Joan is a 17 year old who normally weighs 45 kg. She has lost 9 kg over past 3 months and has amenorrhea; Joan expresses an intense fear of gaining weight and is preoccupied with food. She is admitted with a diagnosis of anorexia nervosa. Joan's lunch consists of a small salad, a dinner roll and a bowl of soup and tea. What it is the responsibility of the nurse in order to assess intake?

Choice A reason: Avoiding the issue allows the patient's hygiene to deteriorate further, which can lead to skin breakdown or infections. While minimizing stress is important, neglecting physical care in a patient with psychomotor retardation is a failure to meet basic physiological needs that the patient currently cannot meet.

Choice B reason: Simply telling a patient with severe depression and psychomotor retardation that they "must" bathe is often ineffective. These patients frequently lack the physical energy or cognitive drive to initiate complex tasks. Such demands may increase feelings of inadequacy or worthlessness without providing the necessary support.

Choice C reason: Bringing a personal hygiene issue to a community meeting is a violation of the patient's privacy and dignity. It can cause significant embarrassment and shame, potentially worsening the patient's depressive symptoms and damaging the therapeutic alliance between the nurse and the patient.

Choice D reason: Patients with severe psychomotor retardation require direct assistance because they lack the volition to perform ADLs. A firm, neutral, and supportive approach provides the necessary structure and physical help to maintain hygiene and self-respect without being punitive or overly demanding, ensuring the patient's safety.

Choice A reason: Maladaptive defensive coping usually involves active behaviors such as denial, projection, or rationalization to protect the ego. The patient's presentation here is characterized by a complete lack of engagement and withdrawal (mutism), which does not clearly fit the diagnostic criteria for an active defensive coping mechanism.

Choice B reason: There is no evidence in the description (mutism, lack of eye contact, upward gazing) to suggest the patient is at risk for violence. These behaviors are more indicative of catatonia, severe depression, or profound psychotic withdrawal, none of which inherently imply a threat of physical aggression toward others.

Choice C reason: This is the most appropriate diagnosis because it directly describes the patient's inability to transmit or receive verbal and non-verbal signals. The patient’s mutism and lack of eye contact are defining characteristics of impaired communication, which will be the primary barrier to psychiatric assessment and intervention.

Choice D reason: Decisional conflict occurs when a patient is uncertain about a course of action involving risk, loss, or challenge to personal values. Since the patient is entirely non-responsive and mute, it is impossible to assess their internal decision-making process or identify any specific conflict regarding choices or actions.