A nurse is reinforcing teaching with a client about electroconvulsive therapy (ECT). Which of the following information should the nurse include in the teaching?

Protecting the client and others from impulsive behavior is the nurse's priority intervention for a client experiencing an acute manic episode. This is because impulsive behavior is a hallmark of mania and can lead to potentially harmful or dangerous consequences for the client and those around them.

Here is a detailed rationale for this choice, addressing key aspects of impulsive behavior in mania and the nurse's role in managing it:

Impulsive Behavior in Mania:

Impaired judgment: During a manic episode, the client's ability to make rational decisions is significantly impaired. They may engage in activities without considering the potential risks or consequences.

Increased energy and activity levels: Mania is characterized by excessive energy and activity, often manifested as restlessness, agitation, and a decreased need for sleep. This heightened energy can fuel impulsive actions.

Grandiosity and risk-taking: Clients in a manic state often experience inflated self-esteem and a sense of invincibility, which can lead to risky behaviors such as reckless driving, spending sprees, or sexual promiscuity.

Distractibility and lack of focus: The client's attention span is often shortened during mania, making it difficult for them to concentrate or follow through on tasks. This can contribute to impulsive decision-making.

Impaired impulse control: Mania directly affects the brain's ability to regulate impulses. This neurological impairment makes it challenging for the client to resist urges or temptations.

Nursing Interventions to Protect Against Impulsive Behavior:

Close monitoring: The nurse should closely observe the client's behavior and intervene promptly to prevent harmful actions. This may involve setting limits, redirecting the client's energy, or initiating one-on-one supervision.

Structured environment: Providing a structured and predictable environment can help reduce the client's anxiety and impulsivity. This includes establishing clear expectations, maintaining a consistent routine, and minimizing overstimulation.

Medication management: Medications such as mood stabilizers and antipsychotics can help regulate mood and reduce impulsive behaviors. The nurse plays a crucial role in administering these medications as prescribed and monitoring their effectiveness.

Therapeutic communication: The nurse can use therapeutic communication techniques to help the client identify triggers for impulsive behavior, develop coping strategies, and make safer choices.

Collaboration with the healthcare team: The nurse should collaborate with other members of the healthcare team, including psychiatrists, therapists, and social workers, to develop a comprehensive plan to address the client's impulsive behaviors.

Addressing Other Choices:

Choice B: Maintaining contact with family members is important, but it is not the priority intervention in the acute phase of mania.

Choice C: Discouraging inappropriate sexual expression is necessary, but it does not address the immediate risk of harm posed by impulsive behavior.

Choice D: Controlling loud and vulgar language is important for maintaining a therapeutic environment, but it is not the priority intervention in terms of safety.

Choice A rationale:

Disorientation is a significant neurological finding that can signal a serious adverse reaction to lorazepam, particularly in older adults. It's crucial to report it immediately to the provider for prompt assessment and intervention.

Lorazepam, a benzodiazepine, can cause central nervous system (CNS) depression, which can manifest as disorientation, confusion, memory impairment, and even delirium.

Older adults are more vulnerable to CNS depressant effects due to age-related physiological changes, such as decreased metabolism and clearance of medications, as well as increased brain sensitivity.

Early identification and management of disorientation can prevent potential complications, such as falls, injuries, and worsening cognitive decline.

Choice B rationale:

Increased anxiety can be a paradoxical reaction to lorazepam, but it's not as immediately concerning as disorientation in terms of potential for serious harm.

The nurse should still monitor anxiety levels and report any significant changes to the provider, as dosage adjustments or alternative medications may be necessary.

Choice C rationale:

Blurred vision is a common side effect of lorazepam, but it's typically mild and transient.

It's important to assess the severity and duration of blurred vision and report it to the provider if it persists or interferes with daily activities.

Choice D rationale:

Anorexia, or loss of appetite, can be a side effect of lorazepam, but it's not as urgent as disorientation.

The nurse should monitor the patient's nutritional intake and weight, and report any significant changes to the provider.