Body Image Disturbance-Selected Examples

1. Definition-a body image disturbance arises when a person is unable to accept the body as is and to adapt to it; a conflict develops between the body as it actually is and the body that is pictured mentally, that is, the ideal self.
2. Analysis/nursing diagnosisbody image disturbance may be related to:
   1. Sensation of size change due to obesity, pregnancy, weight loss.
   2. Feelings of being dirty-may be imaginary due to hallucinogenic drugs, psychoses.
   3. Dual change of body structure and function due to trauma, amputation, stroke, etc.
   4. Progressive deformities due to chronic illness, burns, arthritis.
   5. Loss of body boundaries and depersonalization due to sensory deprivation, such as blindness, immobility, fatigue, stress, anesthesia. May also be due to psychoses or hallucinogenic drugs.
3. Assessment.

Body Image Disturbance Caused by Amputation

1. Assessment:
   1. Loss of self-esteem; feelings of helplessness, worthlessness, shame, and guilt.
   2. Fear of abandonment may lead to appeals for sympathy by exhibiting helplessness and vulnerability.
   3. Feelings of castration (loss of self) and symbolic death; loss of wholeness.
   4. Existence of phantom pain (most clients).
   5. Passivity, lack of responsibility for use of disabled body parts.
2. Nursing care plan/implementation:
   1. Avoid stereotyping person as being less competent now than previously by not referring to client as the “amputee.”
   2. Foster independence; encourage self-care by assessing what client can do for himself or herself.
   3. Help person set realistic short-term and longterm goals by exploring with the client his or her strengths and resources.
   4. Health teaching:
      1. Encourage family members to work through their feelings, to accept person as he or she presents self.
      2. Teach how to set realistic goals and limitations.
      3. Explain what phantom pain is; that it is a normal experience.
      4. Explain role and function of prosthetic devices, where and how to obtain them, and how to find assistance in their use.
3. Evaluation/outcome criteria:
   1. Can acknowledge the loss and move through three stages of mourning (shock and disbelief, developing awareness, and resolution).
   2. Can discuss fears and concerns about loss of body part, its meaning, the problem of compensating for the loss, and reaction of persons (repulsion, rejection, and sympathy).

Body Image Disturbance in Cerebrovascular Accident (Stroke)

1. Assessment:
   1. Feelings of shame (personal, private, selfjudgment of failure) due to loss of bowel and bladder control, speech function.
   2. Body image boundaries disrupted; contact with environment is hindered by inability to ambulate or manipulate environment physically; may result in personality deterioration due to diminished number of sensory experiences. Loses orientation to body sphere; feels confused, trapped in own body.
2. Nursing care plan/implementation:
   1. Reduce frustration and infantilism due to communication problems by:
      1. Rewarding all speech efforts.
      2. Listening and observing for all nonverbal cues.
      3. Restating verbalizations to see if correct meaning is understood.
      4. Speaking slowly, using two-to three-word sentences.
   2. Assist reintegration of body parts and function; help regain awareness of paralyzed side by:
      1. Tactile stimulation.
      2. Verbal reminders of existence of affected parts.
      3. Direct visual contact via mirrors and grooming.
      4. Use of safety features (Posey belt).
   3. Health teaching: control of bowel and bladder function; how to prevent problems of immobility.
3. Evaluation/outcome criteria: dignity is maintained while relearning to control elimination.

Body Image Disturbance in Myocardial Infarction
Emotional problems (anxiety, depression, sleep disturbance, fear of another myocardial infarction [MI]) during convalescence can seriously hamper rehabilitation. The adaptation and convalescence is influenced by the multiple symbolic meanings of the heart, for example:

