A client who has been using large amounts of alcohol for years is admitted for withdrawal management and suddenly becomes disoriented and combative. What is the primary nursing concern in this situation?

A. Delirium tremens (DTs) is a severe and life-threatening complication of alcohol withdrawal that typically occurs 48 to 72 hours after the last drink. It is characterized by disorientation, agitation, confusion, hallucinations, tachycardia, hypertension, fever, and diaphoresis. Sudden disorientation and combative behavior in a client with long-term heavy alcohol use strongly suggest the development of DTs, which requires immediate medical intervention to prevent seizures, cardiovascular collapse, or death. Therefore, this is the primary nursing concern. B. Although clients experiencing alcohol withdrawal may have coexisting depression or suicidal ideation, the immediate presentation of acute disorientation and combativeness indicates a physiologic withdrawal complication rather than suicidal intent. Suicide risk assessment is important but not the priority in this acute scenario. C. Risk of falling is a valid concern because disorientation and agitation increase the likelihood of injury. However, this is a secondary safety concern. The underlying cause—possible delirium tremens—is life-threatening and must be addressed first. D. Nutritional deficiencies, such as thiamine deficiency, are common in chronic alcohol use and should be assessed and treated. However, nutritional assessment is not the immediate priority when the client shows acute signs of severe withdrawal and altered mental status.