Clozapine Induced Myocardia Assessment 2022

Running head: ASSESSMENT 3
ASSESSMENT 3
Name of the Student:
Name of the university:
Author Note:

ASSESSMENT 31
Introduction
A 37 year old male patient, named Job, was brought to the hospital because he was experiencing
pain in his chest, arrhythmias, shortness of breath both during the resting period and also when
engaged in physical activity. 17 years ago, after experiencing an episode of psychotic symptoms,
the patient was diagnosed with schizophrenia, since he was experiencing delusions and
hallucinations for over six months. Additionally Job also got diagnosed with type 2 diabetes. The
diagnostic tests like glycated haemoglobin (A1C) test was performed for the detection of type 2
diabetes in the patient. Along with this, the C-peptide level and the circulating insulin level in the
blood of the patient was also subjected to measurement to be sure that the patient did not have
LADA. The medication he was being prescribed for his diabetic condition was metformin. Job
had a habit of consuming unlimited alcohol and also abusing drugs like opiates and cannabis.
After his diagnosis with diabetes, he stopped using the drugs but continued to smoke about 10-15
cigarettes per day along with occasional drinking in the social occasions. Job is registered with
the disability support pension scheme presently. The community mental health services keep
track of Job’s healthcare progress and status.
After getting admitted to the hospital, it was found that one of the current medication of Job, was
clozapine for his schizophrenic condition, which he was regularly taking for 22 days. The
clozapine was only prescribed to him after there was no visible improvement in his condition
after the administration of risperidone, quetiapine XR and olanzapine, which are some other
drugs that are used in the treatment of schizophrenia. He was prescribed with 12.5 mg of the
medication, which was supposed to reach about 300 mg in the oncoming weeks, after it is
ensured that he is not experiencing any side effects of the medication. A team from the
community mental services, monitored the health condition of Job very closely for the symptoms

ASSESSMENT 32
of myocarditis, like tachycardia, chest pain and flu-like symptoms. After his admission into
hospital for 5 days, he was found to be experiencing transient mild tachycardia with about 200
beats per minute and constipation. On the sixth day, he was found to be suffering from the pain
in his chest, severe tachycardia with 350 heartbeat per minute along with experiencing dizziness.
He got admitted to the emergency department of the hospital, where it was found that the
troponin level in the patient was high and there is an elevation in the ST segment in the ECG
report of the patient, suggesting the possibility of clozapine induced myocardia.
Nursing Issues in the Patient and Therapeutic Interventions
From the above introduction, it can be decided that the patient have mainly three health
conditions, which are Schizophrenia, Type-2 diabetes and the Clozapine induced myocardia.
Among all three conditions, the last condition, that is, the Clozapine induced myocardia presents
the highest challenge to the health condition of the patient, since the symptoms associated with
this health problem are most severe and put the patient’s life in an immediate risk.
Clozapine Induced Myocardia:
The patient was experiencing chest pain, shortness of breath and tachycardia, which are
the symptoms of myocarditis (Engler et al., 2015). Even though the risk of myocarditis is high
enough in the alcoholic patients, in this case another higher risk causative agent was found in this
case study. Clozapine is a drug that is used in the treatment of schizophrenia. Though it has been
found in many studies that this drug clozapine can often be associated with myocarditis and it is
considered to be a risk factor for inducing myocardia in the schizophrenic patients (Hatton, Bhat
& Gandhi, 2015). Since in this case study, Job was a schizophrenic patient, who was prescribed
with clozapine drug and the symptoms of myocarditis were only observed after he started to take
that medication, it could be concluded that Job has encountered Clozapine induced myocardia.

ASSESSMENT 33
The nursing goal for this condition in the patient was to reduce the severity of the
symptoms in patient. The symptoms include chest pain, rapid beating of the heart and shortness
of breath. All those symptoms was brought under control within few hours and thus providing
relief to the patient. The measurement of improvement was done by enquiring the patient on the
level of pain he is experiencing and by observing the patient for discomfort.
In order to lower the chest pain in the patient, various medications antianginal was used,
since they are known to lower the myocardial workload by providing sedation (Padala et al.,
2017). To lower the rapid heart rate in the patient, beta-blocker drugs was used (Otto, 2016). To
help the patient with his shortness of breath, oxygen was administered. Along with this the
patient was also sedated and was prevented from excitement.
The outcomes of the action was evaluated by checking the heart rate of the patient, which
was supposed to be lowered to normal, which is about 100 per minute. After that the patient was
observed for any discomfort he might be experiencing. The check for the shortness of breath in
patients, the pulse rate was subjected to measurement along with observing the patient for any
show of discomfort.
Schizophrenia:
A patient is said to have schizophrenia, if they seems to be having any two of the
following five symptoms, which are, abnormality in speech, delusions, hallucinations, catatonic
behavior and negative speech (Hallak et al., 2013). In this case, the patient was experiencing
anxiety, hallucination and delusions for about six months. When consulted with a physician, Job
was diagnosed with schizophrenia. The assessment was done as per the consideration of his
symptoms along with using various assessment tools such as, PANSS, SANS, SAPS, CGL-SCH
and NSA-16 (Kumari et al., 2017). Schizophrenia is a complicated mental disease, which affects