The last time I gave Haldol (haloperidol)I was in a room with five other nurses trying to get an extremely agitated patient to calm down before he became a serious danger to himself and my colleagues. This particular patient had come up from the emergency room in full drug-induced psychosis related to methamphetamine use. He was in four-point restraints and STILL required an entire gaggle of RNs to keep him (and ourselves) safe. Show
The MD ordered some meds to help the situation and Haldol/haloperidol just happened to be one of those meds. So, what is Haldol, how do you give it and, most importantly, what do you need to know BEFORE you give it? Haloperidol: Drug Class and IndicationHaldol (haloperidol) is a conventional antipsychotic (in other words, it’s “old school” folks). Though it is certainly used for chronic disorders such as schizophrenia, we use it in the clinical setting typically as a way to manage acute psychosis. In other words, this is your extremely agitated patient who is not able to follow commands, is disconnected to reality, having delusions or so altered and combative that it is an impediment to his care. Haloperidol: Three types given three waysThere are essentially three forms of haloperidol.
Note that giving haloperidol via IV is considered an “off-label” use but you’ll likely still see it prescribed in the acute care setting for severe delirium/agitation. So, how do you give it safely? Glad you asked. Giving haloperidol safely: Know the QT intervalWhen your physician friend orders haloperidol lactate to be given IVP, it’s not as simple as getting it from the med room and administering it. We have to actually be really careful about one thing in particular. And that one thing is (drum roll please…) the QT-interval. That’s because haloperidol has a knack for aggressively prolonging the QT-interval. When the QT-interval is prolonged, it increases the risk of the R wave falling on the T wave of the preceding beat, which kicks the ventricle into doing things that are Not Good…namely going into a sustained polymorphic ventricular tachycardia known as torsades de pointes. This is called “R on T phenomenon” and you definitely want to avoid it. That’s why we keep such a close eye on the QT-interval in the clinical setting…after all, many drugs can prolong the QT and haloperidol is definitely one of them. And, as a side note it’s also why it’s so important to measure it accurately, which is very easy to do…just measure from the beginning of the Q-wave to the end of the T-wave. Simple! Well, not entirely…but more on that in a bit when we talk about the “corrected QT-interval.” Now, back to the risks associated with haloperidol. Just how serious is this risk of haloperidol-induced torsades de pointes? Studies show that doses above 2mg of haloperidol can prolong the QT-interval to the point of causing torsades de pointes. And considering that many standard orders are for 5mg haloperidol IV, you see how careful you must be. So what are you going to do about it?
Side Effects of HaloperidolAfter you’ve given your patient the haloperidol, you’ll want to monitor for side effects. In addition to keeping an eye on that QTc, you’ll also watch for:
If you notice anything worrisome in your patient, let your MD colleagues know ASAP. Part of being a good nurse is advocating for your patient at all times and this means conveying your concerns in a timely manner so they can be managed appropriately. That’s it! I hope this helps you give this high-alert medication safely…and please reach out if you have any questions, comments or stories to share! Get this on audio in podcast episode 91.What are the adverse effects of haloperidol?Haloperidol may cause side effects.. dry mouth.. increased saliva.. blurred vision.. loss of appetite.. constipation.. diarrhea.. heartburn.. nausea.. What should be monitored with haloperidol?If HALDOL is administered intravenously, the ECG should be monitored for QTc prolongation and arrhythmias. Tachycardia and hypotension (including orthostatic hypotension) have also been reported in occasional patients (see ADVERSE REACTIONS).
What are two major side effects of haloperidol the nurse should anticipate?Adverse Effects. Acute Dystonia - (Develops within hours to days of initiation. ... . Akathisia - (Develops within days to months of use of haloperidol - characterized by restlessness.). Neuroleptic malignant syndrome - (NMS; infrequent but severe condition. ... . Parkinsonism - (Develops after days to month use of haloperidol). What is the nursing considerations for haloperidol?Monitor signs of hypersensitivity reactions, including pulmonary symptoms (laryngeal edema, wheezing, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur. Assess BP periodically, and compare to normal values (See Appendix F).
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