Nursing Care Plan: Disturbed body image related to change in body structure and function.

Scientific Basis:

The image of physical self, or body image, is how a person perceives the size appearance, an functioning of the body and its parts. Body image has both cognitive and affective aspects. The cognitive is the knowledge of the material body; the affective includes the sensations of the body, such as pain, pleasure, fatigue, and physical movement. Body image is the sum of these attitudes, conscious and unconscious, that a person has toward his or her body. The individual who has a body image disturbance may hide or not look at or touch a body part that is significantly changes in structure by illness or trauma. Some individuals may also express feelings of helplessness, hopelessness, powerlessness, and vulnerability, and may exhibit self-destructive behavior such as over- or under eating or suicide attempts.

The attitude is dynamic and is altered through interaction with other persons and situations, and is influenced by age and developmental level. As an important part of one’s self-concept, body image disturbance can have a profound impact on how individuals view their overall selves. In cultures where one’s appearance is important, variations from the norm can result in body image disturbance. The importance that an individual places on a body part or function may be more important in determining the degree of disturbance that the actual alteration in structure or function.

Gulanick, 2007; Bearman, et at, 2008; Taylor, et al, 2005

Intervention and Rationale

I: Assess perception of change in structure or function of the body part.
R: The extent of the response is more related to the value or importance the client places on the part or function than the actual value or importance. Even when an alteration improves the overall health of the individual, the alteration may result in a body image disturbance.

I: Assess perceived impact of change on activities of daily living (ADLs), social behavior, personal relationships, and occupational activities.
R: Changes in body image can have an impact on the person’s ability to carry out daily roles and responsibilities.

I: Assess impact of body image disturbance in relation to the client’s developmental stage.
R: In every developmental stage, they see their body image differently.

I: Note the client’s behavior regarding the actual or perceived change body part or function.
R: 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.

I: Note the frequency of the client’s self-critical remarks.
R: Negative statements about the affected body part indicate limited ability to integrate the change into the client’s self-concept.

I: Acknowledge normalcy of emotional response to actual change in body structure or function.
R: Stages of grief over loss of a body part or function is normal and typically involves a period of denial, the length of which varies between individuals.

I: Help the client identify actual changes.
R: clients may perceive changes that are not present or real, or they place an unrealistic value on a body structure or function.

I: Support and encourage client; provide care with a positive, friendly attitude.
R: Caregivers sometimes allow judgmental feelings to affect the care of client and need to make every effort to help patient feel valued as a person.

I: Encourage verbalization of positive or negative feelings about the actual or perceived change.
R: It is worthwhile to encourage the client to separate feelings about changes in body structure and/or function from feelings about self-worth. Expression of feelings can enhance the person’s coping strategies.

I: Assist the client in incorporating actual changes into ADLs, social life, interpersonal relationships, and occupational activities.
R: Opportunities for positive feedback and success in social situations may hasten adaptation.

I: Demonstrate positive caring in routine activities.
R: Professional caregivers represent a microcosm of society, and their actions and behaviors are scrutinized as the client plans to return to home, work, and other activities.

I: Teach the client about the normalcy of body image disturbance and the grief process.
R: The person experiencing a body image changes needs new information to support cognitive appraisal of the change.

I: Teach the client adaptive behavior (e.g., wearing shoes)
R: This compensates for the actual changed body structure and function.

I: Encourage family/SO to verbalize feelings, visit freely/participate in care.
R: Family members may feel guilty about client’s condition and may be fearful of impending death. They need nonjudgmental emotional support and free access to client. Participation in care helps them feel useful and promotes trust between staff, client, and SO.

I: Help the client identify ways of coping that have been useful in the past.
R: Asking client to remember other body image issues and how they were managed may help the client adjust to current issue.

I: May refer the client and caregivers to support groups composed of individuals with similar alterations.
R: Lay persons in similar situations offer a different type of support, which is perceived as helpful.

Doenges, et al, 2008; Gulanick, 2007; Kruse, et al, 2003


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