a. Changes in lifestyle—eating, smoking, drinking; activities, employment, sex.
b. Family members—may be anxious, overprotective.
c. Role in family—role reversal may result in loss of incentive for work.
d. Dependence-independence—issues related to family conflicts (especially restrictive attitudes about desirable activity and dietary regimen).
e. Job—social pressure to “slow down” may result in loss of job, reassignment, forced early retirement, “has-been” social status.

B. Nursing care plan/implementation:

a. Instill optimism.
1. Prevent “cardiac cripple” by shaping person’s and family’s attitude toward damaged organ.

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.

C. Evaluation/outcome criteria:

Body Image and Obesity

A. 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.

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.

a. In obese newborns and infants, there is an increased number of adipocytes via hyperplastic process.
b. In obese adults, there may be increased body fat deposits, resulting in increased size of adipocytes via hypertrophic process.
c. When an obese infant becomes an obese adult, the result may be an increased number of cells available for fat storage.

C. Analysis/nursing diagnosis: Defensive coping related to eating disorder. Contributing factors:

a. Compensation for feelings of helplessness and inadequacy.
b. Maternal overprotection; overfed and forcefed, especially formula-fed infants.
c. Food offered and used to relieve anxiety, frustration, anger, and rage can lead to difficulty in differentiating between hunger and other needs.
d. As a child, food offered instead of love.

a. 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).
b. 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.
c. Help mothers differentiate between hunger and other infant cries; help her to try out different responses to the expressed needs other than offering food.