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Many clinical syndromes involve disturbances of body image. Disturbed body image is a nursing diagnosis that was approved by the North American Nursing Diagnosis Association, defined as confusion in the mental picture of one's physical self. Surgery or trauma involving disfigurement or loss of a body part can be very threatening to a patient. Diseases involving a loss of body function, such as stroke syndrome, paraplegia, quadriplegia, coronary heart disease, and bowel or bladder incontinence, and diseases involving disfiguring skin lesions or the feeling of “rotting away” as in cancer or gangrene, can all cause changes in body image. Body image is frequently disturbed in schizophrenia, and patients may feel that their body or its parts are changing in size or shape or are ugly or threatening. Rape or violent physical assault can disturb the feeling of being secure in one's own body. Changes in body image involving sexual attractiveness or sexual identity, such as surgery or trauma involving the genitals or breasts and tubal ligation, hysterectomy, or vasectomy, can be especially difficult for the patient to deal with. Intrusive therapeutic or diagnostic procedures, such as insertion of a nasogastric tube, bladder catheterization, administration of intravenous fluids, endoscopy, and cardiac catheterization, can also threaten a patient's body image.
The reaction of a patient to an alteration in body image can include mourning the loss of the former body image, fear of rejection by significant others, hostility, and experiencing of “phantom” sensations from missing body parts. Patients with less ability to cope with their loss may respond with denial or depression. This can lead to a rejection of the altered body image and feelings of depersonalization that can involve avoidance of interpersonal contact and an unwillingness to discuss the deformity or to accept corrective medical treatment or vocational rehabilitation.
for·eign bod·y (FB),
foreign bodyA microscopic or macroscopic object introduced into the human economy at the time of an invasive procedure–ie iatrogenic, by accident, or by intent
for·eign bod·y(fōr'ĕn bod'ē)
foreign body; FB material abnormal to its site of location, promoting a painful and inflammatory rejection response by local tissues; may predispose to local hypergranulation tissue and bacterial infection (see pyogenic granuloma Table 1)
endogenous FB e.g. nail spike/edge of nail plate; slough; synovial fluid that has leaked from a traumatized joint capsule; epithelial pearls; Box 1; see inclusion cyst
exogenous FB e.g. wood or metal splinters; scraps of wire or hair
|O||Operate||Remove the cause of the infection where possible, e.g. remove focal hyperkeratosis/foreign body/nail spike|
|C||Cleanse||Irrigate area/cleanse cavity with Warmasol delivered under pressure from a sterile syringe|
|H||Heat||Assist drainage of pus/exudate by applying heat, e.g. immersion in a warm hypertonic NaCl bath|
|A||Antiseptic||Apply a liquid or powder antiseptic (e.g. Betadine)|
|D||Dress||Cover the lesion with a sterile dressing (e.g. sterile gauze; Lyofoam)|
|R||Rest||Impose rest, e.g. deflective padding; shoe modification; walking cast; crutches, as necessary|
|A||Reappoint||Arrange to review case in 24–72 hours|
|R||Review||At the subsequent appointment, review progress|
If resolution has been initiated, continue to treat as above (O–A) and review weekly until healing is complete
If the infection has not improved, arrange for antibiosis, and continue to review and dress until healing is complete
|R||Refer||Refer for specialist review via GP: remember, slow-to-resolve infection can characterize undiagnosed diabetes, or other ‘at-risk’ patient category|
Use all normal preoperative procedures; keep infected lesions covered until ready to treat; take a swab for pathology laboratory analysis of any exudate; use a sterile dressings pack; follow the OCH-A-DRARR treatment mnemonic.
‘At-risk’ patients presenting with infection or patients presenting with acute or spreading infection should be treated using the OCH-A-DRARR protocol, but provided with or referred for immediate antibiosis.