11.Sample answers:
a.Help her find meaning in the experience, regain
mastery to the extent that this is possible, and
realistically evaluate the adequacy of her coping
strategy. Teach her to develop a “game plan” for
confronting anxiety-producing situations. Iden-
tify and secure interventions for treatable depres-
sion. Remedy treatable causes of self-identity
disturbances, such as pain or substance abuse.
b.Notice and affirm positive physiologic
characteristics of the patient. Teach preventive
self-care measures that reduce uncomfortable
signs of aging. Explore new activities (which
may include old hobbies) that are within the
changing physical abilities of the patient.
c. Help patient identify and use personal
strengths. Let him know that you value him
simply for who he is. Use the name he prefers.
Ask him questions about his life, interests, and
values. Engage him in activities in which he
can be successful. Empower him to meet his
needs. Provide necessary knowledge, teach new
behaviors, and instill in him the belief that he
can change.
d.Explore with patient the many roles she has ful-
filled throughout her lifetime. Encourage her to
reminisce. Facilitate grieving over valued roles
that she can no longer perform.APPLYING YOUR KNOWLEDGE
REFLECTIVE PRACTICE USING CRITICAL
THINKING SKILLS
1.What interventions might the nurse employ to try
to resolve Mr. Santorini’s self-image disturbance?
The nurse would need to assess Mr. Santorini’s self-
knowledge, self-expectations, and self-evaluation for
each component of self-concept to determine if he
will still be able to fulfill his role expectation to func-
tion as a complete, intact man. The nurse should
keep in mind that major stressors place anyone at
relative risk for maladaptive responses, such as with-
drawal, isolation, depression, extreme anxiety, sub-
stance abuse, or exacerbation of physical illness.
How Mr. Santorini perceives the amputation and
his ability to mobilize personal strengths and other
resources are determined largely by his self-concept,
which, in turn, is influenced by the response he
chooses. Following a complete history and assess-
ment, the nurse could work with Mr. Santorini and
assist with adapting to the loss of his leg. Patient
teaching involving the use of a prosthesis may be
helpful as he begins to adapt to his body change.
2.What would be a successful outcome for Mr.
Santorini?
By next visit, Mr. Santorini lists three positive
aspects of his self-image.
By next visit, Mr. Santorini reports acceptance of his
amputation and successful use of his new prosthesis.3.What intellectual, technical, interpersonal, and/or
ethical/legal competencies are most likely to bring
about the desired outcome?
Intellectual: knowledge of measures to modify a
negative self-concept for a middle-aged man with a
new amputation
Interpersonal: strong interpersonal skills to
establish a trusting relationship with a middle-aged
man with an amputation
Ethical/Legal: a commitment to patient advocacy,
including getting Mr. Santorini the help needed to
achieve his health goals
4.What resources might be helpful for Mr. Santorini?
Counseling services, printed or AV materials on the
use of prostheses
PATIENT CARE STUDY
1.Objective data are underlined; subjective data are in
boldface.
An English teacher asks you, the school nurse, to
see one of her students, Julie, whose grades have
recently droppedand who no longer seems to be
interested in schoolor anything else. “She was one
of my best students, and I can’t figure out what’s
going on,” the teacher says. “She seems reluctant to
talk about this change.” When Julie, a 16-year-old
junior, walks into your office, you are immediately
struck by her stooped posture, unstyled hair, and
sloppy appearance. Julie is attractive, but at 5 foot 3
and 150 pounds, she is overweight. Julie is initially
reluctant to talk, but she breaks down at one point
and confides that for the first time in her life she
feels “absolutely awful”about herself. “I’ve
always concentrated on getting good grades and
achieved this easily. But now, this doesn’t seem
so important. I don’t have any friends.All I hear
the girls talking about is boys, and I was never even
asked out by a boy, which I guess isn’t surprising.
Look at me.” After a few questions, it becomes clear
that Julie has new expectations for herself based on
what she observes in her peers, and she finds herself
falling far short of her new, ideal self. Julie admits
that in the past, once she set a goal for herself,
she was always able to achieve it because she is
strongly self-motivated. Although she has
withdrawn from her parents and teachers, she
admits that she does know adults she can trust who
have been a big support to her in the past. She says,
“If only I could become the kind of teenager other
kids like and have lots of friends!”
2.Nursing Process Worksheet
Health Problem: Situational low self-esteem
Etiology:Perceived inability to meet newly accepted
peer standards regarding socialization/dating
Signs and Symptoms: Feels “absolutely awful” about
herself; 5 foot 3, 150 lb; “I don’t have any friends”;
never dated; grades have dropped recently; new
lack of interest/vitality; stooped posture; unstyled
hair; sloppy appearanceCopyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing:ANSWER KEY 411
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