A client is admitted to the hospital with the diagnosis of bipolar affective disorder, with a current episode of mania without psychotic symptoms. Which of the following nursing diagnoses is appropriate for this client?

1. A

   Knowledge deficit R/T disease condition

2. B

   Risk for violence: Other-directed R/T poor impulse control

3. C

   Social isolation R/T elevated mood

4. D

   Disturbed sleep patterns R/T hyperactivity

Appeared in: UPUMS Nsg officer-2023

Explanation

• A decreased need for sleep is a cardinal and diagnostic symptom of a manic episode, as listed in the DSM-5 criteria.
• According to Maslow's hierarchy of needs, physiological needs such as sleep are a priority over psychosocial needs.
• Severe sleep deprivation can lead to physical exhaustion, cognitive impairment, and can exacerbate the manic symptoms, making it a critical safety concern.
• Addressing the disturbed sleep pattern is fundamental to stabilizing the patient's overall condition.

Why Other Options Were Wrong

• Option A: A knowledge deficit is not a priority during an acute manic phase. The patient's cognitive state, characterized by distractibility and flight of ideas, prevents effective learning. Teaching is deferred until the mania is stabilized.
• Option B: While irritability and impulsivity are present, the question specifies 'without psychotic symptoms,' which often reduces the likelihood of targeted, other-directed violence. The more immediate risk is often self-injury from hyperactivity and poor judgment.
• Option C: This is the opposite of typical manic behavior. Clients with mania are usually overly social, intrusive, and gregarious. They do not feel isolated; rather, they may overwhelm others with their constant need for interaction.

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Clinical Relevance

• Nursing practice connection: Use the key finding related to Prioritizing nursing diagnoses for a patient in a manic episode of bipolar disorder to guide bedside assessment, documentation, and the next nursing action.
• In managing acute mania, the nurse's first priority is always physiological stability and safety. This includes ensuring adequate rest, nutrition, and hydration, which are often compromised by hyperactivity.
• Failure to address sleep deprivation can lead to a state of delirious mania, which is a medical emergency characterized by severe disorientation and physical exhaustion.
• What if the client also had psychotic symptoms like paranoid delusions? The 'Risk for violence: Other-directed' diagnosis would become a much higher priority, potentially even equal to or greater than the sleep disturbance, as the client might act on their paranoid beliefs.

How to Approach the Question

• First, identify the client's diagnosis and current state: 'bipolar affective disorder, mania without psychotic symptoms'.
• Recall the classic signs and symptoms of a manic episode: elevated mood, hyperactivity, decreased need for sleep, racing thoughts, grandiosity, and poor judgment.
• Apply Maslow's hierarchy of needs. Physiological needs (like sleep, nutrition, safety) must be addressed before psychosocial needs (like knowledge, social interaction).
• Evaluate each nursing diagnosis option against the classic manic presentation and Maslow's hierarchy.
• Option A (Knowledge deficit) is a psychosocial need and not a priority in the acute phase.
• Option B (Violence) is a safety risk, but 'Risk for Injury' is often more accurate. Sleep is a more universal and immediate physiological need.

Concept Tested & Keywords

• Concept Tested: Prioritizing nursing diagnoses for a patient in a manic episode of bipolar disorder.
• Stem keywords: bipolar affective disorder, mania without psychotic symptoms, nursing diagnoses
• Lead-in keywords: appropriate
• Clinical cues: Current episode of mania
• Clinical cues: Without psychotic symptoms

Question ID

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Copy ID

Reference Book

E6 Guide to Mental Health & PSYCHIATRIC NURSING R Sreevani— Part 1 (pp 26-289 of 579) pp. 207-209, 206-208, 203-205