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Nursing Care Adults with Chronic Issues > 5.2 Obesity > Flashcards

5.2 Obesity Flashcards

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1
Q

Obesity

A
  • Abnormal excess fat accumulation that may lead to impaired health
  • It is a disease
  • Impairs normal bodily function, has signs and symptoms, and causes morbidity
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2
Q

Characteristics of Obesity

A
  • Perfect storm that involves fast food, decreased physical activity and chemicals
  • Fructose is metabolized in the liver
  • Leptin is “satiety” hormone that tells you are full
  • Ghrelin tells your brain that you are hungry
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3
Q

What is Obesity

A
  • Increased body fat causes adiposopathy (dysfunctional adipose tissue) which promotes metabolic, biomechanical and psychosocial diseases and disorders
  • Adiposopathy causes chronic inflammation which leads to heart disease, hypertension and type 2 diabetes
  • Obesity results in metabolic imbalance, due to excess caloric intake.
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4
Q

Obesity

A
  • BMI over 30
  • More prevalent in women, African Americans, and Hispanics.
  • More prevalent in less educated and less income
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5
Q

Psychosocial Risks of Obesity

A
  • Low self esteem
  • Impaired body image
  • Depression
  • Diminished quality of life
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6
Q

Causes of Obesity

A
  • Complex and Multifactorial
  • Behavioral
  • Environmental
  • Physiologic
  • Genetic
  • Involves demographics and genetics
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7
Q

Inflammation of Obesity

A
  • Caused by dysfunctional adipose tissue
  • Leads to heart disease, hypertension, diabetes, asthma, Alzheimer’s
  • Increase BMI has also been shown to lead to cancer
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8
Q

Statistics of Risks with Obesity

A
  • Life expectancy loss of 6-20 years
  • 10x more likely to have diabetes 2
  • 4x more likely to have asthma and hypertension
  • 2x more likely to have Alzheimer’s
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9
Q

Nursing Assessment

A
  • Assess BMI
  • 25-29.9 is overweight
  • 30+ is obese
  • 40+ is class 3 obesity
  • Assess waist circumference
  • Apple shape carries greater risk for cardiac disease
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10
Q

Obesity Labs

A
  • Triglycerides
  • Cholesterol
  • Lipids
  • Glucose
  • A1C
  • Liver function
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11
Q

Obesity Management

A
  • Lifestyle modifications (Diet, Exercise, Weight loss)
  • Set realistic weight loss goals and behavioral change
  • Use of food journals can be helpful
  • Better sleep habits
  • Obesity medications are not a supplement for diet and exercise, they are in addition to
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12
Q

Sleep and Obesity

A
  • Better sleep leads to decrease in cortisol which can lead to drop in weight.
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13
Q

Vagal Blocking

A
  • Blocks vagus nerve signals which decrease gastric emptying. This leads to patients feeling fuller sooner.
  • Decreases gastric emptying
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14
Q

Intragastric Balloon Therapy

A
  • Decreased Gastric Emptying
  • Patient feels fuller with less food intake
  • Balloon is filled with saline and placed in stomach
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15
Q

Bariatric Surgery

A
  • Can be used to either decrease the size of the stomach or divert food through the intestines.
  • 10-35% weight loss over 2-3 years
  • Patient needs counseling, education and evaluation before surgery to be successful
  • If successful should see decrease in hypertension and type 2 diabetes
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16
Q

Stigmatization of Obesity

A
  • Obese patients can be stigmatized by both society and health care providers
  • We need to offer the same care to obese patients as others including respect, courteous, empathy,
  • They should be referred to as “patients with obesity”
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17
Q

Ventilation and Circulation of Obesity

A
  • Increased neck and chest circumference leads to sleep apnea, hypoventilation, and respiratory failure
  • Raise head of bed to maximize chest expansion
  • Monitor patients pulse oximetry
  • Provide supplemental oxygen if needed
18
Q

CPAP

A
  • Mask with positive air pressure throughout the night to help them breathe
19
Q

Central/Peripheral Circulatory Compromise

A
  • Blood stasis can happen or blood pooling in the calves. This increases risk for the below
  • Heart failure, hypertension, peripheral blood flow, DVT
  • DVT especially important in post-op patients
20
Q

How to Prevent DVT

A
  • Sequential Compression Devices (SD) after surgery
  • Lovenox (Anticoagulant)
  • Early Ambulation
21
Q

Drug Pharmacokinetic Differences

A
  • Some drugs bind to adipose tissue which either inactivate or prolong the effects.
  • General Anesthesia can last longer in obese patients
    (Take longer to wake up)
22
Q

