A client in alcohol withdrawal is being monitored using the CIWA-Ar scale. What does a rising CIWA-Ar score indicate?

CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol, revised): A validated 10-item scale that quantifies alcohol withdrawal severity. ITEMS: Nausea/vomiting, tremor, sweating, anxiety, agitation, tactile/auditory/visual disturbances, headache, orientation; SCORING: Higher score = more severe withdrawal; guides symptom-triggered benzodiazepine dosing; RISING SCORE = worsening — requires more aggressive treatment; WITHDRAWAL PROGRESSION (if untreated): Tremors/anxiety (6-12h) → hallucinations (12-24h) → seizures (24-48h) → delirium tremens (48-96h, life-threatening); TREATMENT: Benzodiazepines (lorazepam, diazepam, chlordiazepoxide) are first-line — symptom-triggered dosing based on CIWA score; thiamine (B1) BEFORE glucose (prevents Wernicke encephalopathy); fluid/electrolyte management; quiet environment; DELIRIUM TREMENS: Medical emergency with high mortality if untreated — confusion, severe autonomic instability, hallucinations; nursing role: assess with CIWA, administer benzodiazepines per protocol, monitor for escalation, ensure safety, give thiamine.