • Its time to shower, I will help you.
  • Youll feel better if you shower.
  • Would you like to take a shower?

44
  • 3. The nurse identifies the nursing diagnosis of
    Disturbed thought process related to exhibiting
    delusions of reference for a client with
    schizophrenia. Which outcome would be most
    appropriate?
  • Client will talk about concrete events in the
    environment without talking about delusions.
  • Client will state 3 symptoms that occur when
    feeling stressed.
  • Client will identify 2 personal interventions
    that decrease intensity of delusional thinking.
  • Client will use distracting techniques when
    having delusions.

45
  • 4. During a community meeting, a client with
    schizophrenia begins to shout and gesture in an
    angry manner. Which nursing intervention would be
    the priority?
  • A. Determine the reason for the clients
    agitation.
  • B. Encourage appropriate group behavior?
  • C. Facilitate group process in responding to the
    client.
  • D. Maintaining safety of client and others.

46
  • A male client who has schizophrenia is admitted
    to the inpatient psychiatric unit. The client is
    actively hallucinating and is unable to provide
    information for the admission process. What is
    the nurses best option for getting information?
  • Wait until the medication works
  • Ask the next shift to do the admission
  • Get the information from the physician
  • Ask the clients family for information.

47
  • A 32 year-old client admitted with catatonic
    schizophrenia has been mute and motionless for 2
    days. The priority nursing diagnosis is
  • High risk for fluid and electrolyte imbalance
  • Impaired mobility
  • Impaired verbal communication
  • Ineffective individual coping.

48
  • In planning care for a client experiencing
    paranoid delusions, which of the following is the
    priority goal?
  • Absence of delusions
  • Establishing trust
  • Participation in all unit activities
  • Performing independent activities

49
  • Which nursing response would be most appropriate
    when a client is hearing voices?
  • I do not hear the voices that you say you hear.
  • Those voices will disappear as soon as the
    medicine works.
  • Try to think about positive things instead of
    the voices.
  • Voices are only in your imagination.

50
  • The nurse expects to assess which of the
    following in a client diagnosed with
    schizophrenia, paranoid type?
  • Anger, auditory hallucinations, persecutory
    delusions.
  • Abnormal motor activity, frequent posturing,
    autism.
  • Flat affect, anhedonia, alogia.
  • Silly behavior, poor personal hygiene, incoherent
    speech.

51
  • Which of the following comments by a client
    indicate the need for an urgent dose of an
    antipsychotic drug?
  • The voices are mumbling and I cant hear them
    very well.
  • The voices are telling me to rip my bed sheets
    and hang myself.
  • The voice I heard this morning sounded like my
    dead grandmother.
  • The voices told me to kill my neighbor when I
    get home.

52
  • . A client with catatonic schizophrenia has sat
    mute and rigid for two hours. Which nursing
    action would be most appropriate?
  • Encourage the client to participate in a group
    sporting activity
  • Put the clients extremities through passive
    range of motion.
  • Seclude the client until voluntary movement is
    observed.
  • Offer short but frequent verbal phrases to
    communicate caring.

53
AGGRESSIVE BEHAVIORS
  • Aggressive behavior - is an acting out of
    aggressive or hostile impulses in a violent or
    destructive manner may be directed towards
    objects, others, self.
  • ETIOLOGY- r/t feelings of anger/hostility/homicid
    al ideation,psychotic process,substance use,
    personality disorders

54
De-escalating Aggressive Behaviors
  • GENERAL INTERVENTIONS
  • SAFETY most important- protect client others
  • Provide safe, non-threatening Therapeutic
    environment

55
  • LEGAL /ETHICAL ISSUES Staff is responsible to
    provide control to protect client others
  • MANAGING THE ENVIRONMENT-
  • Persuade client to move to another area have
    colleagues remove others from area (prevents
    anxiety/contagious responses from other
    clients/provides sense of safety/protects others)

56
De-escalation techniques
  • Encourage Verbalization
  • Ask the client open-ended ,non-threatening
    questions
  • How? What? Where? When? obtain details
    from client .
  • Do NOT ask WHY?
  • Keep voice calm,modulated(focuses on client
    problem-stops anger from escalating

