Disturbed Body Image | Nursing Care Plan for Renal Dialysis

Nursing diagnosis: disturbed Body Image related to situational crisis, chronic illness with changes in usual roles and body image

Possibly evidenced by
Verbalization of changes in lifestyle, focus on past function, negative feelings about body, feelings of helplessness and powerlessness
Continuous physical deterioration, premature aging, disfigurement
Extension of body boundary to incorporate environmental objects (such as dialysis equipment)
Change in social involvement
Overdependence on others for care, not taking responsibility for self-care, lack of follow-through, self-destructive behavior

Desired Outcomes/Evaluation Criteria—Client Will
Self-Esteem
Identify feelings and methods for coping with negative perception of self.
Verbalize acceptance of self in situation.
Demonstrate adaptation to changes and events that have occurred, as evidenced by setting realistic goals and active participation in care and life in general.

Nursing intervention with rationale:
1. Assess level of client’s knowledge about condition and treatment and anxiety related to current situation.
Rationale: dentifies extent of problem or concern and necessary interventions.

2. Discuss meaning of loss and change to client.
Rationale: Many clients and their families have difficulty dealing with changes in life and role performance as well as the client’s loss of ability to control own body.

3. Note withdrawn behavior, ineffective use of denial, or behaviors indicative of overconcern with body and its functions. Investigate reports of feelings of depersonalization or the bestowing of humanlike qualities on machinery.
Rationale: Indicators of developing difficulty handling stress of what is happening. Note: Client may feel tied to and controlled by the technology central to his or her survival, even to the point of extending body boundary to incorporate dialysis equipment.

4. Assess for use of addictive substances, primarily alcohol, other drugs, and self-destructive or suicidal behavior.
Rationale: May reflect dysfunctional coping and attempt to handle problems in an ineffective manner.

5. Determine stage of grieving. Note signs of severe or prolonged depression.
Rationale: Identification of grief stage client is experiencing provides guide to recognizing and dealing appropriately with behavior as client and SO work to come to terms with loss and limitations associated with condition. Prolonged depression may indicate need for further intervention.

6. Acknowledge normalcy of feelings.
Rationale: Recognition that feelings are to be expected helps client accept and deal with them more effectively.

7. Encourage verbalization of personal and work conflicts that may arise. Active-listen concerns.
Rationale: Helps client identify problems and problem-solve solutions. Note: Home dialysis may provide more flexibility and enhance sense of control for clients who are appropriate candidates for this form of therapy.

8. Determine client’s role in family constellation and client’s perception of expectation of self and others.
Rationale: Long-term and permanent illness or disability alter client’s ability to fulfill usual role(s) in family and work setting. Unrealistic expectations can undermine self-esteem and affect outcome of illness.

9. Recommend SO treat client normally and not as an invalid.
Rationale: Conveys expectation that client is able to manage situation and helps maintain sense of self-worth and purpose in life.

10. Assist client to incorporate disease management into lifestyle.
Rationale: Necessities of treatment assume a more normal aspect when they are a part of the daily routine.