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Friday, November 26, 2010

Disturbed Body Image

Disturbed Body Image

NANDA Definition
Disturbance in boy image is the confusion in mental picture of one’s physical self.


Discussion of the Problem
Body image is the sum of a person’s conscious and unconscious attitudes about his or her body. In addition, it is how a person perceives the size, appearance, and functioning of the body and its parts. It is included in the four components of self-concept namely: personal identity, body image, role performance, and self-esteem. Body image is divided in two aspects: cognitive and affective. The cognitive is the awareness of the material body, while the affective includes sensations of the body (pain, pleasure, fatigue, and physical movement). As an important part of one’s self-concept, disturbance in body image can have deep impact on how a person views his or her self. Due to the development, growth, maturation, changes related to childbearing and pregnancy, changes that occur as a result of aging and changes that occur or are imposed as a result of injury or, body image changes through life span. A patient who has a disturbance in body image may conceal or not glance at or touch a part of the body that is considerably altered in structure by either illness or trauma, or both. Other patient may also convey feelings of helplessness, hopelessness, powerlessness, and vulnerability. Further, they may also exhibit self destructive behavior such as over- or underrating or suicide attempts. It is very important in planning care to address body image disturbance, to assess the patient’s perceived alteration and Importance placed by the patient on the structure altered.

Nursing Interventions Classification (NIC)
  • Body Image Enhancement
  • Coping Enhancement
  • Grief Work Facilitation

Nursing Outcomes Classification (NOC)
  • Body Image
  • Self-Esteem

Goal and Objectives
  • Patient will demonstrate improved self-esteem and body image as manifested by ability to look at, touch, care, and talk about for actual or perceived altered part of the body or its function.

Subjective and Objective Data
  • Actual change in structure or function
  • Change in social behavior (e.g., withdrawal, isolation, flamboyance)
  • Compensatory use of concealing clothing or other devices
  • Focusing behavior on changed body part and/or function
  • Naming changed body part or function
  • Refusal to discuss or acknowledge change
  • Refusal to look at, touch, or care for altered body part
  • Verbal preoccupation with changed body part or function
  • Verbalization about altered structure or function of a body part

Related Factors
  • Change in voice quality
  • Malodorous lesions
  • Permanent alterations in structure and/or function (mutilating surgery, removal of internal or external body part)
  • Situational changes (pregnancy, temporary presence of a visible drain or tube, dressing, attached equipment)

Assessment (Dx)
  • Evaluate patient’s behavior regarding the change in structure or function of body part, also proposed change. The response of patient is more directly related to the value or meaning the patient put on the body part or function. The alteration done to the patient still results in body image disturbance, even if the alteration improves the total health of the patient. For example, an ileostomy for a patient with precancerous colon polyps.

GORDON S FUNCTIONAL HEALTH PATTERN ASSESSMENT TOOL
SELF-PERCEPTION AND SELF-CONCEPT PATTERN
SUBJECTIVE
1.         What is your major concern at the current time? ____________________
2.         Do you think this admission will cause any lifestyle changes for you?
            No__ Yes__ What? ___________________________________________
3.         Do you think this admission will result in any body changes for you?
            No__ Yes__ What? ___________________________________________
4.         My usual view of myself is: Positive__ Neutral__ Somewhat negative__
5.         Do you believe you will have any problems dealing with your current health situation?             No__    Yes__ Describe: ___________________________
6.         On a scale of 0 to 5 rank your perception of your level of control in this situation:
7.         On a scale of 0 to 5 rank your usual assertiveness level: ______________

OBJECTIVE
1.         During this assessment, does patient appear: Calm__ Anxious__ Irritable__ Withdrawn__             Restless__
2.         Did any physiologic parameters change? Face reddened: No__ Yes__; Voice volume             changed: No__ Yes__ Louder__ Softer__; Voice quality changed: No__ Yes__             Quavering__      Hesitation__ Other: ______________
3.         Body language observed: ______________________________________
4.         Is current admission going to result in a body structure or function change for the             patient? No__ Yes__ Unsure at this time__


  • Assess impact of alteration on personal relationships, activities of daily living (ADLs), occupational activities and social behavior.

  • Note frequency of self-critical remarks.

  • Note impact of disturbed body image with regards to the developmental stage of the patient. Different ages have a varied response to body image disturbance Adolescents and young adults may particularly be affected by changes in the structure or function of their bodies at a time when developing social and intimate relationships is important.

Therapeutic Interventions (Tx)
  • Acknowledge normalcy of emotional response to actual or perceived change in body structure or function. It is normal to undergo the different stages of grief when a body part or function is altered. Typically it involves a period of denial, the length of which varies from one person to another.

  • Assist patient in recognizing actual changes. Patients may perceive body alterations that are not real or present. They may also place unrealistic value on a body structure or function.

  • Demonstrate positive caring in regular activities. Professional caregivers represent a portion of society, and their actions and behaviors are examines as the patient plans to go back to home, to work, and to other activities.

  • Help patient review methods of coping that have been useful in the past. Asking the patient to recall other body image issues such as getting glasses, wearing orthodontics, having a leg cast and how they were managed may help patient adjust to the current issue.
  • Offer support to patient in integrating actual changes into Activities of Daily Living, interpersonal relationships, social life, and occupational activities. The opportunity to successfully join in social situations and positive feedback may hasten adaptation.

Educative (Edx)                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
  • Educate the patient on adaptive behavior. For instance, use of adaptive equipment, cosmetics, wigs, use of deodorants, perfumes and clothing that hides the changed body part or improves the rest of the part or function. This will assist in the adjustment of actual changed body structure and function.

  • Encourage verbalization of positive or negative feelings about actual or perceived change. Encouragement of the patient separate feelings about self-worth from the feelings about changes in body structure and/or function.

  • Instruct patient concerning the normalcy of disturbance in body image and the process of grieving.

  • Refer patient and caregivers to support groups created by individuals with similar alterations in body part or function. The support of other persons in similar situation is perceived to be helpful in adaptation.

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