The nurse continues to care for the client.

For each assessment finding, click to specify if the finding is consistent with psychosis or mania. Each finding may support more than one diagnosis.

Rationale for correct choices

• Mania: The client exhibits classic signs of mania, including elevated mood, excessive energy, decreased need for sleep, impulsive behavior such as excessive spending, and pressured, disorganized speech. These behaviors are consistent with a manic episode rather than delirium, catatonia, major depressive disorder, or panic disorder.

• Euphoric mood: The client demonstrates an overly joyous and elevated sense of self-confidence, which is characteristic of euphoric mood during a manic episode. Euphoric mood contributes to impulsive behaviors, distractibility, and poor judgment. This finding aligns with the manic episode and helps distinguish mania from other psychiatric conditions that primarily involve negative mood states or anxiety.

Rationale for incorrect choices

• Delirium: Although the client is disoriented to place and exhibits poor concentration, delirium typically develops acutely and fluctuates, often secondary to a medical condition or substance use. The client’s sustained elevated mood, impulsive behavior, and pressured speech are not consistent with delirium.

• Panic disorder: Panic disorder involves sudden episodes of intense fear, palpitations, and autonomic hyperactivity, which are not reported in this client. The client’s persistent elevated mood, lack of fear-driven episodes, and impulsive behaviors do not align with panic disorder symptoms.

• Catatonia: Catatonia is characterized by motor immobility, stupor, mutism, or rigidity, which contrasts sharply with the client’s constant movement, hyperactivity, and pressured speech. The client demonstrates goal-directed and excessive activity rather than the motor inhibition seen in catatonia.

• Major depressive disorder: Major depressive disorder involves persistent low mood, anhedonia, and lack of energy, which is the opposite of the client’s elevated, euphoric mood and hyperactivity. The client’s impulsivity and pressured speech indicate a manic state rather than depression. Depressive symptoms are not evident in the current presentation.

• Magical thinking: Although magical thinking can occur in some psychiatric conditions, the client’s primary feature is euphoric mood and goal-directed hyperactivity. There is no evidence of superstitious beliefs or illogical thought processes driving behavior.

• Alogia: Alogia refers to poverty of speech or reduced verbal output, which is inconsistent with the client’s pressured and loud speech. The client demonstrates excessive verbal output, indicating elevated energy rather than speech poverty.

• Anhedonia: Anhedonia, or lack of pleasure, is a symptom of depression, which is absent here. The client’s enjoyment of activities, desire to host parties, and euphoric mood contradict the presence of anhedonia.

• Hypervigilance: Hypervigilance involves excessive alertness and scanning for threats, often seen in anxiety or PTSD. While the client reports seeing hallucinations, these perceptual disturbances are more consistent with psychosis, not hypervigilance. The primary finding supporting mania is euphoric mood rather than anxiety-driven alertness.

A. Instill normal saline drops to nares before meals: Saline drops are used to loosen nasal secretions in conditions like the common cold or bronchiolitis. They do not address epiglottitis and are not a primary intervention for this life-threatening airway condition.

B. Perform chest percussion and postural drainage twice per day: Chest physiotherapy is indicated for conditions with increased pulmonary secretions, such as cystic fibrosis or pneumonia. Epiglottitis primarily affects the upper airway, so these interventions are not appropriate.

C. Initiate droplet precautions: Epiglottitis is often caused by Haemophilus influenzae type b and can be transmitted via respiratory droplets. Implementing droplet precautions protects healthcare workers and other clients from infection while the child receives care.

D. Administer pancreatic enzymes with meals: Pancreatic enzyme replacement is used in conditions like cystic fibrosis to aid digestion. It is unrelated to epiglottitis and does not address the acute respiratory risk posed by airway inflammation.