1. Seat of emotions (love, pride, fear, sadness).
2. Center of the body (one-of-a-kind organ).
3. Life itself (can no longer rely on the heart; failure of the heart means failure of life).
   1. Assessment:
      1. Attitude-overly cautious and restrictive; may result in boredom, weakness, insomnia, exaggerated dependency.
      2. Acceptance of illness-Use of denial may result in noncompliance.
      3. Behavior-self-destructive.
      4. Family conflicts-related to activity, diet.
      5. Effects of MI on:
         1. Changes in lifestyle-eating, smoking, drinking; activities, employment, sex.
         2. Family members-may be anxious, overprotective.
         3. Role in family-role reversal may result in loss of incentive for work.
         4. Dependence-independence-issues related to family conflicts (especially restrictive attitudes about desirable activity and dietary regimen).
         5. Job-social pressure to “slow down” may result in loss of job, reassignment, forced early retirement, “has-been” social status.
   2. Nursing care plan/implementation:
      1. Prevent “cardiac cripple” by shaping person’s and family’s attitude toward damaged organ.
         1. Instill optimism.
         2. Encourage productive living rather than inactivity.
      2. Set up a physical and mental activity program with client and mate.
      3. Provide anticipatory guidance regarding expected weakness, fear, uncertainty.
      4. Health teaching: nature of coronary disease, interpretation of medical regimen, effect on sexual behavior.
   3. Evaluation/outcome criteria:
      1. Adheres to medical regimen.
      2. Modifies lifestyle without becoming overly dependent on others.

Body Image and Obesity

1. Definition: body weight exceeding 20% above the norm for person’s age, sex, and height constitutes obesity. Body mass index (BMI) is also used. Although a faulty adaptation, obesity may serve as a protection against more severe illness; it represents an effort to function better, be powerful, stay well, or be less sick. The problem may not be difficulty in losing weight; reducing may not be the appropriate cure.
2. Assessment-characteristics:
   1. Age-one out of three persons under 30 years of age is more than 10% overweight.
   2. Increase risks for CVA, MI, diabetes.
   3. Feelings: self-hate, self-derogation, failure, helplessness; tendency to avoid clothes shopping and mirror reflections.
   4. Viewed by others as ugly, repulsive, lacking in will power, weak, unwilling to change, neurotic.
   5. Discrepancy between actual body size (real self) and person’s concept of it (ideal self).
   6. Pattern of successful weight loss followed quickly and repetitively by failure, that is, weight gain.
   7. Eating in response to outer environment (e.g., food odor, time of day, food availability, degree of stress, anger); not inner environment (hunger, increased gastric motility).
   8. Experiences less pleasure in physical activity; less active than others.
   9. All obese people are not the same.
      1. In obese newborns and infants, there is an increased number of adipocytes via hyperplastic process.
      2. In obese adults, there may be increased body fat deposits, resulting in increased size of adipocytes via hypertrophic process.
      3. When an obese infant becomes an obese adult, the result may be an increased number of cells available for fat storage.
   10. Loss of control of own body or eating behavior.
3. Analysis/nursing diagnosis: Defensive coping related to eating disorder. Contributing factors:
   1. Genetic.
   2. Thermodynamic.
   3. Endocrine.
   4. Neuroregulatory.
   5. Biochemical factors in metabolism.
   6. Ethnic and family practices.
   7. Psychological:
      1. Compensation for feelings of helplessness and inadequacy.
      2. Maternal overprotection; overfed and forcefed, especially formula-fed infants.
      3. Food offered and used to relieve anxiety, frustration, anger, and rage can lead to difficulty in differentiating between hunger and other needs.
      4. As a child, food offered instead of love.
   8. Social:
      1. Food easily available.
      2. Use of motorized transportation and labor-saving devices.
      3. Refined carbohydrates.
      4. Social aspects of eating.
      5. Restaurant meals high in salt, sugar.
4. Nursing care plan/implementation:
   1. Encourage prevention of lifelong body image problems.
      1. Support breastfeeding, where infant determines quantity consumed, not mother; work through her feelings against breastfeeding (fear of intimacy, dependence, feelings of repulsion, concern about confinement, and inability to produce enough milk).
      2. Help mothers to not overfeed the baby if formula-fed: suggest water between feedings; do not start solids until 6 months old or 14 pounds; do not enrich the prescribed formula.
      3. Help mothers differentiate between hunger and other infant cries; help her to try out different responses to the expressed needs other than offering food.
   2. Use case findings of obese infants, young children, and adolescents.