Nurseslabs » disturbed body image

4 Dermatitis Nursing Care Plans

NursesLabs — Tue, 24 Jan 2012 17:32:48 +0000

Dermatitis is a general term that describes an inflammation of the skin. There are different types of dermatitis, including seborrheic dermatitis and atopic dermatitis (eczema). Although the disorder can have many causes and occur in many forms, it usually involves swollen, reddened and itchy skin.

Dermatitis is a common condition that usually isn’t life-threatening or contagious. But, it can make you feel uncomfortable and self-conscious. A combination of self-care steps and medications can help you treat dermatitis.

1. Impaired Skin Integrity

Common Related Factor	Defining Characteristics
Contact with irritants or allergens	Inflammation Dry, flaky skin Erosions, excoriations, fissures Pruritus, pain, blisters
Common Expected Outcome Patient maintains optimal skin integrity within limits of the disease, as evidenced by intact skin.	NOC OutcomesKnowledge: Treatment Regimen; Tissue Integrity: Skin and Mucous MembranesNIC Interventions Skin Care: Topical Treatments; Skin Surveillance; Teaching: Procedure/Treatment

Ongoing Assessment

Actions/Interventions	Rationale
Assess skin, noting color, moisture, texture, temperature; note erythema, edema, tenderness.	Specific types of dermatitis may have characteristic patterns of skin changes and lesions.
Assess the skin systematically. Look for areas of irritant and allergic contact.	Flexural areas (elbows, neck, posterior knees) are common areas affected in atopic dermatitis.
Assess skin for lesions. Note presence of excoriations, erosions, fissures, or thickening.	Open skin lesions increase the patient’s risk for infection. Thickening occurs in response to chronic scratching (lichenification).
Identify aggravating factors. Inquire about recent changes in use of products such as soaps, laundry products, cosmetics, wool or synthetic fibers, cleaning solvents, and so forth.	Patients may develop dermatitis in response to changes in their environment. Extremes of temperature, emotional stress, and fatigue may contribute to dermatitis.
Identify signs of itching and scratching.	The patient who scratches the skin to relieve intense itching may cause open skin lesions with an increased risk for infection. Characteristic patterns associated with scratching include reddened papules that run together and become confluent, widespread erythema, and scaling or lichenification
Identify any scarring that may have occurred.	Long-term scarring may result in body image disturbances.

Therapeutic Actions

Actions/Interventions	Rationale
Encourage the patient to adopt skin care routines to decrease skin irritation:	One of the first steps in the management of dermatitis is promoting healthy skin and healing of skin lesions.
Bathe or shower using lukewarm water and mild soap or nonsoap cleansers.	Long bathing or showering in hot water causes drying of the skin and can aggravate itching through vasodilation.
After bathing, allow the skin to air dry or gently pat the skin dry. Avoid rubbing or brisk drying.	Rubbing the skin with a towel can irritate the skin and exacerbate the itch-scratch cycle.
Apply topical lubricants immediately after bathing.	Lubrication with fragrance-free creams or ointments serves as a barrier to prevent further drying of the skin through evaporation. Moisturizing is the cornerstone of treatment. Over-the-counter moisturizing lotions include Eucerin, Lubriderm, and Nivea. Lotions are lighter and less emollient than creams. If more moisturizing is required than a lotion can provide, a cream is recommended. These include Keri cream, Cetaphil cream, Eucerin cream, and Neutrogena Norwegian formula. Ointments are the most emollient. Vaseline Pyre Petroleum Jelly or Aquaphor Natural Healing Ointment may be beneficial.
Apply topical steroid creams or ointments.	These drugs reduce inflammation and promote healing of the skin. The patient may begin using over-the-counter hydrocortisone preparations. If these are not effective, the physician may include prescription corticosteroids for topical use. Usual application is twice daily, thinly and sparingly. Do not use with an occlusive dressing, because this potentiates the action and systemic absorption of the steroid. Usual duration of use of topical steroids is up to 14 days in adults.
Apply topical immunomodulators (TIMs): Tacrolimus (Protopic) Pimecrolimus (Elidel)	Tacrolimus (Protopic) has recently been approved for the treatment of atopic dermatitis. TIMs alter the reactivity of cell-surface immunological responsiveness to relieve redness and itching. In 2005, the Food and Drug Administration advised a potential cancer risk with long-term use of pimecrolimus and tacrolimus based on animal studies.
Prepare the patient for phototherapy or photochemotherapy.	This treatment modality uses ultraviolet A or B light waves to promote healing of the skin. The addition of psoralen, which increases the skin’s sensitivity to light, may benefit patients who do not respond to phototherapy alone.
Encourage the patient to avoid aggravating factors.	Some change in lifestyle may be indicated to reduce triggers.

