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Assessment (Subjective / Objective Data) Nursing Diagnosis Planning Interventions Rationale

The patient verbalized feelings of "Hindi na ba talaga babalik sa normal ang katawan?" indicating disturbed body image related to their altered body structure after ostomy surgery. The nursing diagnosis is disturbed body image, with short term goals of the patient beginning to accept their body by viewing and touching their stoma, and long term goals of verbalizing acceptance of themselves and incorporating the change into their self-concept. Planned interventions include encouraging the patient to discuss their feelings, participating in self-care, counseling, support groups, and frequent visits to acknowledge the patient's worth.

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Maria Lourdes Cruz
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67 views

Assessment (Subjective / Objective Data) Nursing Diagnosis Planning Interventions Rationale

The patient verbalized feelings of "Hindi na ba talaga babalik sa normal ang katawan?" indicating disturbed body image related to their altered body structure after ostomy surgery. The nursing diagnosis is disturbed body image, with short term goals of the patient beginning to accept their body by viewing and touching their stoma, and long term goals of verbalizing acceptance of themselves and incorporating the change into their self-concept. Planned interventions include encouraging the patient to discuss their feelings, participating in self-care, counseling, support groups, and frequent visits to acknowledge the patient's worth.

Uploaded by

Maria Lourdes Cruz
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Assessment Nursing Planning Interventions Rationale

(Subjective / Diagnosis
Objective
Data)
Subjective Disturbed body Short term Independent
Data image may be Patient will start to - Encourage patient/SO to - Helps the patient realize that
“Hindi na ba related to altered demonstrate verbalize feelings regarding the feelings are not unusual and that
talaga babalik body structure as beginning ostomy. Acknowledge feeling guilty about them is not
sa normal ang evidenced by not acceptance by normality of feelings of anger, necessary or helpful. Patient
katawan?” as touching/looking viewing/touching depression, and grief over a needs to recognize feelings
verbalized by at stoma and stoma and loss. Discuss daily “ups and before they can be dealt with
the patient. negative feelings participating in downs” that can occur. effectively.
about body self-care.
Objective - Evaluate the level of the - To observe regarding
Data Long term patient’s knowledge of and emotional changes, which may
- Avoids Patient will anxiety related to the situation. indicate acceptance or
looking at or verbalize nonacceptance of the
touching one’s acceptance of self situation.
body in situation,
- Behavior of: incorporating - Note signs of grieving or - To evaluate need for
acknowledging change into self- indicators of severe or counseling and/or medications.
or monitoring concept without prolonged depression
one’s body negating self-
- Heightened esteem. - Provide opportunities for - Looking at the stoma and
achievement patient/SO to view and touch hearing comments can help the
Hiding or stoma, using the moment to patient with this acceptance.
overexposure point out positive signs of
of body part healing, normal appearance, and
so forth. Remind the patient that
it will take time to adjust, both
physically and emotionally.

- Provide an opportunity for the - Independence in self-care


patient to deal with ostomy helps improve self-confidence
through participation in self- and acceptance of the situation.
care.

- Plan/schedule care activities - Promotes a sense of control


with the patient. and gives a message that patient
can handle the situation,
enhancing self-concept.

- Visit the patient frequently and - This provides opportunities


acknowledge the individual as for listening to concerns and
someone who is worthwhile. questions.

- Assist in correcting underlying - To promote optimal healing


problems. and adaptation.

Collaborative
- Begin counseling/other - To provide early/ongoing
therapies (e.g., biofeedback or sources of support.
relaxation) as soon as possible.
- For faster improvement within
- Refer to appropriate support patient’s recovery.
groups.

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