Tardive Dyskinesia

[84RN]

I work in Home Health, but knew you all would have much more experience with this one. My patient has multiple serious health problems--CHF, HTN, CAD, chronic renal insufficiency, Hep C and more. He's also bipolar and has been on meds for years.

My question is when doing the admission assessment, in my narrative I need to describe his movements which are clearly tardive dyskinesia--repeatedly sticking out his tongue pretty far, licking his lips, constantly.

Is calling the movements tardive dyskinesia a medical diagnosis and something I shouldn't do, or is it ok to call it that? If not ok, then do I just describe the patient's actions?

What do you do when charting and patient has this but you don't see the diagnosis anywhere on the physician's notes or assessments ?

[MrChicagoRN, RN]

Could be TD, or maybe EPS. New or chronic? MD aware?

Best to stick to descriptors until the MD makes it official.

[mariebailey, MSN, RN]

I would promptly and directly notify the physician if there's no documentation that he/she is aware of any Hx of TD -& document that notification. You could document that you observed tongue protrusion and licking of lips repeatedly during your assessment.

[84RN]

Thanks, have a call into physician and awaiting the return call about some med issues, so will definitely mention it.

[VivaLasViejas, ASN, RN]

As a side note: Sometimes mouth movements such as you've described are just nervous habits. A lot depends on whether your patient takes an antipsychotic for his bipolar d/o; mood stabilizers don't usually cause EPS or TD. However, all of the older APs can cause these problems, as can the so-called 'atypical' APs such as Zyprexa, Seroquel et. al. (although they are somewhat less likely to do so).

In any case, you already know you can't "diagnose" the problem, even if you know in your heart of hearts that it really is TD.

[Meriwhen, ASN, BSN, MSN, RN]

Is calling the movements tardive dyskinesia a medical diagnosis and something I shouldn't do, or is it ok to call it that? If not ok, then do I just describe the patient's actions?

Agreeing with everyone else here: if there's not already a medical diagnosis of TD, just chart exactly what you see and let the provider know. It might be TD or it might not be.

[Whispera, MSN, RN]

What you have to do is describe the symptoms. You CAN (but don't have to), in narrative notes, after describing the symptoms, state that the symptoms appear to be or seem to be related to tardive dyskinesia, and that the doctor was informed.

[DenverNurse2B]

Interestingly enough, my nursing note has check boxes for things such as TD under the category of behavior. So, technically, we are diagnosing by checking the TD box, but... in the narrative section of my note, I typically write something like "Pt appears to be experiencing s/sx of TD - continuous repetitive movement of the mouth/tongue". RN will discuss with Psychiatrist and/or CW at next visit.

I'm also an in home/outreach psychiatric nurse.