4 Dermatitis Nursing Care Plans Original source at: Nurseslabs

2 Anorexia Nervosa Nursing Care Plans

NursesLabs — Mon, 31 Oct 2011 06:17:02 +0000

Anorexia nervosa is an eating disorder that causes people to obsess about their weight and the food they eat. People with anorexia nervosa attempt to maintain a weight that’s far below normal for their age and height. To prevent weight gain or to continue losing weight, people with anorexia nervosa may starve themselves or exercise excessively.

Anorexia nervosa is a disease that affects all organ systems, principally the cardiovascular and endocrine systems. However, complications can also involve other systems, including the GI, renal, reproductive, neurologic, orofacial, dermatologic, and hematologic symptoms.

A typical case of anorexia nervosa involves a young person (teenager or young adult) who is mildly overweight or of normal weight and who begins a diet and exercise plan to lose weight. As she loses weight and receives initial positive reinforcement for this behavior (eg, compliments by peers on her appearance), the reward is high and causes an inability to stop this behavior once an ideal weight is achieved.

Nursing Diagnoses:

1. Imbalanced Nutrition: Less Than Body Requirements

Common Related Factors	Defining Characteristics
Severe fear of obesity

Severely distorted self-concept, self-esteem, and/or body image

Absence of physical conditions that would explain weight loss or prevent weight gainBody weight 15% to 29% or more below ideal weight for height

Self-restricted calorie intake despite hunger

Obsession with food, calories, weight, and control issuesCommon Expected Outcomes

Patient stops losing weight.

Patient begins to gain weight.

Patient recognizes eating disorder.NOC Outcomes

Nutritional Status: Food and Fluid Intake; Weight Control

NIC Interventions

Eating Disorders Management; Weight Gain Assistance; Nutritional Therapy

Ongoing Assessment

Actions/Interventions	Rationale
Record the patient’s weight and height on intake. Weigh regularly, maintaining standard conditions (i.e., same scale, same time of day, patient wearing similar clothes).	This ensures accurate record of weight changes.
Weigh the patient in a matter-of-fact manner without discussion.	This reduces risk of acting-out behaviors. Weight gain is only one aspect of the total therapeutic program; other critical factors include nutritional adequacy, behaviors related to eating, appropriate use of exercise, and development of a healthy body image.
Obtain weight history, including initial motivation for weight loss or food restrictions.	Clinical anorexia can follow ordinary weight loss dieting.
Conduct a nutritional assessment:	It is critical that the health care provider openly discuss and have an understanding of the complex food and weight-related behaviors of the patient so that appropriate supports can be integrated into the treatment plan.
Assess the patient’s beliefs and fears about food and weight gain	Excessive focus on food and weight can be a maladaptive method of coping with stress.
Knowledge about nutrition and sources of information	This information provides the basis for an individualized teaching plan about maintaining adequate nutritional intake.
Behaviors used to reduce calorie intake (dieting), to increase energy output (exercising), and generally to lose weight (vomiting, purging, and laxative abuse)	This provides data on patient thinking and thought distortions.
Assess cardiovascular, metabolic, renal, gastric, hematological, and endocrine system functioning.	Assessment provides data on the severity of malnutrition.
Monitor intake (i.e., daily food plans that track eating trends along with emotional states and triggering events). Record intake and output for the hospitalized patient.	These data help determine the patient’s actual caloric intake and eating behaviors.

