A client diagnosed with bipolar I disorder experienced an acute manic episode and was admitted to the in-patient psychiatric unit. The client is now ready for discharge. Which of the following resource services should be included in discharge teaching? Select all that apply.

Bipolar I disorder during manic episodes presents with elevated mood, hyperactivity, and impaired judgment, often leading to risk-taking behaviors and physical exhaustion. Clients may exhibit distractibility, impulsivity, and psychomotor agitation, which significantly increase the risk for injury. Immediate interventions must target physiological stabilization and behavioral containment using pharmacologic and environmental strategies.

Rationale for correct answer

2. PRN antipsychotic medications help reduce agitation and stabilize mood by modulating dopamine activity. They are appropriate for acute symptom control when hyperactivity poses a risk for injury and non-pharmacologic methods are insufficient.

Rationale for incorrect answers

1. Placing the client with another symptomatic peer increases stimulation and risk of behavioral escalation. It compromises safety and violates principles of environmental control in psychiatric care.

3. Discussing consequences requires insight, which is impaired during acute mania. The client may be unable to process or retain such information, making this intervention ineffective in the short term.

4. Reinforcing coping skills assumes cognition and emotional regulation, which are compromised during manic episodes. The client is unlikely to engage meaningfully with learned strategies until stabilized.

Take Home Points

• Bipolar I disorder with hyperactivity requires immediate pharmacologic intervention to reduce risk of injury.
• Antipsychotics are effective in managing acute agitation and restoring behavioral control.
• Environmental stimulation must be minimized to prevent escalation of manic symptoms.
• Insight-based and cognitive interventions are deferred until the client achieves symptom stabilization.

Manic phase of bipolar disorder is marked by elevated mood, hyperactivity, and distractibility, often leading to poor nutritional intake. Clients may be unable to sit through full meals, making finger foods essential for maintaining caloric intake. Nutritional strategies must accommodate erratic behavior and ensure energy-dense, portable options that can be consumed quickly. Foods should be easy to handle, require minimal utensils, and be appealing enough to encourage spontaneous eating during periods of agitation or pacing.

Rationale for correct answer

2. This option provides nutritious, high-calorie finger foods that can be eaten while moving. The sandwich, carrot sticks, grapes, and cookies are portable and require no utensils, supporting adequate intake during hyperactivity.

Rationale for incorrect answers

1. Soup and peaches require utensils and sitting still, which is impractical during manic episodes. The liquid nature of soup also increases spill risk and may discourage consumption.

3. Roast chicken and mashed potatoes are difficult to eat without sitting and using utensils. These foods are less suitable for clients who are pacing or unable to focus on structured meals.

4. Although the tuna sandwich is portable, the ice cream and apple require more effort to consume and may not be appealing or practical during periods of agitation and distractibility.

Take Home Points

• Clients in manic states benefit from high-calorie, portable finger foods that accommodate hyperactivity and distractibility.
• Structured meals requiring utensils are often ineffective during acute mania.
• Nutritional interventions must prioritize accessibility and caloric density to prevent weight loss and exhaustion.
• Food choices should be tailored to behavioral presentation, not just nutritional value.