A psychiatric nurse observes a patient sitting still, staring at the wall, and resisting all attempts at interaction. What is the most appropriate nursing diagnosis?

1. A

   Risk for Violence

2. B

   Disturbed Sensory Perception

3. C

   Social Isolation

4. D

   Catatonia related to Schizophrenia

Appeared in: GMCH Nursing Officer-2025

Explanation

• The patient's symptoms—motor immobility, mutism, and resistance to interaction—are classic signs of the catatonic subtype of schizophrenia.
• This option is the most specific and comprehensive choice, as it accurately describes the unique psychomotor disturbances presented.
• While not a formal NANDA-I diagnosis, in the context of selecting the best fit from given options, 'Catatonia' precisely identifies the syndrome.
• Catatonia involves a significant disturbance in motor behavior, which is the most prominent feature in the described scenario.

Why Other Options Were Wrong

• Option A: There is no information in the stem to suggest the patient is agitated, aggressive, or posing a threat to themselves or others. The patient is described as still and withdrawn.
• Option B: While the patient could be experiencing hallucinations (e.g., staring at the wall), there is no direct evidence of a sensory perception disturbance. The primary observable signs are motor and social.
• Option C: Although the patient is clearly socially isolated, this diagnosis is too general. It fails to capture the severity and the specific psychomotor symptoms (immobility, staring) that are characteristic of catatonia.

Related Visual

• Visual 1: Table - A comparison table showing the signs and symptoms of Social Isolation vs. Catatonia to highlight the key differentiators (psychomotor symptoms).
• Visual 2: Infographic - An infographic illustrating the key features of catatonia, including stupor, mutism, waxy flexibility, and negativism.

Clinical Relevance

• Nursing practice connection: Use the key finding related to Identification of appropriate nursing diagnoses for psychiatric conditions, specifically recognizing the signs of catatonia to guide bedside assessment, documentation, and the next nursing action.
• Recognizing catatonia is a critical nursing skill. It is a serious condition that can lead to life-threatening complications like dehydration, malnutrition, deep vein thrombosis (DVT), and skin breakdown due to immobility.
• Nurses must prioritize the patient's physiological needs (hydration, nutrition, skin integrity) while also providing a safe, structured, and non-threatening environment.
• What if? - If the patient's symptoms included waxy flexibility (maintaining a position they are placed in), it would further confirm the diagnosis of catatonia and necessitate immediate medical evaluation for treatments like benzodiazepines or ECT.

How to Approach the Question

• First, break down the patient's presentation into specific, observable signs: 1) motor immobility ('sitting still'), 2) fixed gaze ('staring'), and 3) unresponsiveness ('resisting interaction').
• Next, evaluate each option against these signs.
• Eliminate options that are not supported by the evidence. 'Risk for Violence' is unsupported as the patient is immobile, not agitated.
• Differentiate between the remaining plausible options. 'Social Isolation' is true but general. 'Disturbed Sensory Perception' is possible but not directly observed.
• Select the diagnosis that is most specific and accounts for the entire clinical picture. 'Catatonia' uniquely explains the combination of severe withdrawal and psychomotor immobility.
• Recognize that in nursing exams, you must often choose the 'most' appropriate answer, even if options are not perfectly formulated according to NANDA-I standards.

Concept Tested & Keywords

• Concept Tested: Identification of appropriate nursing diagnoses for psychiatric conditions, specifically recognizing the signs of catatonia.
• Stem keywords: psychiatric nurse, patient sitting still, staring at the wall, resisting interaction
• Lead-in keywords: most appropriate, nursing diagnosis
• Clinical cues: The combination of motor immobility ('sitting still') and lack of engagement ('resisting interaction') points towards a psychomotor disturbance rather than simple social withdrawal.

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Q6pUBplpW2furFc7A_sQlL

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