A client has been admitted in withdrawal delirium. He is dehydrated and has a bruised, swollen tongue. He is experiencing illusions and auditory hallucinations and is confused. In developing a care plan for this client, what measure should the nurse include to ensure physiologic stability?

Choice A reason: Mutism, the absence of speech, is not typical in acute mania, where dopamine-driven hyperactivity increases verbal output. Mutism is more associated with catatonia or severe depression, where psychomotor inhibition or serotonin deficits reduce communication, making this inconsistent with mania’s neurobiological profile.

Choice B reason: Flight of ideas, characterized by rapid, disjointed speech, typifies acute mania due to dopamine and norepinephrine hyperactivity in the prefrontal cortex and limbic system. This leads to accelerated thought processes and pressured speech, reflecting the manic state’s heightened neural excitability and reduced inhibitory control.

Choice C reason: Hesitant speech is not characteristic of acute mania, where dopamine-driven hyperactivity results in rapid, pressured speech. Hesitancy may occur in anxiety or depression, linked to serotonin dysregulation or prefrontal inhibition, contrasting with mania’s uninhibited, accelerated verbal output driven by neurochemical overstimulation.

Choice D reason: Psychomotor retardation, slowed speech and movement, is typical of depression, driven by serotonin and dopamine deficits. In acute mania, heightened dopamine and norepinephrine activity cause rapid speech and agitation, making psychomotor retardation incompatible with the neurobiological profile of manic speech patterns.

Choice A reason: Aphasia, a language impairment, is not a hallmark of delirium but is associated with neurological conditions like stroke affecting Broca’s or Wernicke’s areas. Delirium involves acute cognitive dysfunction due to underlying causes like infection or hypoxia, primarily affecting attention and awareness, not specific language processing, making this choice scientifically inaccurate for delirium.

Choice B reason: Confusion is a core feature of delirium, characterized by disorientation and impaired attention due to acute brain dysfunction. It results from disruptions in cerebral metabolism, often triggered by systemic issues like electrolyte imbalances or sepsis. This symptom distinguishes delirium from dementia, as it reflects rapid, reversible cognitive changes, requiring immediate assessment.

Choice C reason: Impaired level of consciousness, such as fluctuating alertness or stupor, is a defining feature of delirium. It stems from diffuse brain dysfunction, often due to toxic, metabolic, or infectious causes affecting neurotransmitter balance or cerebral perfusion. This distinguishes delirium from dementia, which typically preserves consciousness, making this a critical diagnostic criterion.

Choice D reason: Long-term memory impairment is characteristic of dementia, not delirium. Delirium involves acute, reversible cognitive deficits, primarily affecting attention and short-term memory due to transient brain dysfunction. Long-term memory remains relatively intact in delirium, as the underlying pathology does not typically involve chronic neuronal loss, unlike Alzheimer’s or other dementias.

Choice E reason: Mood fluctuations occur in delirium due to acute brain dysfunction affecting emotional regulation, often linked to neurotransmitter imbalances or systemic stressors like infection. However, they are not a primary diagnostic criterion compared to confusion, impaired consciousness, and rapid onset, as they may also occur in other psychiatric conditions, reducing specificity.

Choice F reason: Rapid onset of symptoms is a hallmark of delirium, distinguishing it from dementia’s gradual progression. Symptoms develop over hours to days due to acute insults like hypoxia, infection, or medication toxicity, disrupting cerebral function. This rapid timeline is critical for diagnosis, as it indicates a reversible condition requiring urgent intervention.