A client is admitted with bipolar disorder, manic psychosis. The client is placed in seclusion after unsuccessful attempts by staff at deescalating the client during a sudden mood swing from laughter to jumping and screaming threats while waving a plastic dinner knife. The client is given haloperidol 5 mg IM STAT prior to seclusion. Which intervention is most important for the nurse to implement immediately after seclusion?

A. Phototherapy involves exposure to specific wavelengths of light to help regulate mood and alleviate symptoms of depression, anxiety, or sleep disorders. It can be particularly beneficial in a hospital setting where natural light exposure may be limited, potentially aiding in mood stabilization and improving sleep patterns.
B. Lithium is a mood stabilizer commonly used to treat bipolar disorder. While the client's symptoms and presentation do not immediately suggest bipolar disorder, lithium could be considered if there are indications of mood instability or severe emotional dysregulation that are not adequately controlled by other medications.
C. Consciousness raising refers to increasing awareness and understanding of one's thoughts, emotions, and behaviors. In the context of therapy, it can help the client process traumatic experiences, gain insight into their reactions, and develop coping strategies. This approach can be integrated into various forms of psychotherapy.
D. CBT is a structured form of psychotherapy that focuses on identifying and modifying dysfunctional thought patterns and behaviors. It has been shown to be effective in treating anxiety, depression, PTSD, and other trauma-related disorders by helping individuals challenge negative thoughts and develop healthier coping mechanisms.
E. ECT involves passing electrical currents through the brain to intentionally trigger a brief seizure. It is primarily used for severe depression or other mental illnesses that have not responded to other treatments. Given the client's presentation and the availability of less invasive treatments, ECT would generally not be considered unless her condition worsens significantly and other therapies are ineffective or contraindicated.
F. Animal therapy involves interacting with animals, such as therapy dogs or horses, to improve mood, reduce stress, and provide emotional support. This type of therapy can be beneficial for individuals experiencing trauma or emotional distress, offering comfort and companionship.

At risk of hypovolemia

D. Total blood loss of 800 mL

A total blood loss of 800 mL indicates significant hemorrhage, which puts the client at risk for hypovolemia (low blood volume). While exact definitions may vary, typically, blood loss exceeding 500 mL postpartum is considered significant and increases the risk of hypovolemia if not managed appropriately.

F. 200 mL blood loss

While 200 mL of blood loss is within the normal range for immediate postpartum period, it still represents a loss of blood that, if ongoing, could potentially lead to hypovolemia if not monitored closely.

Condition has improved

A. Fundus massaged until firm and at umbilicus

Massaging the fundus until it is firm and at the umbilicus helps ensure uterine contraction, which reduces the risk of excessive bleeding and promotes hemostasis. This indicates that uterine tone is adequate, which is a positive sign.

C. Straight catheter produced 500 mL clear yellow urine

The passage of 500 mL of clear yellow urine indicates adequate renal perfusion and hydration status, suggesting that the client's fluid balance is being maintained or improved, which is important in preventing hypovolemia.

E. Blood pressure of 110/80 mm Hg, heart rate of 66 beats/minute, oxygen saturation at 98% on room air

Stable vital signs with normal blood pressure, heart rate, and oxygen saturation indicate adequate perfusion and oxygenation. This suggests that the client's condition is stable and not immediately at risk for hypovolemia.

G. Fundus remains firm with slight lochia noted on pad

A firm fundus with slight lochia (postpartum vaginal discharge) indicates ongoing normal involution (shrinking) of the uterus with minimal bleeding. This suggests that the client's uterus is contracting well, which is favorable for preventing hypovolemia.