Characteristics of lithium toxicity include which of the following: (Select all that apply)

Nursing management during administration of opioid analgesics such as Morphine sulfate requires careful monitoring for both therapeutic effects and potentially serious adverse effects. Morphine acts on central opioid receptors to relieve pain but also depresses the central nervous system and gastrointestinal motility. Common complications include respiratory depression, constipation, urinary retention, and hypotension. Preventive care and continuous assessment are essential to ensure patient safety in the postoperative period.

Rationale:
A. Encouraging physical activity and offering increased fluids helps counteract opioid-induced decreased gastrointestinal motility. Morphine slows peristalsis by binding to mu receptors in the gut, leading to constipation. Early ambulation stimulates bowel function, while adequate hydration softens stool and promotes transit.

B. Monitoring the patient's blood pressure closely for hypertension is not appropriate because morphine more commonly causes hypotension rather than elevated blood pressure. It induces vasodilation through histamine release and decreased sympathetic tone, which can lead to orthostatic hypotension. Nursing assessment should therefore focus on detecting low blood pressure and signs of hypoperfusion rather than hypertension.

C. Requesting an order for Methylnaltrexone (Relistor) is appropriate for preventing or treating opioid-induced constipation. This medication is a peripherally acting mu-opioid receptor antagonist that reverses the constipating effects of opioids without affecting analgesia. It is useful when conventional laxatives are insufficient, especially in postoperative or chronically treated patients.

D. Palpating the patient's lower abdomen every 4 to 6 hours helps assess for urinary retention, a known side effect of opioids. Morphine can reduce bladder tone and inhibit the micturition reflex, leading to retention and bladder distention. Regular assessment allows early detection of complications such as bladder overdistension, which may require catheterization.

E. Counting respirations before and after giving the medication is critical due to the risk of respiratory depression. Morphine suppresses the respiratory center in the medulla, decreasing both respiratory rate and depth. Baseline and ongoing monitoring ensures early identification of hypoventilation, allowing timely intervention such as withholding doses or administering an opioid antagonist if necessary.

First-generation antipsychotics (FGAs) are dopamine D2 receptor antagonists used in the management of schizophrenia and other psychotic disorders. While effective for controlling positive symptoms, they are strongly associated with extrapyramidal side effects due to dopamine blockade in the nigrostriatal pathway. These adverse effects can range from acute movement disorders to delayed, often irreversible dyskinesias. Recognizing specific motor abnormalities is essential for early intervention and prevention of progression.

Rationale:
A. Akathisia is characterized by a subjective feeling of inner restlessness accompanied by observable motor agitation such as pacing or inability to sit still. It is distressing but does not involve abnormal involuntary facial or tongue movements.

B. Tardive dyskinesia is a late-onset extrapyramidal side effect of long-term dopamine blockade from First-generation antipsychotics. It is characterized by involuntary, repetitive, and often irreversible movements such as lip smacking, tongue protrusion, chewing motions, and “worm-like” tongue movements (lingual dyskinesia). It typically develops after prolonged treatment and may persist even after discontinuation of the drug.

C. Acute dystonia presents as sudden, sustained muscle contractions that can cause abnormal postures such as torticollis, oculogyric crisis, or jaw spasms. It usually occurs within hours to days of starting antipsychotic therapy. It is painful and dramatic but does not present as slow, writhing tongue movements or chewing difficulty.

D. Parkinsonism due to antipsychotics includes symptoms such as bradykinesia, rigidity, tremor, and a masked facial expression. It resembles Parkinson’s disease and results from dopamine blockade in the basal ganglia. However, it does not produce the choreoathetoid, repetitive oral-facial movements seen in tardive dyskinesia.