A patient who is experiencing a manic episode approaches the nurse and with pressured speech states,"I hate oatmeal.Let's get everybody together to do exercises.I'm thirsty and I'm burning up.Get out of my way; I have to see that guy." The priority nursing action is to:

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During a manic episode,the patient may be inattentive to physical needs or illness.The brief remark about "burning up" could suggest fever.Thirst may accompany fever,be a sign of dehydration,or be related to lithium administration.More information is needed.Because hyperactive patients have difficulty remaining still,taking the temperature and pulse will give priority information.If necessary,BP can be taken later.A nutritional consult is not a priority intervention.It is not appropriate to foster increased hyperactivity.To show relief would be disrespectful on the part of the nurse.

A Patient Who Is Experiencing a Manic Episode Approaches the Nurse