An older client with prostatic enlargement takes trihexyphenidyl and develops confusion, dry mouth, blurred vision, and inability to urinate. Which action should the nurse take?
1Give another dose because confusion indicates inadequate control of parkinsonian symptoms.
2Encourage ambulation alone because urinary retention reflects normal aging.
3Restrict fluids and wait for the symptoms to resolve before reporting them.
4Hold trihexyphenidyl, notify the prescriber promptly, and evaluate anticholinergic toxicity.✓ Correct answer
Explanation
Confusion, dry mouth, blurred vision, and acute urinary retention are consistent with excessive anticholinergic effects from trihexyphenidyl. Older adults have increased sensitivity, and prostatic enlargement raises the risk of urinary obstruction. The nurse should hold the medication, notify the prescriber promptly, assess bladder distention and vital signs, and anticipate a dose or treatment reassessment. Additional medication, independent ambulation, fluid restriction, and delayed reporting are unsafe.
Clinical reasoning Trihexyphenidyl blocks parasympathetic muscarinic activity. Reduced secretions, impaired accommodation, cognitive change, and poor bladder contraction can appear together as anticholinergic toxicity.
Decision rule Escalate new confusion or urinary retention during trihexyphenidyl therapy, especially in an older client or one with possible outlet obstruction.
Scenario 79-year-old male, Parkinson disease on trihexyphenidyl 4 mg/day, admitted with new confusion, urinary retention, dry mouth, constipation, blurred vision.