Obesity Skin Integrity and Body Mechanics

A
  • In skin folds, there is decreased blood supply, nutrients, and oxygen
  • Moisture and friction can also result in pressure ulcers.
  • Turn patients every 2 hours or get them mobile to prevent pressure ulcers (this is very important)
  • If patient can get out of bed get them mobile
23
Q

Assistive Devices to Lift Obesity Patients

A
  • Bariatric Lifts

- Lift Teams

24
Q

Open vs Closed Bariatric Surgery

A

Open - Abdomen is open
Closed - Laparoscopic procedure or scope is used
(Small incision with camera)

25
Q

Obesity Surgery Mobility

A 
Open
- Patients may experience pain which decreases mobility
- This causes risk of DVT
- Increased length of stay
Closed
- Less pain
- Quicker mobility
- Decreased length of stay
- Lower risk of DVT
26
Q

Roux-en-Y. Roux-en-Y

A
  • Restrictive and Malabsorption Bariatric Bypass
  • Most common procedure
  • Staples placed across fundus of stomach that creates a pouch (20-30mL) and bypasses a portion of small intestines.
  • Restrictive with smaller stomach
  • Malabsorption with bypass section of small intestines
27
Q

Gastric Banding

A
  • Restrictive Procedure
  • Prosthetic Device restricts oral intake by creating a pouch (10-15mL) that empties into narrow outlet the remainder of the stomach
  • Helps patients feel fuller sooner
28
Q

Vertical Banded Gastro Pasty

A
  • Restrictive
  • Not common because it requires cutting the stomach or having a staple line.
  • Gastric Banding more common
  • Also known as stomach stapling
  • Uses bands and staples to create a small pouch which flow to narrow opening into stomach.
29
Q

Sleeve Gastrectomy

A
  • Both restrictive and malabsorption
  • 85% of stomach is removed with just a sleeve left that retains intact nerves.
  • Does not obstruct or decrease size of gastric outlet
30
Q

Biliopancreatic Diversion with Duodenal Switch

A
  • Malabsorptive Procedure
  • Works better than Roux-en-Y but has more complications
  • Nutritional Deficiency is an issue
  • Half the stomach is removed with the remaining (60mL)
  • Duodenum is disconnected and sealed off
  • Jejunum is anastomosed or re-attached to first portion of duodenum.
31
Q

Goals for Bariatric Patients

A
  • Knowledgeable about pre/post-op
  • Dietary routines and restrictions
  • Decreased anxiety about surgery
32
Q

Post-op Goals for Bariatric Patients

A
  • Relief of pain
  • Homeostatic fluid balance
  • Prevention of infection
  • Adherence to diet
  • Prevent Dehydration
  • Necessary vitamin supplements
  • Normal bowel habits
33
Q

Risks of Bariatric Surgery

A
  • Diarrhea or Constipation
  • Vitamin deficiency
  • Fluid imbalance
34
Q

Lifelong achievement of Bariatric Surgery

A
  • Positive body image (measured through their actions)

- Normal bowel habits (Patient will have bowel movements every so often)

35
Q

Risks of lifelong Bariatric Surgery

A
  • Hemorrhage
  • Post-op bleeding at surgical site
  • DVT
36
Q

Bile Reflux Dumping Syndrome

A
  • Rapid gastric emptying after bariatric surgery
  • Occurs when sugar moves too quickly from the stomach to the small bowel
    Symptoms
  • Abdominal cramps, nausea, vomiting, diarrhea
  • Sweaty, flush skin, increased heart rate (or felt)
37
Q

Dysphagia

A
  • Trouble swallowing
38
Q

Obstructions

A
  • Scar tissue from healing can lead to smaller gastric outlets or obstructions
39
Q

Roux-en-Y Gastric Bypass

A
  • Horizontal row of staples across fundus creating a pouch of 20-30 mL
  • Jejunum divided distal to ligament of Treitz
  • Distal end is connected to new pouch
  • Proximal segment attached to jejunum.
  • Pouch in stomach leads directly to small intestines
  • Parts of small intestines are also bypassed
40
Q

Gastric Banding

A
  • Prosthetic device creates pouch (10-15 mL) that goes into narrow outlet of small intestines
  • Decreases stomach size
41
Q

Sleeve Gastrectomy

A
  • Stomach reduced in size to about 15% but does not affect gastric oulet
42
Q

Biliopancreatic Diversion with Duodenal Switch

Sleeve Gastrectomy with Duodenal Switch

A
  • Remove half the stomach leaving 60mL left
  • Does not affect Gastric Opening
  • ## Bypasses entire Jejunum

Nursing Care Adults with Chronic Issues (16 decks)

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