Bariatrics Flashcards
what is BMI?
A measure of nutritional status that does not depend on frame size. Indirectly estimates total fat stores by a height to weight relationship. Clinical scale used to indicate obesity
what does a BMI less than 18.5 indicate?
underweight
what does a BMI from 18.5-25 indicate?
normal
what does a BMI for 25-29.9 indicate?
Overweight
what does a BMI of 30 or higher indicate?
obesity
what does a BMI of 40 or higher indicate?
morbidly obese
what is another way we predict increased health risk other than BMI?
waist circumference
waist-to-hip ratio
what is a healthy waist circumference for men and women?
men- <40 inches
women- <35 inches
how is waist to hip ratio calculated?
by dividing waist measurements by hip measurements to obtain a ratio
what is an health waist-to-hip ratio for men and women?
men- <0.9
women- <0.8
(greater than these values can indicate increased risk)
what are the major complications of obesity?
-Cardiovascular and respiratory systems
-Degeneration of the musculoskeletal system
-Increased risk for infection and infectious diseases
-Slower healing processes
almost 80% of obese adults have what diseases?
-DM
-dislipidemia
-CAD
-gallbladder disease
-osteoarthritis
(almost 40% of obese adults have 2 or more of these problems)
what are the major (underlined by jenna) risk factors for obesity?
*Eating high-fat and high-cholesterol diets
*Genetics & environment
*Behavioral issues
*Physical inactivity
how should blood pressure be taken on a bariatric client?
*Correct size blood pressure cuff (avoid inaccurate readings)
*Consider alternative sites for readings (lower leg or wrist)
how should pulse be taken on a bariatric client?
*Carotid & femoral pulses are difficult to access
*Consider alternative sites – radial pulse
how should respirations be different for a bariatric client?
*Distant lung sounds
*Unable to tolerate lying flat on back
*Consider Bi-pap or C-pap machine use
*Consider ability to ventilate
how should you assess weigh of a bariatric client?
*Assess equipment capabilities before getting starting
*Accurate readings are essential
*Protect client’s dignity
what is a concern regarding a bariatric patients skin related to infection?
Moist conditions under skin folds are a great place for yeasts & fungi to grow.
-(Keep skin clean (mild soap and water), rinse well, and dry )
what is a concern regarding a bariatric patients skin related to wound care?
-Poor circulation
-co-morbid conditions
-malnutrition
-delayed healing
how do you asses a bariatric clients GI/Gu compared to a non-bariatric client?
-Bowel tones are distant.
-Need to assess close to umbilicus for four quadrants.
why might a bariatric client be urinary incontinent?
Often r/t decreased mobility due to reluctance or inability to ambulate
what are some examples of bariatric equipment?
-Ceiling lifts, portable lifts
-large furniture (beds & commodes)
-plus sized gowns
-Gore-Tex sheets
-hover mats
-adequate staff
how should you give an IM injection to a bariatric client?
Use long needle and a muscle close to the skin (Deltoid)
what special considerations should be taken for radiologic imaging of a bariatric client?
Always check abdominal girth & weight limits before exams
what are the categories of non-surgical treatment options for a bariatric patient?
-diets
-exercise
-behavior modification
-medications
-holistic therapies
what is important regarding dieting for a bariatric patient?
-Generally do not work. Most weight is regained in about 5 years
-Set realistic goals (1 lb./week)
what is important regarding exercise for a bariatric patient?
-start slow
-make activity an enjoyable habit
what is important regarding behavior modification for a bariatric patient?
-Learn to identify what triggers overeating
-Lifestyle changes
-This could entail keeping a diary or record of foods eaten; exercise patterns; emotional/situational stimuli for overeating. (Use of a reward system or counseling to help modify negative beliefs.)
how is bariatric surgery perceived?
-Bariatric surgery is perceived as a last resort to address weight issues, but is the only method with long-term impact on obesity.
what are some surgical risks or complications for the bariatric patient?
-Wound healing issues
-respiratory issues (PNA)
-pulmonary emboli
what is the benefits of bariatric surgery?
After bariatric surgery, many patients decrease or eliminate complications of obesity such as DM, HTN, depression, or sleep apnea.
what are the two types of bariatric surgery?
-restrictive (minimally invasive)
-malabsoptive
what are some examples of restrictive or minimally invasive surgery options?
-Laparoscopic Adjustable Gastric Banding (LAGB, also reversible)
-Laparoscopic Sleeve Gastrectomy (LSG, can be reversed but not as easily)
what is the form of surgery considered malabsorptive?
Roux-en-Y gastric bypass (RNYGB) or “gastric bypass”
what are the unique needs and risks for the bariatric client post-op?
-Priority is airway management immediately post-op (encourage IS use, TCDB!)
-Abdominal binder (to prevent wound dehiscence) including thorough skin management. Encourage splinting (with pillow) when moving to decrease pain.
-Observe for s/s of Dumping Syndrome
what is Dumping Syndrome? S/S?
-Common post-op complication for bariatric surgery – food is rapidly emptied from the stomach into the small bowel —–(S/S – tachycardia, nausea, abdominal cramps, and diarrhea 10-30 minutes after eating.) Prevention – eating smaller meals and limiting high-sugar foods.
what is important for aftercare of surgery for the bariatric client?
-Continual dietetic guidance
-Education is needed regarding limiting or avoiding drinking fluids with meals to increase room for more nutrient-dense foods.
-Counseling help with changes in body and relationships
-Cosmetic surgeries to remove excess skin
what are the common co-morbidities usually with a bariatric patient?
-sleep apnea
-TTDM
-HTN
-CAD
-gallbladder issues (cholecystitis)
-dislipidemia
-osteoarthritis
