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MANIA
| Question | Answer |
|---|---|
| Mania is the opposite of ________ | DEPRESSION |
| What does mania mean? | Greek word meaning "madness" - an abnormally elevated mood state; excessive excitement or enthusiasm; craze |
| What can cause manic disorder? | 1. unresolved diffuse anger and hostility 2. denial of depression 3. may develop from early childhood as a result of high parental expectations |
| During infancy, needs and narcissistic goals are not met, which leads to _______________ | Impairment in the development of self-esteem |
| Low self-esteem and helplessness lead to _____________ | a need for excessive attention, affection, warmth, and appreciation |
| The air of happiness and self-confidence that the manic client may show is a defense against __________ | dependency feelings |
| Manic onset before the age of _______ years | Before the age of 30 years |
| What are s/s of Mania? | Continuous high, emotions labile, flight of ideas, delusions, hallucinations, constant motor activity, decreased attention span, altered sleep patterns, poor judgement, hypersexual, no inhibitions, inappropriate dress, spending sprees, manipulation |
| What are delusions? | A fixed, false belief or idea |
| What are delusions of grandeur? | a delusion that you are much greater and more powerful and influential than you really are - Example: They think they are Jesus. |
| What is the underlying need in this delusions? (Delusions of grandeur) | the need is to feel good about self or self-esteem needs |
| What are delusions of persecution? | a delusion that one is being attacked, harassed, persecuted, cheated, or conspired against - they think that everyone is out to get them - they feel threatened all the time |
| What is the underlying need in this delusions? (Delusions of persecition) | the need is to feel safe |
| When a psychiatric client is having a delusion, do you argue about the belief? | NO! Let the client know that you ACCEPT the belief, but you do not believe it. This helps with security & self-esteem. Do not talk a lot about the delusion with the client. |
| What is the difference between hallucinations & delusions? | a hallucination is something a person experiences through one of their 5 SENSES (see, hear, smell, taste or feel), but that isn't real. A delusion is something a person THINKS, something they strongly believe to be true, which is not. |
| What is the most common type of hallucination? | Auditory hallucinations are by far the most common type of hallucination and they are usually experienced as voices, whether familiar or unfamiliar, that are perceived as distinct from the person’s own thoughts. |
| What are flight of ideas? | a continuous stream of talk in which the patient switches rapidly from one topic to another and each subject is incoherent and unrelated to the preceding one or is stimulated by some environmental circumstance. |
| Constant motor activity eventually leads to ___________ | EXHAUSTION - The constant motor activity can be loud, rapid, difficult to interpret, rhyming, punning, and clanging |
| What is "clanging" speech? | using words that sound like the meaning rather than the actual word |
| What is the nurses role when a manic person is dressed inappropriately (wild/seductive)for a situation? | A manic person may dress INAPPROPRIATE FOR A SITUATION (WILD/SEDUCTIVE)and the nurses role is to maintain the person's integrity & bring them back to their room & assist the them changing their clothes. Don't ever just ignore their inappropriate clothing |
| What kind of diet should a manic client be on? What is the best type of foods to give them? | A manic person can't stop to eat. They are too busy to stop and eat. The nurse should provide a HIGH-CALORIE, HIGH-VITAMIN DIET. FINGER FOODS are the best type of food to give the client so they can eat as they move about. |
| What kind of sleep patterns does a manic client have? How is their personal hygiene? | Altered sleep patterns - decreased need for sleep. They have poor personal hygiene so the nurse should assist the client with personal hygiene and grooming. |
| Explain how manic clients have no inhibitions and are hypersexual. | They have no inhibitions - they do anything (take off their clothes) & they say anything (profane/vulgar). They are hypersexual and may exploit other clients. They may make inappropriate sexual advances and be obscene or exhibitionistic |
| What does exhibitionistic mean? | compulsively attracting attention to yourself especially by public exposure or exaggerated behavior; a psychosexual disorder marked by the compulsive exposure of the genitals in public |
| What is the course of a manic episode? | It begins suddenly, rapidly escalates over a few days, and ends more abruptly than major depressive episodes |
| How does a manic client try to manipulate others? Why do they like to manipulate others/how does it make them feel? What happens when the manipulation fails? | They try to "charm" you or compliment you as a form of manipulation. Manipulation makes them feel SECURE & POWERFUL. When a manic client tries to manipulate you and fails, they get mad and turn on you. |
| What is the nurses role when a client tries to manipulate the staff? | SET LIMITS; STAFF MUST BE CONSISTENT!!! If you go along with it then you are just reinforcing bad behavior. |
| Should we encourage the manic client to participate in group activities? | Limit group activities - we want to decrease stimuli becuase the more people (stimuli)the louder they will get. We want to provide them with a nonstimulating environment. |
| What kind of activities should we encourage manic clients to participate in? | NONCOMPETITIVE solitary activities such as walking, swimming, or painting. Writing activites are also good because they provide an energy outlet without too much stimulation. |
| What kind of nurse-client relationship should the nurse provide for a manic client? | The nurse must use a FIRM, CONSISTENT, HONEST approach. The client feels more secure in a ONE-ON-ONE RELATIONSHIP. Maintain some distance b/w self and client to allow freedom of movement & to prevent feelings of being overpowered |
| We want the manic client to have _________, ________ contact with the staff. | We want the manic client to have BRIEF, FREQUENT contact with the staff. We want to initiate regularly scheduled contacts with the client to demonstrate acceptance. Too much intense conversation stimulates the client. |
| What should the nurse do as a manic client's anxiety increases? | Nurse should STAY with the client as anxiety increases - we need to keep them calmed down |
| What should the nurse do if the manic client is being loud and running in and out of other client's rooms? | Give them an activity to do - provide an activity to replace purposeless activity. |
| What kind of schedule should a manic client have? | A structured schedule - makes them feel secure. Involve the client in their own care planning. |
| How should the nurse set limits on manic client's behavior? | The nurse instructions should be CLEAR & CONCISE. The nurse should not argue or try to reason with the client b/c this will increase their anxiety & stimulate the client. The nurse should not hurry the client b/c this leads to anxiety & hostile behavior. |
| What are some nursing considerations for manic clients nutrition? | WEIGH DAILY (b/c they are losing weight); keep snacks avaliable; provide the client with FINGER FOODS that are high in vitamins & calories. The nurse should walk with the client during meals - this keeps them calmer & they eat more. |
| The nurse should remove anything that could be potential hazards. Examples include: | Anything can be a potential hazard (even a cotton ball). Watch them when they are smoking because they can cause danger to themselves or danger to other clients. |
| Other key points on mania: | It is important that no matter what the client's dignity is maintained b/c they may do things or say things that they wouldn't normally do or say. They BLAME everybody for everything - Everyone else is the problem, not them. |
| In a manic patient, which is priority: Caloric Intake or Coping Skills? | CALORIC INTAKE |
| ***NURSING PRIORITY*** | In a hyperactive state, the client is extremely distractible, and responses to even the slightest stimuli are exaggerated. |
| ***NURSING PRIORITY*** | During the manic phase, the client's physical safety is at risk because the hyperactivity may lead to exhaustion, and ultimately, cardiac failure. |
| *****NCLEX HINT***** | On the NCLEX, they don't like nurses that use restraints! |
| What medications may be given to treat the client with mania? | Haldol, Thorazine, Zyprexa or Risperdal --> used to decrease agitation & hyperactivity; Lithium --> anti-manic medication; Anticonvulsants --> used to stabilize mood |
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