A nurse is speaking with a family member of a client who has a terminal diagnosis. The family member states, "I'm having a hard time letting her go." The nurse should recognize that the family member is experiencing which of the following types of grief?

Rationale:

• Disorganized thought process: The client exhibits difficulty concentrating, constant movement, and disorganized speech, which can occur in both psychotic and manic episodes. In psychosis, disorganized thinking may result from impaired reality testing, whereas in mania, it can manifest as flight of ideas or tangential thinking. Both conditions share cognitive disorganization.

• Lack of sleep: The client has not slept for 2 days, a classic symptom of mania. Sleep deprivation often accompanies manic episodes, contributing to increased energy, impulsivity, and impaired judgment. This distinguishes mania from psychosis, where sleep patterns may vary but are not necessarily markedly reduced.

• Excessive spending habits: The client demonstrates impulsive financial behaviors, giving away large sums of money and making erratic purchases. This symptom is characteristic of mania, reflecting poor judgment, elevated self-esteem, and risk-taking behavior. Excessive spending is not associated with psychosis unless part of a delusional belief.

• Hallucinations: The client reports seeing and interacting with someone who is not present, which is a core symptom of psychosis. Hallucinations involve sensory perception without external stimulus and indicate a break from reality. These are not inherently features of mania unless comorbid psychotic symptoms are present, making this symptom specific to psychosis.

• Pressured speech: The client’s loud, rapid, and continuous speech reflects pressured speech, a hallmark of manic episodes. It indicates increased thought speed, distractibility, and elevated energy. While speech may be disorganized in psychosis, the rapid, overproductive pattern is more characteristic of mania.

A. Presence of bloody show: Bloody show, or the passage of a small amount of blood-tinged mucus, is an indication of cervical changes and impending labor. It is associated with true labor and not a feature of false labor.

B. Intermittent, painless contractions: Painless, irregular contractions that do not increase in intensity or frequency are characteristic of false labor. These contractions often resolve with rest, position changes, or ambulation and do not produce progressive cervical dilation or effacement.

C. Contraction intensity increased by ambulation: In true labor, contractions typically intensify with ambulation or activity. Contractions that remain unchanged or decrease with movement are more consistent with false labor.

D. Slow change in dilation and effacement: Any progressive change in the cervix (dilation or effacement) is a hallmark of true labor. In false labor, the cervix remains closed and thick despite the presence of contractions.