This article is about disturbed body image, subjective data, objective data, expected outcomes, nursing diagnosis and rationale, and nursing care plan and rationale for the same.
What is body image?
Body image is how a person feels about his or her body and what they do about those feelings. It can also be defined as the subjective perception of one’s physical appearance based on self-evaluation, reactions, and feedback from others. Some people may feel inferior about their bodies and try to improve them through a variety of means called appearance management behaviors.
What is body image disturbance?
Body image disturbance refers to confusion in the mental picture of one’s physical self.
What are the situational factors related to disturbed body image?
- Trauma due but not limited to sexual abuse, rape, accidents, and assault.
- Equipment, tubes, drains
- Eating disorder
- Weight loss
- Effects on Appearance: obesity, r/t cog/percep factors, r/t morbid fear of obesity
- Maturational: r/t developmental changes, immobility, pregnancy
What is self-concept?
- Thinking component of the self
Organized & dynamic system of learned beliefs
- Attitudes & opinions that each person holds to be true about themself
As a significant component of one’s self-concept, body image disturbance can have an intense impression on how individuals see their overall selves.
A person begins forming his or her perceptions of the body’s attractiveness, health, acceptability, and functionality in early childhood. This body image continues throughout the lifespan and receives feedback from peers, family members, and coaches. For example, a woman may experience Disturbed Body Image during pregnancy. Physical changes associated with aging may result in body image disturbance for older adults. Personality traits such as perfectionism and self-criticism can also affect the development of a negative internalized image of the body. Appropriate care for distorted body image is a significant step to recovery. Cognitive Behavioral Therapy, an approach where irrational thoughts are recognized, analyzed, and restructured to more rational self-talk, is frequently used in planning care to address body image disturbance.
Subjective Data that indicates a Problem of Disturbed Body Image: Patient’s Feelings, Perceptions, and Concerns. (Symptoms)
What subjective data indicates a problem of disturbed body image?
- Verbalizes negative feelings about bodily changes
- Reports fear of rejection by others
- Talks about the affected body part
- Talks negatively about physical change or body part
Objective Data that indicates a Problem of Disturbed Body Image: Assessment, Diagnostic Tests, and Lab Values. (Signs)
What objective data indicates a problem of disturbed body image?
- Refusal to talk about physical changes
- Hiding of affected body part
- Verbal detachment from physical change
- Missing body part
- Does not look at the body part
- Does not touch the body part
- Refuses to participate in teaching sessions to become accustomed to the new situation.
What are the desired/expected outcomes for nursing diagnosis of disturbed body image?
- The patient will use learned coping strategies to adjust to a new reality
- The patient will recognize self-sabotage and accept help
- The patient will identify irrational beliefs and use new coping strategies to enhance perception about body image.
Disturbed Body Image Nursing Diagnosis and Rationale
What are the nursing diagnoses and rationales for disturbed body image?
|Assess the meaning of loss or change to the patient and SO, including future expectations and impact of cultural or religious beliefs.||The extent of response is more related to the value or importance the patient places in the part or function than the actual value or importance. This necessitates support to work through to optimal resolution.|
|Assess the perceived impact of change in ADLs, social participation, personal relationships, and occupational activities.||Alteration in body image can have an effect on the patient’s ability to carry out daily roles and responsibilities.|
|Assess the result of body image disturbance in relation to the patient’s developmental stage.||Adolescents and young adults may be individually affected by changes in the structure or function of their bodies at a time when developmental changes are normally rapid and at a time when developing social and intimate relationships is particularly important.|
|Evaluate the patient’s behavior regarding the actual or perceived changed body part or function.||There is a broad range of behaviors associated with body image disturbance, ranging from totally ignoring the altered structure or function to preoccupation with it.|
|Evaluate the patient’s verbal remarks about the actual or perceived change in body part or function.||Negative statements about the affected body part may indicate limited ability to integrate the change into the patient’s self-concept.|
Disturbed Body Image Nursing Care plan and Rationale
What are the nursing care plans and rationales for disturbed body image?
