A patient in the manic phase of bipolar disorder throws a meal tray at lunch. Which of the following are appropriate initial responses? 


• Patients in the manic phase of bipolar disorder may have labile moods (rapidly shifting) and can quickly go from very happy to angry.  

• It is important to listen carefully to these patients about how they perceive the situation so the situation can be resolved. Open-ended questions and invitations to share their feelings are appropriate.

• The nurse and patient should work together to seek solutions to the problem. This strengthens the nurse-patient relationship and empowers the patient to problem-solve in a more productive and collaborative way.

• The use of restraints is only indicated if a patient is an immediate threat of harm to him or herself or others and will not agree to safety, and only after less restrictive interventions have been attempted.

• Offering a PRN may be appropriate if it is ordered for agitation, but this should not be the first response. The nurse should first attempt to help the patient problem-solve collaboratively and use other means of coping, and reserve the use of PRN medication as a last resort.

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