# A 79-year-old client on trihexyphenidyl for Parkinson tremor is hospitalized with new confusion, urinary retention, and dry mouth. Which is the nurse's most appropriate interpretation?

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> subject: Crisis Intervention  
> category: PSI

## Question

A 79-year-old client on trihexyphenidyl for Parkinson tremor is hospitalized with new confusion, urinary retention, and dry mouth. Which is the nurse's most appropriate interpretation?

## Option

1. Symptoms of acute pulmonary embolism
2. These are normal findings for an elderly client
3. Anticholinergic toxicity from trihexyphenidyl — Beers Criteria recommend avoiding anticholinergic antiparkinsonian agents in older adults **✔ Correct answer**
4. Signs of NMS from the trihexyphenidyl

**Correct answer: 3**

## Explanation

Correct (2): The constellation — confusion, dry mouth, urinary retention, constipation, blurred vision — is classic anticholinergic toxicity. Beers Criteria strongly recommend AVOIDING anticholinergic antiparkinsonian drugs (trihexyphenidyl, benztropine) in older adults due to delirium, fall, and cognitive decline risk; safer alternatives (carbidopa-levodopa, amantadine) are preferred. (1) Not normal. (3) PE has different presentation. (4) NMS requires fever, rigidity, autonomic instability.

## In-depth explanation

Memory Tip Anticholinergic toxicity = "Hot as a hare, Dry as a bone, Red as a beet, Blind as a bat, Mad as a hatter, Full as a flask" — hyperthermia, dry, flushed, mydriasis, delirium, urinary retention.

## Clinical scenario

Scenario 79-year-old male, Parkinson disease on trihexyphenidyl 4 mg/day, admitted with new confusion, urinary retention, dry mouth, constipation, blurred vision.

## Key concepts

- **Anticholinergic burden** — Cumulative anticholinergic load from multiple medications; significant cognitive risk in older adults.
- **Beers Criteria** — AGS list of medications potentially inappropriate for adults ≥65; includes anticholinergic antiparkinsonian agents.
- **Anticholinergic toxicity** — "Hot/Dry/Red/Blind/Mad/Full" symptom complex from excess muscarinic blockade.

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