A nurse is caring for a client who has just started having a seizure. Which of the following interventions should the nurse implement?

Rationale for Correct Choices:

• Mania is characterized by an abnormally elevated, expansive, or irritable mood accompanied by increased energy or activity. This client’s obsessive cleaning, excessive spending, sleeplessness, pressured speech, and overly joyous behavior strongly support a manic episode.
• Euphoric mood refers to an exaggerated feeling of well-being or elation not consistent with the client's circumstances. It often presents in mania alongside impulsivity and grandiosity, such as the client’s obsession with hosting parties and giving away money without regard for consequences.

Rationale for Incorrect Choices:

• Delirium: Typically presents with fluctuating consciousness, acute onset confusion, and disorganized thinking often due to a medical cause. The client is alert and oriented to person and time, which is inconsistent with the inattention and acute cognitive changes of delirium.
• Catatonia: Characterized by motor immobility, extreme negativism, mutism, or stupor. The client displays hyperactivity and pressured speech, which are the opposite of the psychomotor retardation seen in catatonia.
• Panic disorder: Involves sudden onset of intense fear with physical symptoms such as palpitations, chest pain, or shortness of breath. It lacks the prolonged mood elevation, impulsivity, and grandiosity observed in this case.
• Major depressive disorder: Presents with persistent sadness, fatigue, anhedonia, and social withdrawal. The client’s symptoms of increased activity, grandiosity, and reduced need for sleep do not align with depression.

• Alogia: Refers to poverty of speech or reduced speech output, often associated with schizophrenia or severe depression. This contrasts with the client’s pressured and excessive speech.
• Magical thinking: Involves believing one’s thoughts can influence the physical world, often seen in psychotic disorders or schizotypal personality disorder. The client describes hallucinations, but no evidence of magical thinking is present.
• Hypervigilance: Describes excessive alertness or scanning for threats, commonly associated with anxiety or PTSD. The client’s symptoms point to elevated mood and disinhibition, not heightened fear or threat perception.
• Anhedonia: A core symptom of depression, characterized by a loss of interest or pleasure in activities. The client’s increased goal-directed activity and enjoyment in planning events contradict this finding.

Rationale for Correct Choices:

• Intravenous antibiotic: The client exhibits signs of postpartum infection, most consistent with endometritis—elevated WBC count, low-grade fever, uterine tenderness, foul-smelling lochia, and a history of prolonged rupture of membranes and cesarean delivery. IV antibiotics are the first-line treatment to control uterine infection and prevent sepsis.
• Increase in daily fluid intake: Maintaining adequate hydration is essential to support tissue perfusion and aid in the clearance of infection. Fever and elevated WBCs increase metabolic demands, so increased fluid intake can help mitigate dehydration and support antibiotic therapy.

Rationale for Incorrect Choices:

• Kleihauer-Betke test: This test detects fetal-to-maternal hemorrhage, typically used after trauma or suspected placental abruption. It is not indicated in cases of suspected postpartum infection.
• Intrauterine tamponade balloon: This intervention is used for managing postpartum hemorrhage due to uterine atony or trauma, not infection. The client’s bleeding is moderate and not indicative of uncontrolled hemorrhage.
• Tocolytic medication: Tocolytics are used to suppress premature labor and have no role in postpartum care, especially in the presence of infection, where uterine relaxation could worsen outcomes.