Therapeutic interactions between the nurse and a manic patient ...

[dollx]

Therapeutic interactions between the nurse and a manic patient will be facilitated when the nurse:
 
  a. Uses a calm, matter-of-fact approach to structuring
  b. Focuses primarily on enforcing rigid limits on behaviors
  c. Implements a laissez-faire approach to the patient's symptoms
  d. Encourages the patient to use humor and wit to redirect energy

Question 2

A patient who is experiencing a manic episode approaches the nurse and with pressured speech states, I hate oatmeal. Let's get everybody together to do exercises.
 
  I'm thirsty and I'm burning up. Get out of my way; I have to see that guy. The priority nursing action is to:
  a. Measure the patient's temperature and pulse.
  b. Offer to have the dietitian visit to discuss his diet.
  c. Tell the patient he can lead exercises at the community meeting.
  d. Show relief when the patient ends the interaction and walks away.

[lgoldst9]

Answer to Question 1

ANS: A
A calm, matter-of-fact approach minimizes patient need for defensiveness and minimizes power struggles. The use of rigid limit setting leads to power struggles and escalation of pa-tient hyperactive, aggressive behavior. Structure and judicious limit setting are more thera-peutic. A laissez-faire approach is nontherapeutic; manic patients usually need structure. En-couraging humor and wit is generally ineffective since patients with mania cannot maintain control of emotions and may shift from witty to angry in seconds.

Answer to Question 2

ANS: A
During a manic episode, the patient may be inattentive to physical needs or illness. The brief remark about burning up could suggest fever. Thirst may accompany fever, be a sign of dehydration, or be related to lithium administration. More information is needed. Because hyperactive patients have difficulty remaining still, taking the temperature and pulse will give priority information. If necessary, BP can be taken later. A nutritional consult is not a priority intervention. It is not appropriate to foster increased hyperactivity. To show relief would be disrespectful on the part of the nurse.