NU245 Unit 5 Long-Acting Injectable Rationale Example

One Injection a Month Instead of Pills He Stops: A Medication Rationale for Starting a Long-Acting Injectable Antipsychotic in a Composite Twenty-Nine-Year-Old With Schizophrenia After Three Admissions in a Year

[Student Name]

Purdue University Global

NU245: Mental Health Nursing

Unit 5 Medication Rationale

[Instructor Name]

[Date]

The patient is composite; the medication, doses and schedule are the prescriber's, doses are bracketed or omitted, and the paper explains the nursing rationale for screening, monitoring and teaching.

The Patient and the Prior Treatment

[Mr. W.], composite, 29, diagnosed with schizophrenia at [22]. Oral risperidone controlled his voices and suspiciousness when he took it. Over the past year he stopped it three times, each time a few weeks after discharge, saying he forgot doses, then felt well and saw no need, and once that it made him "slow in the mornings." Each relapse led to an admission, the last after he stopped eating, believing his food was poisoned. He lives with his mother, who would like to help but cannot make him take pills.

The Ordered Medication and Why It Fits

Paliperidone palmitate is a long-acting injectable form of paliperidone, the main active metabolite of risperidone. It is given into the deltoid or gluteal muscle, with two starting injections about a week apart and then once a month, as ordered. Because it is closely related to risperidone, which he has tolerated, the risk of an unexpected reaction is lower. The main advantage is that he does not need to remember a daily pill, and a missed dose is known to the team as soon as he misses an appointment rather than weeks later. In a nationwide cohort of nearly 30,000 people with schizophrenia, long-acting injectable antipsychotics were associated with a substantially lower risk of psychiatric rehospitalization than the equivalent oral forms, and once-monthly paliperidone was among the treatments with the lowest rehospitalization risk (Tiihonen et al., 2017).

The pills worked when he took them; the problem was every day he had to decide again, and a monthly injection removes thirty decisions.

Screening Before the First Dose

Confirm he has tolerated oral risperidone or paliperidone without a serious reaction. Record a baseline: weight, waist, blood pressure, fasting glucose or A1c and lipids, since antipsychotics can cause weight gain and metabolic changes (American Diabetes Association et al., 2004). Ask about movement problems, sexual side effects and breast changes. Check kidney function, because poor renal clearance would change the dosing. Ask about falls or dizziness on standing.

Monitoring and Teaching

After each injection: check the site for pain, redness or swelling, and alternate sites. Watch for restlessness, stiffness or tremor, and for dizziness on standing. Over the following months, weigh him at each visit and repeat metabolic labs as ordered, at least at about three months and then yearly according to the consensus schedule. Ask directly about sexual side effects and breast symptoms, since raised prolactin is common with this drug. Report fever with muscle rigidity and confusion at once. Teaching for him and his mother, in plain words: why the injection replaces the pill; that the medicine stays in his body for weeks, so any side effect will not disappear the next day and should be reported early; the date of the next injection, written down; and that feeling well is a sign the medicine is working, not a sign it is no longer needed (Halter, 2022).

What Might Make Him Stop This One

1. Feeling "slow in the mornings" again. Ask at every visit; the dose or timing can be discussed with the prescriber.

2. Weight gain. Early weighing and teaching about food and activity matter, since weight gain is a common reason young men stop antipsychotics.

3. Sexual side effects he is embarrassed to mention. Ask directly and privately.

4. Missed appointments. A reminder call and his mother's support help, and a missed injection is followed up within days.

Talking About the Injection Without Coercion

A long-acting injection can feel like control to someone who has stopped pills before. The decision is presented as his, with the reasons from his own history: three admissions, each after stopping. The nurse asks what worries him about an injection, answers honestly and does not suggest that refusing would lead to admission. If he agrees, he chooses the injection site and the day of the month that suits his schedule, which keeps some control in his hands. If he refuses, his reasons are recorded and the team returns to the conversation, since a forced start is likely to end in another stop.

His Mother's Role

His mother is involved with his permission. She learns the injection dates, the side effects to watch for and how to encourage him without nagging. She is also told that relapse warning signs, such as poor sleep, withdrawal from family or new suspicion about food, should be reported early to the clinic rather than waiting for a crisis.

Weeks, Not Days

Improvement after the switch is judged over weeks to months. Success looks like a year without an admission, steady weight and his own report that he can live with the side effects.

References

American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, & North American Association for the Study of Obesity. (2004). Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care, 27(2), 596-601. https://doi.org/10.2337/diacare.27.2.596

Halter, M. J. (2022). Varcarolis' foundations of psychiatric-mental health nursing: A clinical approach (9th ed.). Elsevier.

Tiihonen, J., Mittendorfer-Rutz, E., Majak, M., Mehtälä, J., Hoti, F., Jedenius, E., Enkusson, D., Leval, A., Sermon, J., Tanskanen, A., & Taipale, H. (2017). Real-world effectiveness of antipsychotic treatments in a nationwide cohort of 29 823 patients with schizophrenia. JAMA Psychiatry, 74(7), 686-693. https://doi.org/10.1001/jamapsychiatry.2017.1322