A nurse is developing a plan of care for a client who has a gambling disorder. Which of the following actions should the nurse plan to take?

Rationale for correct choices

• Mania: The client exhibits classic signs of mania, including elevated mood, excessive energy, decreased need for sleep, impulsive behavior such as excessive spending, and pressured, disorganized speech. These behaviors are consistent with a manic episode rather than delirium, catatonia, major depressive disorder, or panic disorder.

• Euphoric mood: The client demonstrates an overly joyous and elevated sense of self-confidence, which is characteristic of euphoric mood during a manic episode. Euphoric mood contributes to impulsive behaviors, distractibility, and poor judgment. This finding aligns with the manic episode and helps distinguish mania from other psychiatric conditions that primarily involve negative mood states or anxiety.

Rationale for incorrect choices

• Delirium: Although the client is disoriented to place and exhibits poor concentration, delirium typically develops acutely and fluctuates, often secondary to a medical condition or substance use. The client’s sustained elevated mood, impulsive behavior, and pressured speech are not consistent with delirium.

• Panic disorder: Panic disorder involves sudden episodes of intense fear, palpitations, and autonomic hyperactivity, which are not reported in this client. The client’s persistent elevated mood, lack of fear-driven episodes, and impulsive behaviors do not align with panic disorder symptoms.

• Catatonia: Catatonia is characterized by motor immobility, stupor, mutism, or rigidity, which contrasts sharply with the client’s constant movement, hyperactivity, and pressured speech. The client demonstrates goal-directed and excessive activity rather than the motor inhibition seen in catatonia.

• Major depressive disorder: Major depressive disorder involves persistent low mood, anhedonia, and lack of energy, which is the opposite of the client’s elevated, euphoric mood and hyperactivity. The client’s impulsivity and pressured speech indicate a manic state rather than depression. Depressive symptoms are not evident in the current presentation.

• Magical thinking: Although magical thinking can occur in some psychiatric conditions, the client’s primary feature is euphoric mood and goal-directed hyperactivity. There is no evidence of superstitious beliefs or illogical thought processes driving behavior.

• Alogia: Alogia refers to poverty of speech or reduced verbal output, which is inconsistent with the client’s pressured and loud speech. The client demonstrates excessive verbal output, indicating elevated energy rather than speech poverty.

• Anhedonia: Anhedonia, or lack of pleasure, is a symptom of depression, which is absent here. The client’s enjoyment of activities, desire to host parties, and euphoric mood contradict the presence of anhedonia.

• Hypervigilance: Hypervigilance involves excessive alertness and scanning for threats, often seen in anxiety or PTSD. While the client reports seeing hallucinations, these perceptual disturbances are more consistent with psychosis, not hypervigilance. The primary finding supporting mania is euphoric mood rather than anxiety-driven alertness.

A. Start another IV line in another extremity: Establishing a new IV line is necessary to continue therapy, but it is not the first action. Immediate steps must focus on preventing further tissue damage from the infiltrated vesicant.

B. Apply a warm, moist compress: Warm or cold compresses may be applied depending on the type of vesicant and institutional protocol, but this is a secondary intervention after stopping the infusion and protecting the tissue.

C. Disconnect IV tubing and aspirate medication from the IV catheter: Aspirating the remaining medication may help reduce tissue exposure, but it is performed after the infusion is stopped to prevent further infiltration.

D. Stop the infusion: Stopping the infusion immediately is the first and most critical action to prevent further tissue damage. Halting the delivery of the vesicant stops the source of injury and allows subsequent interventions to minimize local tissue necrosis.