while unemployed and broke, starting several busi-
ness ventures at once, having promiscuous sex, gam-
bling, taking impulsive trips, embarking on illegal
endeavors, making risky investments, talking with
multiple people, and speeding (APA, 2000).
Some clients experience psychotic features dur-
ing mania; they express grandiose delusions involv-
ing importance, fame, privilege, and wealth. Some
may claim to be the President, a famous movie star,
or even God or a prophet.SENSORIUM AND
INTELLECTUAL PROCESSES
Clients may be oriented to person and place but rarely
to time. Intellectual functioning, such as fund of knowl-
edge, is difficult to assess during the manic phase.
Clients may claim to have many abilities that they do
not possess. Ability to concentrate or to pay attention
is grossly impaired. Again, if a client is psychotic, he
or she may experience hallucinations.
JUDGMENT AND INSIGHT
People in the manic phase are easily angered and
irritated and strike back at what they perceive as
censorship by others because they impose no restric-
tions on themselves. They are impulsive and rarely
think before acting or speaking, which makes their
judgment poor. Insight is limited because they believe
they are “fine” and have no problems. They blame any
difficulties on others.
SELF-CONCEPT
Clients with mania often have exaggerated self-
esteem; they believe they can accomplish anything.
They rarely discuss their self-concept realistically.
Nevertheless, a false sense of well-being masks dif-
ficulties with chronic low self-esteem.
ROLES AND RELATIONSHIPS
Clients in the manic phase rarely can fulfill role re-
sponsibilities. They have trouble at work or school
(if they are even attending) and are too distracted
and hyperactive to pay attention to children or ADLs.
While they may begin many tasks or projects, they
complete few.
These clients have a great need to socialize but
little understanding of their excessive, overpowering,
and confrontational social interactions. Their need
for socialization often leads to promiscuity. Clients
invade the intimate space and personal business of
others. Arguments result when others feel threatened
by such boundary invasions. Although the usual mood
of manic people is elation, emotions are unstable and
can fluctuate (labile emotions) readily between
euphoria and hostility. Clients with mania can be-
come hostile to others whom they perceive as stand-
ing in way of desired goals. They cannot postpone or
delay gratification. For example, a manic client tells
his wife, “You are the most wonderful woman in the
world. Give me $50 so I can buy you a ticket to the
opera.” When she refuses, he snarls and accuses her
of being cheap and selfish and may even strike her.PHYSIOLOGIC AND SELF-CARE
CONSIDERATIONS
Clients with mania can go days without sleep or food
and not even realize they are hungry or tired. They
may be on the brink of physical exhaustion but are
unwilling to stop or unable to rest or sleep. They often
ignore personal hygiene as “boring” when they have
“more important things” to do. Clients may throw
away possessions or destroy valued items. They may
even physically injure themselves and tend to ignore
or be unaware of health needs that can worsen.Data Analysis
The nurse analyzes assessment data to determine
priorities and to establish a plan of care. Nursing
diagnoses commonly established for clients in the
manic phase are as follows:- Risk for Other-Directed Violence
- Risk for Injury
- Imbalanced Nutrition: Less Than Body
Requirements - Ineffective Coping
- Noncompliance
- Ineffective Role Performance
- Self-Care Deficit
- Chronic Low Self-Esteem
- Disturbed Sleep Pattern
Outcome Identification
Examples of outcomes appropriate to mania are as
follows:- The client will not injure self or others.
- The client will establish a balance of rest,
sleep, and activity. - The client will establish adequate nutrition,
hydration, and elimination. - The client will participate in self-care
activities. - The client will evaluate personal qualities
realistically. - The client will engage in socially appropriate,
reality-based interaction. - The client will verbalize knowledge of his or
her illness and treatment.
15 MOODDISORDERS ANDSUICIDE 357