Therapeutic Interventions

Actions/Interventions	Rationale
Prescribe appropriate nutrition and total calories per day to relieve acute starvation.	A gradual refeeding prescription ensures steady weight gain and reduces risk of medical complications.
Supervise all activities immediately before and after meals; maintain supervision consistency.	This decreases opportunity to engage in compensatory activities to reduce calorie intake.
Provide food and meals without comment.	This helps separate emotional behaviors from eating behaviors.
Set limits on all exercise but allow daily activity.	Preventing all forms of exercise may induce severe anxiety.
Assure the patient that treatment is not designed to produce obesity.	Patients have an overwhelming fear of weight gain and obesity.
Acknowledge any anger, sadness, or feeling of loss that the patient may have toward treatment.	This helps provide external emotional controls that have not yet been internalized by the patient.
Provide supplemental feedings and nutrition as indicated.	Nutritional supplements may be necessary if the patient is malnourished. Tube or parenteral feedings may be necessary if the patient is unable to allow herself or himself oral feedings.

2. Disturbed Body Image

Common Related Factors	Defining Characteristics
Difficulty coping with development and maturation

Inability to achieve unreasonable personal goals

Alexithymia (channeling uncomfortable feelings into behaviors such as self-starvation)Distorted views of one’s body weight and shape for age

Negative feelings about self and body

Self-loathing (impulsive or obsessive)

Intense fear of gaining or not being able to lose weightCommon Expected Outcomes

Patient identifies positive thoughts and feelings regarding body and self.

Patient identifies a direct means of coping with problems.NOC Outcome

Body Image

NIC Interventions

Self-Awareness Enhancement; Body Image Enhancement

Ongoing Assessment

Actions/Interventions	Rationale
Explore the patient’s understanding of his or her physical body, especially as it relates to maturation. Assess to what degree the patient’s negative body image and negative self-concept are related to overwhelming anxiety.	Patients with anorexia have a distorted body image.
Assess to what degree culture, religion, race, and gender influence the patient’s negative views of self.	Cultural and social norms about body size and shape may influence the patient’s thinking and feelings about his or her body image.
Determine the family or patient’s perceptions regarding psychological and physical changes brought about by anorexia.	These data need to be compared to the patient’s thinking prior to the onset of anorexia.
Obtain the patient’s assessment of personal strengths and weaknesses.	Patients learn they have the ability to handle day-to-day stress.
Assess the patient’s ability to identify “here and now” emotional states and precipitating events that trigger negative behaviors.	The patient may not be aware of the relationship between feelings and eating behaviors.

Therapeutic Interventions

Actions/Interventions	Rationale
Encourage reexamination of positive and negative self-perceptions.	The patient needs to develop a realistic understanding of his or her body image.
Encourage the patient to identify the differences between “real people” and celebrities.	Patients often use media reports of celebrities as a guide for their eating behaviors.
Encourage recognition, expression, and acceptance of unpleasant feelings.	Patients with anorexia have a need for control in multiple areas of their lives. Mastery over food may have become a method for reducing tensions.
Help the patient develop a realistic, acceptable perception of body image and food.	Patients must understand the complex health problems associated with anorexia.
Refer the patient to individual counseling and a support group for eating disorders.	Multiple approaches are needed to achieve long-term changes in behavior. Groups that come together for mutual support and guidance can provide long-term assistance.

