Chapter 42 Assessment & Management of Patients w/ Obesity Flashcards
Obesity
Abnormal/excessive fat accumulation that may impair health
Prevalence of Obesity
70.9% of American Adults are obese or overweight
Prevalence higher in:
- Women
- African Americans
- Hispanics
Diseases/Disorders Associated w/ Obesity
Alzheimer’s
Anxiety & depression
Asthma
Obstructive sleep apnea
Respiratory infections
Non alcoholic fatty liver disease
Liver cancer
Cholecystitis
Cholelithiasis
Gallbladder cancer
Osteoarthritis
Prostate cancer
Thyroid cancer
CAD
MI
HF
HTN
Renal cancer
Type II Diabetes
Pancreatic cancer
What does obesity put patients at a higher risk for?
Increased risk for disease, disorders, low self-esteem, impaired body image, depression, and diminished quality of life
Obesity is associated with 6‐ to 20‐year decrease in life expectancy
Risk for cancer increases with increased BMI
Likelihood of type 2 diabetes by 10-fold
Asthma or hypertension by fourfold
Twice as likely to have Alzheimer’s
Gerontological Considerations for Bariatric Patients
Prevalence of obesity for adults 60 yrs & up is 42.8% (slightly higher than other population)
As adults age, lean skeletal mass decreases & adipose tissue increases
Basal metabolism drops by 2% for each additional decade of adult life
Greater risk for falls & mobility impairments
Adiposopathy
Dysfunction of adipose tissue
Obesogenic
Promotes weight gain
Satiety
The feeling of having eaten sufficient amounts of food
Orexigenic
Hormones that stimulate appetite via CNS pathways that lead to hypothalamus-> signals higher neural pathways-> eating behavior
Health History Assessment for Patients w/ Obesity
Recent increase or decrease in body weight
- Determine if it was intentional or not to see if another disease process could be at work
Personal Hx of Obesity (if it started at childhood or after pregnancy, ie)
Family History of Obesity
Any patterns of weight loss over time
- Prior successful or unsuccessful weight loss strategies
Dietary & Exercise Pattern History
Evaluate sleeping habits
-Usually patients w/obesity have:
- Difficulty falling asleep
- Difficulty staying asleep
Smoking habits
- Smoking cessation can cause weight gain
Current list of medications: Certain medications can cause weight gain
Body Mass Index (BMI)
Definitive measure used to determine whether or not a patient has obesity
- Based on a ratio of body weight in (kg) & height in meters
Overweight/ Preobese BMI Score
25 – 29.9 kg/m^2
Class I Obesity BMI Score
30 – 34.9 kg/m^2
Class II Obesity BMI Score
35 – 39.9 kg/m^2
Severe/ Extreme Obesity BMI Score
Equal to or > 40 kg/m^2
Waist Circumference Risk Factor
Women: > 35 inches
Men: > 40 inches
Waist-to-Hip Ratio Risk Factor
Women: > 0.80
Men: > 0.90
Presumed to have proportionally more abdomina;
Lab Studies for Bariatric Patients
Cholesterol
Triglycerides
Fasting blood
Glucose
HA1c
Liver function tests
Nursing Management of Bariatric Patients
Approach patients with obesity with the same respectful, courteous, and empathetic behavior as extended to patients without obesity
Understand the effects of obesity
Mechanics of ventilation and circulation
Pharmacokinetics and pharmacodynamics
Skin integrity
Body mechanics and mobility
Effects of Obesity on Mechanics of ventilation and circulation
Maintain in low Fowler position to maximize chest expansion
* Continuous pulse oximetry
* Supplemental oxygen
* Frequent respiratory assessments
Effects of Obesity on Central & Peripheral circulatory compromise
Use appropriately sized BP cuff
* Monitor for DVT
* Correct medication dose
* Pressure injuries
Other Areas to Take BP
Wrist, & Legs
Effects of Obesity on Pharmacokinetics and Pharmacodynamics
Understand that some drugs have enhanced effects while others have diminished effects with patients with obesity
- Be cognizant that weight-based calculations of drug dosages
for patients with obesity may need to be altered
Behavioral Interventions for Obesity
Set weight goals
Improve lifestyle behaviors: diet habits, physical activity
Addressing barriers to change
Consider adjunct use of pharmacological therapy
Self-monitoring & strategizing ongoing lifestyle changes aimed at a healthy weight
Effects of Obesity on Skin integrity and body mechanics
Assess for pressure ulcers
* Specialty bariatric equipment
Dietary Considerations for Bariatric Patients
Calorie deficit should be between 500-1,000 calories daily from baseline
- To achieve 5-10% weight reduction w/in 6 months
Foods to be Limited/Eliminated
Processed foods w/ limited nutritional value: packaged cakes, cookies, chips
High caloric beverages: sugar-sweetened, juice, cream-enhanced
Fast foods
Vending machine foods
Foods high in sugar (candies) & saturated foods (fried foods, hot dogs)
Dietary Habits to Encourage
Reduce portions
- Use smaller portions & measure foods
Schedule meals & plan snacks & meals in advance for each day
Eat more food at home than outside
Eat together w/ family to foster healthy eating environment
Avoid screen time when eating
Eat breakfast
Limit snacks
Drink plenty of fluids
Nursing Interventions to Address the Effects of Obesity on Mechanics of Ventilation & Circulation
Maintain in low Fowler position to maximize chest expansion
Continuous pulse oximetry
Supplemental oxygen
Frequent respiratory assessments
Nursing Interventions to Address the Effects of Obesity on Central & Peripheral Circulatory Compromise
Use appropriately sized BP cuff
Monitor for DVT
Correct medication dose
Pressure injuries
Nursing Interventions to Address the Effects of Obesity on Pharmacokinetics & Pharmacodynamics
Understand that some drugs have enhanced effects while others have diminished effects w/ patients with obesity
Be cognizant that weight-based calculations of drug dosages
for patients with obesity may need to be altered
Nursing Interventions to Address the Effects of Obesity on Skin Integrity & Body Mechanics
Assess for pressure ulcers
Specialty bariatric equipment
Bariatric Surgery
Surgery used to treat obesity
- Typically performed after nonsurgical interventions have failed
Results of Bariatric Surgery
Results in weight loss of 10% to 35% body weight within 2 to 3 years
-Improvement in comorbid conditions
Bariatric Procedures
Roux-en-Y gastric bypass
(RYGB)
Gastric banding
Sleeve gastrectomy
Biliopancreatic diversion
with duodenal switch
Performed by
laparoscopy or by an
open surgical technique
Inclusion Criteria for Bariatric Surgery
Ability to perform ADLs & self-care
Presence of a support network of family & friends
Failure of previous nonsurgical attempts at weight loss, including nonprofessional programs
Expectation that the patient will adhere to postop care, follow-up visits, & recommended medical management
- Includes use of dietary supplements
Exclusion Criteria for Bariatric Surgery
Reversible endocrine or other disorders that cause obesity
Current substance use disorder
Uncontrolled, severe psychiatric illness
Lack of comprehension of:
- Risks
- Benefits
- Expected outcomes
- Alternatives
- Lifestyle changes required w/ bariatric surgery
Pre-op Considerations for Bariatric Surgery
Education and counseling
Risks and benefits of surgery
Complications
Post-surgical outcomes
Dietary changes
Lifelong follow-up
Lab testing
Post-Op Considerations for Bariatric Surgery
Assess to ensure goals for recovery
are met
Assess for absence of complications
Manage pain
Nutritional status: Increase in protein intake
Fluid volume balance
Decrease anxiety
Body image: Excess skin
