A provocatively dressed client diagnosed with bipolar I disorder is observed laughing loudly with peers in the milieu. Which nursing action is a priority in this situation?

Manic phase of bipolar disorder is marked by elevated mood, impulsivity, and agitation, which can escalate into threatening or aggressive behavior. Management follows a least-to-most restrictive approach to preserve autonomy while ensuring safety. Initial strategies focus on redirecting energy and setting boundaries. If these fail, pharmacologic intervention is used to reduce symptoms. Physical containment measures like seclusion and restraints are reserved for imminent risk when other interventions are ineffective.

Rationale for answer

4. Diversional activities are the least restrictive and aim to redirect excess energy into safe, structured outlets. They help reduce agitation and promote engagement without limiting freedom.

3. Limit setting involves establishing behavioral boundaries and expectations. It maintains safety while preserving the client’s autonomy and is essential in early behavioral de-escalation.

5. Medication administration is more restrictive as it involves pharmacologic intervention to manage symptoms. It is used when behavioral strategies are insufficient to control agitation or risk.

1. Seclusion removes the client from the environment to prevent harm. It is restrictive and used only when the client poses a danger to others and cannot be managed through verbal or pharmacologic means.

2. Restraints are the most restrictive, involving physical containment. They are used as a last resort when all other measures fail and there is an immediate threat to safety.

Take Home Points

• Managing mania requires a stepwise approach from behavioral redirection to physical containment.
• Diversional activities and limit setting preserve autonomy and reduce escalation.
• Medications are used when non-pharmacologic strategies fail to control symptoms.
• Seclusion and restraints are reserved for imminent risk and must follow strict legal and ethical protocols.

Bipolar I disorder is a chronic psychiatric condition marked by alternating episodes of mania and depression. During manic phases, clients exhibit elevated mood, hyperactivity, grandiosity, and poor impulse control. These episodes often impair judgment and increase risk-taking behaviors, including aggression, self-harm, and harm to others. The manic state may also include psychotic features such as hallucinations or delusions, but the most immediate concern is safety—especially when disinhibition and impulsivity escalate to violent behavior.

Rationale for correct answer

1. During acute mania, impulsivity and poor judgment heighten the risk of aggressive outbursts toward others. The client may misinterpret interactions or act on grandiose beliefs, making violence a priority concern for nursing safety interventions.

Rationale for incorrect answers

2. Although hallucinations may occur in manic episodes, they are not the most immediate threat unless they directly provoke harmful behavior. The priority is safety, not perceptual disturbances.

3. Manic clients are typically hyper-social and intrusive, not withdrawn. Isolation is more characteristic of depressive phases, making this diagnosis less relevant during acute mania.

4. Feelings of guilt and low self-esteem are more prominent in depressive episodes. During mania, clients often display inflated self-worth and lack insight into inappropriate behaviors.

Take Home Points

• In acute mania, safety risks due to impulsivity and aggression take precedence over other psychosocial concerns.
• Bipolar I disorder includes manic episodes that may escalate to psychosis or violence, requiring close monitoring.
• Differentiating manic symptoms from depressive or psychotic features is essential for accurate nursing diagnosis.
• Nursing priorities shift with phase of illness—mania demands safety-focused interventions, while depression may focus on mood and cognition.