Assessment

• Assess mental status (orientation, mood, behavior) before and periodically during therapy

» Monitor blood pressure (sitting, standing, lying), ECG, pulse, and respiratory rate before and frequently during dose adjustment

» Assess weight and BMI initially and throughout therapy

» Assess fasting blood glucose and cholesterol levels initially and throughout therapy

» Observe patient carefully when administering medication to ensure that medication is taken and not hoarded or cheeked

» Assess fluid intake and bowel function. Increased bulk and fluids in the diet may help minimize constipation

» Monitor patient for onset of akathisia (restlessness or desire to keep moving) and extrapyramidal side effects (parkinsonian—difficulty speaking or swallowing, loss of balance control, pill rolling of hands, mask-like face, shuffling gait, rigidity, tremors; and dystonic—muscle spasms, twisting motions, twitching, inability to move eyes, weakness of arms or legs) every 2 mo during therapy and 8–12 wk after therapy has been discontinued. Report these symptoms if they occur, as reduction in dose or discontinuation of medication may be necessary. Trihexyphenidyl or benztropine may be used to control symptoms

» Monitor for tardive dyskinesia (uncontrolled rhythmic movement of mouth, face, and extremities; lip smacking or puckering; puffing of cheeks; uncontrolled chewing; rapid or worm-like movements of tongue, excessive blinking of eyes). Report immediately; may be irreversible

» Monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, seizures, diaphoresis, hypertension or hypotension, pallor, tiredness, severe muscle stiffness, loss of bladder control). Notify health care professional immediately if these symptoms occur

• Evaluate CBC, liver function tests, and ocular examinations periodically during therapy. May cause platelets. May cause bilirubin, AST, ALT, GGT, CPK, and alkaline phosphatase

» Monitor blood glucose prior to and periodically during therapy

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