5.2 Obesity Flashcards
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
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
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.
4
Q
Obesity
A
- BMI over 30
- More prevalent in women, African Americans, and Hispanics.
- More prevalent in less educated and less income
5
Q
Psychosocial Risks of Obesity
A
- Low self esteem
- Impaired body image
- Depression
- Diminished quality of life
6
Q
Causes of Obesity
A
- Complex and Multifactorial
- Behavioral
- Environmental
- Physiologic
- Genetic
- Involves demographics and genetics
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
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
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
10
Q
Obesity Labs
A
- Triglycerides
- Cholesterol
- Lipids
- Glucose
- A1C
- Liver function
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
12
Q
Sleep and Obesity
A
- Better sleep leads to decrease in cortisol which can lead to drop in weight.
13
Q
Vagal Blocking
A
- Blocks vagus nerve signals which decrease gastric emptying. This leads to patients feeling fuller sooner.
- Decreases gastric emptying
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
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
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”
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
Obesity Surgery Mobility
```
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
Roux-en-Y. Roux-en-Y
- 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
Gastric Banding
- 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
Vertical Banded Gastro Pasty
- 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
Sleeve Gastrectomy
- 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
Biliopancreatic Diversion with Duodenal Switch
- 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
Goals for Bariatric Patients
- Knowledgeable about pre/post-op
- Dietary routines and restrictions
- Decreased anxiety about surgery
32
Post-op Goals for Bariatric Patients
- Relief of pain
- Homeostatic fluid balance
- Prevention of infection
- Adherence to diet
- Prevent Dehydration
- Necessary vitamin supplements
- Normal bowel habits
33
Risks of Bariatric Surgery
- Diarrhea or Constipation
- Vitamin deficiency
- Fluid imbalance
34
Lifelong achievement of Bariatric Surgery
- Positive body image (measured through their actions)
| - Normal bowel habits (Patient will have bowel movements every so often)
35
Risks of lifelong Bariatric Surgery
- Hemorrhage
- Post-op bleeding at surgical site
- DVT
36
Bile Reflux Dumping Syndrome
- 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
Dysphagia
- Trouble swallowing
38
Obstructions
- Scar tissue from healing can lead to smaller gastric outlets or obstructions
39
Roux-en-Y Gastric Bypass
- 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
Gastric Banding
- Prosthetic device creates pouch (10-15 mL) that goes into *narrow outlet* of small intestines
- Decreases stomach size
41
Sleeve Gastrectomy
- Stomach reduced in size to about 15% but does not affect gastric oulet
42
Biliopancreatic Diversion with Duodenal Switch
| Sleeve Gastrectomy with Duodenal Switch
- Remove half the stomach leaving 60mL left
- Does not affect Gastric Opening
- Bypasses entire Jejunum
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