The following are the therapeutic nursing interventions for Disturbed Body Image:
|Acknowledge and accept the expression of feelings of frustration, dependency, anger, grief, and hostility. Note withdrawn behavior and use of denial.||Acceptance of these feelings as a normal response to what has occurred facilitates resolution. It is not helpful or possible to push the patient before ready to deal with the situation. Denial may be prolonged and be an adaptive mechanism because the patient is not ready to cope with personal problems.|
|Recognize the normalcy of response to the actual or perceived change in body structure or function.||Experiencing stages of grief over the loss of a body part or function is normal and typically involves a period of denial, the length of which varies among individuals.|
|Set limits on maladaptive behavior. Maintain a non-judgmental attitude while giving care, and help the patient identify positive behaviors that will aid in recovery.||Patients and SO tend to deal with this crisis in the same way in which they have dealt with problems in the past. Staff may find it difficult and frustrating to handle behavior that is disrupting and not helpful to recuperation but should realize that the behavior is usually directed toward the situation and not the caregiver.|
|Support verbalization of positive or negative feelings about the actual or perceived loss.||It is worthwhile to encourage the patient to separate feelings about changes in body structure or function from feelings about self-worth. Expression of feelings can enhance the patient’s coping strategies.|
|Assist the patient in incorporating actual changes into ADLs, social life, interpersonal relationships, and occupational activities.||The more noticeable the change in body structure or function, the more anxious the patient may have about the response of others to the change. Opportunities for positive feedback and success in social situations may hasten adaptation.|
|Exhibit positive caring in routine activities.||Positive remarks by the nurse may encourage the patient to develop more positive responses to the changes in his or her body.|
|Be realistic and positive during treatments, in health teaching, and in setting goals within limitations.||This enhances trust and rapport between patient and nurse.|
|Provide hope within parameters of the individual’s situation; do not give false reassurance.||This promotes a positive attitude and provides an opportunity to set goals and plan for the future based on reality.|
|Give positive reinforcement of progress and encourage endeavors toward the attainment of rehabilitation goals.||Words of encouragement can support the development of positive coping behaviors.|
|Encourage family interaction with each other and with the rehabilitation team.||A good conversation provides ongoing support for the patient and family.|
|Provide a support group for SO. Give information about how the SO can be helpful to the patient.||Support groups promote the ventilation of feelings and allow for more helpful responses to the patient.|
|Provide thorough teaching and complete aftercare instructions for the patient.||Reinforcing teaching can help the patient achieve self-care.|
|Discuss with the patient about the normalcy of body image disturbance and the grief process.||The patient experiencing a body image change needs new information to support the cognitive appraisal of the change.|
|Teach the patient adaptive behavior (e.g., use of adaptive equipment, wigs, cosmetics, clothing that conceals the altered body part or enhances remaining part or function, use of deodorants).||Adaptive behaviors help the patient compensate for the actual changed body structure and function.|
|Support the patient in identifying ways of coping that have been beneficial in the past.||These may help the patient adjust to the current issue.|
|Refer the patient and caregivers to support groups composed of individuals with similar alterations.||Lay people in similar situations offer a different type of support, which is perceived as helpful (e.g., United Ostomy Association, Y Me?, I Can Cope, Mended hearts).|
|Refer to physical and occupational therapy, vocational counselor, psychiatric counseling, clinical specialist psychiatric nurse, social services, and psychologist, as needed.||These are helpful in identifying ways/devices to regain and maintain independence. The patient may need further assistance to resolve persistent emotional problems.|
Disturbed Body Image Subjective Data, Objective Data, Expected Outcomes, Nursing Diagnosis and Rationale, and Nursing Care Plan and Rationale Example.
Nursing Care Plan for: Disturbed Body Image, Residual Limb, Amputation, and Amputee
|Your patient, who is a 42 year old male, is post-opt day 5 from an emergent right below the knee amputation due to a bulldozer accident. The patient’s incision is open to air with staples well intact. No drainage or swelling is noted. The patient’s wife has verbalized concern to you that her husband doesn’t understand that he will need therapy to help him walk again with a prosthesis. She shares concerns that “it is like he thinks his leg is still there”. You note that the patient refuses to look or touch his right residual limb. When you start to ask the patient about how he feels about therapy the patient cuts you short and says “I don’t understand why everyone is making a big deal about this. Once my staples are gone I will be able to walk. I don’t need therapy. My legs are fine.” During the md rounds, you discuss with the md about your concern with the patient accepting his amputation. The md order a psych consult.|
|Disturbed body image related to permanent alterations in structure and function of the right leg as evidenced by refusal to discuss or acknowledge change and refusal to look or touch right residual limb.|
|The patient’s wife has verbalized concern to you that her husband doesn’t understand that he will need therapy to help him walk again with a prosthesis. She shares concerns that “it is like he thinks his leg is still there”. “I don’t understand why everyone is making a big deal about this. Once my staples are gone I will be able to walk. I don’t need therapy. My legs are fine.”|
|Your patient, who is a 42 year old male, is post-opt day 5 from an emergent right below the knee amputation due to a bulldozer accident. The patient’s incision is open to air with staples well intact. No drainage or swelling is noted. During the md rounds, you discuss with the md about your concern with the patient accepting his amputation. The md order a psych consult.|
|-The patient will look and touch his residual limb before discharge.-The patient will verbalize and acknowledge he has a right below the knee amputation before discharge.
-The patient’s wife will report an increase in the patient’s willingness to accept his amputation by discharge.
-The patient will verbalize his concerns and needs to the nurse regarding his amputation by discharge.
|-The nurse will consult the psych doctor per md request within 1 hour.
-The nurse will encourage the patient to talk about his amputation during each shift.
-The nurse will encourage the patient to look and touch his residual limb during each shift.
-The nurse will educate the patient’s wife on 3 techniques to use on how to get the patient to understand and accept his amputation.
-The nurse will assess for the patient’s acceptance regarding his amputation every shift.