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NURS3313 Adult Health > Chapter 42 Assessment & Management of Patients w/ Obesity > Flashcards

Chapter 42 Assessment & Management of Patients w/ Obesity Flashcards

1
Q

Obesity

A

Abnormal/excessive fat accumulation that may impair health

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2
Q

Prevalence of Obesity

A

70.9% of American Adults are obese or overweight

Prevalence higher in:
- Women
- African Americans
- Hispanics

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3
Q

Diseases/Disorders Associated w/ Obesity

A

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

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4
Q

What does obesity put patients at a higher risk for?

A

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

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5
Q

Gerontological Considerations for Bariatric Patients

A

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

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6
Q

Adiposopathy

A

Dysfunction of adipose tissue

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7
Q

Obesogenic

A

Promotes weight gain

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8
Q

Satiety

A

The feeling of having eaten sufficient amounts of food

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9
Q

Orexigenic

A

Hormones that stimulate appetite via CNS pathways that lead to hypothalamus-> signals higher neural pathways-> eating behavior

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10
Q

Health History Assessment for Patients w/ Obesity

A

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

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11
Q

Body Mass Index (BMI)

A

Definitive measure used to determine whether or not a patient has obesity
- Based on a ratio of body weight in (kg) & height in meters

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12
Q

Overweight/ Preobese BMI Score

A

25 – 29.9 kg/m^2

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13
Q

Class I Obesity BMI Score

A

30 – 34.9 kg/m^2

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14
Q

Class II Obesity BMI Score

A

35 – 39.9 kg/m^2

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15
Q

Severe/ Extreme Obesity BMI Score

A

Equal to or > 40 kg/m^2

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16
Q

Waist Circumference Risk Factor

A

Women: > 35 inches

Men: > 40 inches

17
Q

Waist-to-Hip Ratio Risk Factor

A

Women: > 0.80

Men: > 0.90

Presumed to have proportionally more abdomina;

18
Q

Lab Studies for Bariatric Patients

A

Cholesterol
Triglycerides
Fasting blood
Glucose
HA1c
Liver function tests

19
Q

Nursing Management of Bariatric Patients

A

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

20
Q

Effects of Obesity on Mechanics of ventilation and circulation

A

Maintain in low Fowler position to maximize chest expansion
* Continuous pulse oximetry
* Supplemental oxygen
* Frequent respiratory assessments

21
Q

Effects of Obesity on Central & Peripheral circulatory compromise

A

Use appropriately sized BP cuff
* Monitor for DVT
* Correct medication dose
* Pressure injuries

22
Q

Other Areas to Take BP

A

Wrist, & Legs

23
Q

Effects of Obesity on Pharmacokinetics and Pharmacodynamics

A

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

24
Q

Behavioral Interventions for Obesity

A

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

25
Q

Effects of Obesity on Skin integrity and body mechanics

A

Assess for pressure ulcers
* Specialty bariatric equipment

26
Q

Dietary Considerations for Bariatric Patients

A

Calorie deficit should be between 500-1,000 calories daily from baseline
- To achieve 5-10% weight reduction w/in 6 months

27
Q

Foods to be Limited/Eliminated

A

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)

28
Q

Dietary Habits to Encourage

A

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

29
Q

Nursing Interventions to Address the Effects of Obesity on Mechanics of Ventilation & Circulation

A

Maintain in low Fowler position to maximize chest expansion

Continuous pulse oximetry

Supplemental oxygen

Frequent respiratory assessments

30
Q

Nursing Interventions to Address the Effects of Obesity on Central & Peripheral Circulatory Compromise

A

Use appropriately sized BP cuff

Monitor for DVT

Correct medication dose

Pressure injuries

31
Q

Nursing Interventions to Address the Effects of Obesity on Pharmacokinetics & Pharmacodynamics

A

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

32
Q

Nursing Interventions to Address the Effects of Obesity on Skin Integrity & Body Mechanics

A

Assess for pressure ulcers

Specialty bariatric equipment

33
Q

Bariatric Surgery

A

Surgery used to treat obesity
- Typically performed after nonsurgical interventions have failed

34
Q

Results of Bariatric Surgery

A

Results in weight loss of 10% to 35% body weight within 2 to 3 years
-Improvement in comorbid conditions

35
Q

Bariatric Procedures

A

Roux-en-Y gastric bypass
(RYGB)

Gastric banding

Sleeve gastrectomy

Biliopancreatic diversion
with duodenal switch

Performed by
laparoscopy or by an
open surgical technique

36
Q

Inclusion Criteria for Bariatric Surgery

A

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

37
Q

Exclusion Criteria for Bariatric Surgery

A

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

38
Q

Pre-op Considerations for Bariatric Surgery

A

Education and counseling

Risks and benefits of surgery

Complications

Post-surgical outcomes

Dietary changes

Lifelong follow-up

Lab testing

39
Q

Post-Op Considerations for Bariatric Surgery

A

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

NURS3313 Adult Health (27 decks)

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