# A nurse is caring for a client with bipolar disorder who is experiencing a severe manic episode. The client has been awake for 72 hours, is hyperverbal, pacing rapidly, speaking loudly and incoherently, and has not eaten or slept in the past 3 days. Vital signs show tachycardia and elevated blood pressure. Which nursing intervention should be the priority?

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## 문제

A nurse is caring for a client with bipolar disorder who is experiencing a severe manic episode. The client has been awake for 72 hours, is hyperverbal, pacing rapidly, speaking loudly and incoherently, and has not eaten or slept in the past 3 days. Vital signs show tachycardia and elevated blood pressure. Which nursing intervention should be the priority?

## 보기

1. Encourage the client to participate in group therapy sessions to improve social skills
2. Provide detailed explanations about the importance of medication compliance
3. Create a calm, low-stimulation environment and ensure basic physiological needs are met **✔ 정답**
4. Engage the client in high-energy recreational activities to redirect manic energy

**정답: 3**

## 해설

In severe mania, priority is safety and meeting basic physiological needs (e.g., sleep, nutrition) in a low-stimulation environment to prevent exhaustion and escalation. Other interventions (group therapy, medication education, high-energy activities) are inappropriate during acute agitation.

## 심화 해설

Priority Intervention for Severe Mania

The correct answer is 3. Create a calm, low-stimulation environment and ensure basic physiological needs are met.

In a severe manic episode, the client's physiological stability is profoundly compromised, establishing this as the clear nursing priority. The scenario describes a client who has been awake for 72 hours without food or sleep, presenting with tachycardia and elevated blood pressure. A qualitative study on nursing care for individuals in a manic phase highlights that the core of nursing management involves addressing the patient's basic biological needs, which are often neglected due to psychomotor agitation [1]. The physiological consequences of prolonged sleep deprivation and dehydration can lead to cardiovascular strain and physical exhaustion, which are immediate threats to safety and must be stabilized before any other therapeutic intervention can be effective.

The other options are inappropriate because they do not align with the client's current capacity or safety requirements. Encouraging participation in group therapy (Option 1) is contraindicated; a client who is hyperverbal, incoherent, and highly agitated cannot process group dynamics and would be overstimulated and disruptive to others. Providing detailed explanations about medication compliance (Option 2) is futile during acute mania because the client's cognitive ability to concentrate and process complex information is severely impaired. Similarly, engaging the client in high-energy recreational activities (Option 4) would dangerously escalate psychomotor activity rather than redirect it. The foundational nursing approach, supported by the research, is to first focus on reducing external stimuli and meeting fundamental needs such as nutrition, hydration, and sleep to prevent physical collapse [1].References (research sources)

- [1]Exploration of Nursing Care for Individuals With Bipolar Disorder in a Manic Episode: A Qualitative Study.Research articleFradelos EC, Gkatzogia K, Toska A, Saridi M, Dimitriadou I, Mantzorou M, Zartaloudi A. (2024) · DOI: 10.7759/cureus.63150

## 임상 시나리오

Managing Severe Mania: Physiological PriorityStabilization before psychoeducation
For a client in a severe manic episode with prolonged sleep deprivation and poor oral intake, the immediate priority is to prevent physical exhaustion and cardiovascular collapse. Address basic needs first: provide a calm, low-stimulation environment and offer finger foods and high-calorie fluids the client can consume while pacing.

Monitor vital signs closely. Tachycardia and hypertension are expected due to increased sympathetic activity, but a risk of dehydration and eventual cardiac strain exists. Maintain a firm but calm approach, using clear, simple sentences.

CautionDo not attempt insight-oriented therapy or detailed teaching during acute mania. The client's cognitive function is impaired, and these interventions can increase frustration and agitation. Group activities are contraindicated due to overstimulation.

## 핵심 개념

- **Mania** — A distinct period of abnormally and persistently elevated, expansive, or irritable mood and increased goal-directed activity or energy, lasting at least 1 week.
- **Psychomotor agitation** — Excessive motor and cognitive activity, usually nonproductive, repetitious, and in response to inner tension, as seen in severe mania.
- **Low-stimulation environment** — A therapeutic milieu characterized by reduced noise, light, and interpersonal interaction to minimize triggers for agitation.
- **Physiological integrity** — A core NCLEX category addressing the nurse's ability to promote physical health and wellness by providing care related to basic needs.
- **Prioritization** — The clinical judgment skill of ranking nursing actions by urgency, often guided by Maslow's hierarchy or the ABCs (Airway, Breathing, Circulation).

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