57
De-escalating techniques contd
  • Use of Non-Verbal expression
  • Allow client body space gt 8 feet
  • Keep your body at a 45 degree angle
  • Assume OPEN POSTURE hands at side,palms
    outward. this conveys a non-threatening message,
    gives client message that you are willing to
    listen and help

58
De-escalating techniques
  • Personalize self and show concern
  • Remind client who you are (that you are his
    nurse-he is in the hospital and is safe here)
  • Use words ie we or us
  • Use encouraging responses ie go
    ondemonstrates empathy/encourages and reflects
    cooperation on your part

59
Managing aggressive Behaviors
  • Hold regular drills with staff to practice
    strategies
  • Practice use of disengagement breakaways
  • Rehearse procedures regarding the removal of
    client to seclusion or restraints
  • Document all events and hold debriefing sessions
    with staff allows staff to de-escalate and learn
    from event

60
  • A client who is agitated begins to shout insults
    and threats at others, and starts demolishing the
    recreation room. What is the best response or
    action by the nurse?
  • Firmly set limits on the behavior.
  • Allow the client to continue, because this is an
    expression of his/her feelings.
  • Let the client know that he/she does not need to
    express anger at the nurse by demolishing the
    recreation room.
  • Tell the client that he/she is trying to
    intimidate other clients.

61
  • Which nursing intervention is inappropriate to
    use with a person who is expressing anger?
  • Stating observations of the expressed anger.
  • Assisting the person to describe his/her
    feelings.
  • Helping the person find out what preceded the
    anger.
  • Helping the person refrain from expressing the
    anger verbally.

62
  • A teenager with acting-out behaviors tells the
    nurse, I want you to go tell my teacher that I
    am sick and I should be allowed to do whatever I
    want. The nurse determines that this statement
    best represents
  • Insight
  • Manipulation
  • Dependency
  • Trust

63
  • A client who is acutely agitated becomes
    increasingly aggressive despite staffs verbal
    attempts to stop the aggression. The client
  • shout threats at other clients, throws
    furniture,
  • and begins to kick and bite clients and
    staff.
  • A prn order for medication when agitated is
    available. Which action should the nurse take
    initially?
  • A. Orient the client to reality, and place the
    client in
  • a well lit, quiet room.
  • B. Give the ordered tranquilizer and pout the
    client
  • in bed with the side rails up.
  • C. Lock the client in his/her room and call the
    doctor.
  • D. Have at least two staff members physically
  • restrain the client and take the client to a
    quiet room.

64
  • Which nursing action would be best for a client
    who is hospitalized , and is constantly upset
    with the staff, easily angers, and frequently
    shouts at the nurses?
  • A Request that the client be moved to another
    unit.
  • B. Schedule a conference with the MD, nurse
    manager, and client about his behavior.
  • C. Contact social services to meet with the
    client and family about the problem.
  • D. Involve the client and the family in the
    development of the care plan.

65
PSYCHOPHARMACOLOGY
  • ANTIPSYCHOTIC MEDICATIONS

66
Mode and Mechanisms
  • Dopamine receptor blockers drug occupies
    dopamine receptor at the post synaptic neuron
    blocks endogenous dopamine from having its
    effect
  • Dopamine receptors confined primarily to four
    major areas of the brain
  • Mesolimbic cortical(positive sxs of schizo.)
  • nigrostriataltuberoinfundibular pathways

67
Dopamine 2 receptor
  • Responsible for many s/es of antipsychotics
  • Nigrostriatal pathway begins at substantia nigra
    ascend to caudate nucleus putamen in the
    extrapyramidal system.
  • Blockade in the nigrostriatal is responsible for
    pseudoparkinsonism or EPS
  • Atypical antipsychotics also block dopamine
    receptors as well as seratonin

68
Side Effects r/t Receptor Blockade
  • Histamine 1 Blockade causes sedation,
  • Cholinergic Blockade causes anticholinergic
    side effects (dry mouth, blurred vision,sinus
    tachycardia,constipation,impaired memory
    cognition)
  • Alpha 1 Blockade causes (hypotension reflex
    tachycardia)

69
CLINICAL USE //EFFICACY
  • MOST TOXIC DRUGS USED IN PSYCHIATRY!!
  • Use lowest possible dose esp in Geriatric client
    start low go slow!
  • Positive (aggressive symptoms) most
    responsive-relieved within hours
  • Negative( Affective symptoms)- may take up to 2-4
    weeks to respond.

