Key Concepts
Overview
Neuroleptic malignant syndrome ties high-yield nursing judgment to airway, perfusion, infection control, and safe medication administration. NMS is a life-threatening idiosyncratic reaction to dopamine D2 antagonists (typical and atypical antipsychotics) and rarely other dopamine-depleting drugs. Hypothalamic dysfunction produces hyperthermia, severe muscle rigidity (“lead pipe”), autonomic instability (labile BP, tachycardia, diaphoresis), altered mental status, and elevated CK from rhabdomyolysis. Management is stop the offending agent, supportive ICU care, bromocriptine or dantrolene themes per psychiatry/neurocritical care protocols, benzodiazepines for agitation, IV fluids for CK/myoglobin, and cooling for hyperthermia. Rechallenge decisions are specialist-led. Differentiate from serotonin syndrome (medication class exposure, hyperreflexia/clonus, GI hyperactivity), malignant hyperthermia (anesthetic triggers), anticholinergic toxicity, and sepsis. Cross-link US RN lessons hub · Canada RN lessons hub and related LESSON cards where the stem crosses systems. Pathophysiology in plain language. Think in layers: cells → organs → whole-person compensation. When a stem describes acute change (fever, pain, new neuro deficit, hypoxia, hypotension), ask what system is failing to compensate and what reversible threat is most time-sensitive. Nurses are the continuity layer: you trend objective data, reconcile subjective reports, and...