A 35-year-old patient with a history of alcohol use disorder is admitted to the psychiatric unit. Which actions should the nurse prioritize in the initial care plan? (Select all that apply)

Choice A reason: A daily routine and relaxation techniques stabilize post-disaster symptoms like nightmares or hyperarousal. Scientifically, routines reduce cortisol, while relaxation calms amygdala activity, promoting emotional regulation. This mitigates trauma’s neurobiological impact, supporting recovery from acute stress or PTSD by fostering predictability and calm.

Choice B reason: Immediate psychiatric referral for medication is premature without assessment. Symptoms like nightmares stem from trauma-induced neural changes. Scientifically, unguided medication risks inappropriate treatment, potentially disrupting neurotransmitter balance and delaying psychological stabilization, as specific trauma needs must be evaluated first for effective care.

Choice C reason: Avoiding trauma discussion may suppress processing, worsening symptoms. Scientifically, unaddressed trauma increases amygdala-driven hyperarousal and cortisol, risking chronic PTSD. Encouraging avoidance delays recovery by preventing engagement with therapeutic interventions needed to reframe trauma’s psychological and neurobiological impact effectively.

Choice D reason: Isolation exacerbates symptoms by limiting support. Post-disaster stress involves heightened amygdala activity, and isolation increases cortisol, worsening anxiety. Scientifically, social withdrawal delays trauma processing, risking chronic mental health issues, as engagement with support systems is critical for stabilizing neurobiological responses and recovery.

Choice A reason: Assessing delirium causes, like medication or dehydration, identifies reversible triggers. Scientifically, delirium involves acetylcholine deficits and neuroinflammation, causing confusion. A thorough evaluation guides targeted interventions, stabilizing neural function and ensuring safety by addressing underlying physiological or pharmacological factors effectively.

Choice B reason: Administering sedatives without assessment risks masking delirium causes. Scientifically, sedatives may worsen confusion by further disrupting acetylcholine or dopamine pathways, delaying recovery. Identifying underlying triggers, like infection, is critical to stabilize neurobiological imbalances and ensure safe, effective management of agitation.

Choice C reason: Group activities are inappropriate during acute delirium, as stimulation worsens confusion. Scientifically, sensory overload increases cortisol and neural excitability, exacerbating symptoms. Stabilization through assessment is needed first, as social engagement risks further disorientation in patients with neurocognitive impairments.

Choice D reason: Restricting visitors may reduce stimulation but doesn’t address delirium’s cause. Scientifically, unaddressed triggers, like medication or infection, perpetuate acetylcholine deficits and confusion. Assessment prioritizes identifying reversible factors, ensuring safety and recovery over non-specific interventions that fail to target neurobiological issues.