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Difficulty: MediumMental Health Concepts

A client diagnosed with bipolar disorder is in the dayroom. The client is experiencing an acute manic episode, speaking loudly, and intruding on the personal space of peers who are trying to watch television. Which action should the practical nurse take first?

  1. A
    Ask the client why they feel the need to interrupt the other individuals in the room.
  2. B
    Remind the client about the unit rules regarding respect and personal boundaries.
  3. Suggest walking together to a quiet area and offer the client a high-protein snack.Answer
  4. D
    Prepare to administer a prescribed as-needed intramuscular sedative medication.

Answer

The practical nurse should redirect the client to a low-stimulus environment and offer a portable snack, as this addresses the acute symptoms of mania without confrontation.
Clients experiencing acute mania have poor impulse control, high distractibility, and elevated energy levels that can lead to exhaustion or altercations. The most effective initial action is to reduce environmental stimulation by gently redirecting the client to a quieter area. Offering a handheld, high-protein snack provides a constructive physical outlet and addresses the high risk of nutritional deficits common in manic episodes.

Step-by-Step Solution

1
Analyze the client's current behavioral presentation within the milieu.
The client is exhibiting signs of acute mania, including hyperactivity, loud speech, and poor boundary control, which is disrupting other clients.
Accurately identifying the client's state dictates the priority of nursing interventions needed to maintain safety and therapeutic environment.
2
Determine the priority goal for a manic client exhibiting intrusive behavior.
The primary goals are to reduce environmental stimuli, protect peers from intrusion, and ensure the client's basic physiological needs are met.
Clients in acute mania are easily overstimulated, prone to physical exhaustion, and can inadvertently provoke altercations with others.
3
Select the least restrictive and most therapeutic nursing intervention.
Gently redirecting the client to a quiet area while providing a snack effectively de-escalates the situation and provides a safe outlet for their energy.
Physical or chemical restraints are a last resort. Furthermore, logical reasoning or probing questions are ineffective due to the client's impaired cognitive focus.

Key Concept

Crisis De-escalation and Milieu Management in Bipolar Disorder
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Topics

Mental Health Concepts

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