Sources: (1) (2) (3)

2 Anorexia Nervosa Nursing Care Plans Original source at: Nurseslabs

Disturbed Body Image Nursing Diagnosis

NursesLabs — Mon, 03 Oct 2011 18:02:35 +0000

Nursing Diagnosis: Disturbed Body Image

NOC Outcomes (Nursing Outcomes Classification)

Suggested NOC Labels

• Body Image

• Self-Esteem

NIC Interventions (Nursing Interventions Classification)

Suggested NIC Labels

• Body Image Enhancement

• Grief Work Facilitation

• Coping Enhancement

NANDA Definition

• Confusion in mental picture of one’s physical self

• Body image is the attitude a person has about the actual or perceived structure or function of all or part of his or her body. This attitude is dynamic and is altered through interaction with other persons and situations and influenced by age and developmental level. As an important part of one’s self-concept, body image disturbance can have profound impact on how individuals view their overall selves.

• Throughout the life span, body image changes as a matter of 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 illness.

• 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 than the actual alteration in the structure or function. Therefore the loss of a limb may result in a greater body image disturbance for an athlete than for a computer programmer. The loss of a breast to a fashion model or a hysterectomy in a nulliparous woman may cause serious body image disturbances even though the overall health of the individual has been improved. Removal of skin lesions, altered elimination resulting from bowel or bladder surgery, and head and neck resections are other examples that can lead to body image disturbance.

• The nurse’s assessment of the perceived alteration and importance placed by the patient on the altered structure or function will be very important in planning care to address body image disturbance.

Defining Characteristics

• Verbalization about altered structure or function of a body part

• Verbal preoccupation with changed body part or function

• Naming changed body part or function

• Refusal to discuss or acknowledge change

• Focusing behavior on changed body part and/or function

• Actual change in structure or function

• Refusal to look at, touch, or care for altered body part

• Change in social behavior (e.g., withdrawal, isolation, flamboyance)

• Compensatory use of concealing clothing or other devices

Related Factors

• Situational changes (e.g., pregnancy, temporary presence of a visible drain or tube, dressing, attached equipment)

• Permanent alterations in structure and/or function (e.g., mutilating surgery, removal of body part [internal or external])

• Malodorous lesions

• Change in voice quality

• Expected Outcomes Patient

• Demonstrates enhanced body image and self-esteem as evidenced by ability to look at, touch, talk about, and care for actual or perceived altered body part or function.

Ongoing Assessment

• Assess perception of change in structure or function of body part (also proposed change). The extent of the response is more related to the value or importance the patient places on the part or function than the actual value or importance. Even when an alteration improves the overall health of the individual (e.g., an ileostomy for an individual with precancerous colon polyps), the alteration results in a body image disturbance.

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

• Assess impact of body image disturbance in relation to patient’s developmental stage. Adolescents and young adults may be particularly affected by changes in the structure or function of their bodies at a time when developmental changes are normally rapid, and at a time when developing social and intimate relationships is particularly important.

• Note patient’s behavior regarding actual or perceived changed body part or function. 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.

• Note frequency of self-critical remarks.

Therapeutic Interventions

• Acknowledge normalcy of emotional response to actual or perceived change in body structure or function. Stages of grief over loss of a body part or function are normal, and typically involves a period of denial, the length of which varies from individual to individual.

• Help patient identify actual changes. Patients may perceive changes that are not present or real, or they may be placing unrealistic value on a body structure or function.

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

• Assist patient in incorporating actual changes into ADLs, social life, interpersonal relationships, and occupational activities. Opportunities for positive feedback and success in social situations may hasten adaptation.

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

Education/Continuity of Care

• Teach patient about the normalcy of body image disturbance and the grief process.

• Teach patient adaptive behavior (e.g., use of adaptive equipment, wigs, cosmetics, clothing that conceals altered body part or enhances remaining part or function, use of deodorants). This compensates for actual changed body structure and function.

• Help patient identify ways of coping that have been useful in the past. Asking patients to remember other body image issues (e.g., getting glasses, wearing orthodontics, being pregnant, having a leg cast) and how they were managed may help patient adjust to the current issue.

• Refer patient and caregivers to support groups composed of individuals with similar alterations.

Disturbed Body Image Nursing Diagnosis Original source at: Nurseslabs