70
Use/clinical efficacy cont
  • Cognitive/Perceptual symptoms ie hallucinations,
    delusions, thought broadcasting 2 to 8 weeks to
    respond
  • Increasing meds will not hasten relief of slow
    responding symptoms
  • Usually start with divided doses(minimizes s/es)
  • Once effective change to QD or Bid
    dosing(increases med compliance)

71
  • Absorption absorbed well in GI tract
  • Metabolism metabolized in the liver
  • Half Life Adults (20 40 hours)
  • Half Life Elderly client may be doubled
  • Adult steady state 4-7 days
  • Monitor liver functions esp. elderly and
    physically compromised

72
Medication Forms
  • INJECTABLE form I M use for emergencies only
  • (client imminent danger to self/others)
  • Simultaneous use of a benzodiazepine may help
    client to gain control more rapidly ie
    combination of Haldol and Ativan
  • LIQUID form-used when client has hx. Of
    non-compliance or has been suspected of
    cheeking meds.

73
Additional medication forms
  • LONG ACTING INJECTABLE
  • Used to increase compliance
  • Eg. Haldol Decanoate/Prolixin Decanoate
  • Given monthly or bi-weekly
  • Half life Haldol decanoate- 21 days
  • Half-life for Prolixin decanoate 14 days
  • Monitor carefully as out patient

74
SIDE EFFECTS (EPS)
  • ACUTE DYSTONIA- MUSCLE SPASMS
  • Symptoms may include
  • Blepharospasm eye closing
  • Torticolis neck muscle contraction pulling head
    to side
  • Oculogyric Crisis severe upward deviation of
    eyeballs
  • Opisthotonos severe dorsal arching of neck and
    back
  • Larngospasm/involvement of tongue dysphasia-
    difficulty swallowing

75
  • PARKINSONISM symptoms include
  • Tremors
  • Bradykinesia/akinesia slowness, absence of
    movement
  • Cogwheel rigidityslow regular muscular jerks
  • Postural instability
  • Stooped/hunched posture
  • Shuffling gait
  • Restricted movements
  • Masked faceloss of mobility in facial muscles
  • Hypersalivation drooling

76
  • AKATHISIA not sitting
  • Pacing, Motor restlessness,Rocking, Foot taping
  • Subjective c/o inner restlessness, irritability,
    inability to sit still or lie down.
  • Need to differentiate between Akathisia and
    psychomotor agitation or restlessness

77
  • TARDIVE DYSKINESIA(means late occurring abnormal
    movements)
  • effects 4 of persons taking antipsychotics
  • Choreoathetoid movements rapid,jerky and
    slow,writhing movements may occur anywhere in
    the body arms,feet,legs,trunk
  • Classic descriptionoral,buccal, lingual,
    masticatory movements tongue thrusting,lip
    pursing smacking,facial grimaces and chewing
    movements.

78
NEUROLEPTIC MALIGNANT SYNDROME
  • NMS- A medical emergency
  • Potentially fatal reaction to an antipsychotic
    medication
  • Occurs in 0.5 1.4 of persons taking APs
  • May occur at any stage of tx.
  • SXs include high fever,
  • muscular rigidity,altered consciousness
  • Autonomic dysfunction

79
NMS Lab findings
  • LEUCOCYTOSIS (15,000 30,000 cells)
  • Elevated Creatine Phosphokinase
  • lt 3,000iu/ml
  • Myoglobinuria(large amounts of myoglobin released
    in urine due to destruction of muscle tissue)
  • Predisposing factors---
  • Rapid tranquilization
  • Increased number of IM injections

80
NMS COMPLICATIONS
  • Myocardial Infarction
  • Hepatic failure
  • Disseminated Intravascular Coagulation
  • Pulmonary Edema
  • Rhabdomyolysis(rapid destruction of muscle
    tissue)- can result in renal failure
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