II. Analysis/nursing diagnosis: body image disturbance may be related to:
A. Sensation of size change due to obesity, pregnancy, weight loss.
B. Feelings of being dirty—may be imaginary due to hallucinogenic drugs, psychoses.
C. Dual change of body structure and function due to trauma, amputation, stroke, etc.
D. Progressive deformities due to chronic illness, burns, arthritis.
E. 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.
III. Assessment—see Table 6-6.
Body Image Disturbance Caused by Amputation
A. 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.
B. 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:
a. Encourage family members to work through their feelings, to accept person as he or she presents self.
b. Teach how to set realistic goals and limitations.
c. Explain what phantom pain is; that it is a normal experience.
d. Explain role and function of prosthetic devices, where and how to obtain them, and how to find assistance in their use.
C. 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)
A. 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.
B. Nursing care plan/implementation:
1. Reduce frustration and infantilism due to communication problems by:
a. Rewarding all speech efforts.
b. Listening and observing for all nonverbal cues.
c. Restating verbalizations to see if correct meaning is understood.
d. Speaking slowly, using two- to three-word sentences.
2. Assist reintegration of body parts and function; help regain awareness of paralyzed side by:
a. Tactile stimulation.
b. Verbal reminders of existence of affected parts.
c. Direct visual contact via mirrors and grooming.
d. Use of safety features (e.g., Posey belt).
3. Health teaching: control of bowel and bladder function; how to prevent problems of immobility.
C. Evaluation/outcome criteria: dignity is maintained while relearning to control elimination.
Body Image Disturbance in Myocardial Infarction
Emotional problems (e.g., 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).
A. 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: