Chapter 48 Obesity Flashcards
Obesity is a chronic and relapsing disease characterized by an excessive accumulation of __ fat and __ gain.
body fat
weight gain
Dysfunctional adipose tissue cells release biochemical mediators that cause chronic inflammatory changes, which can lead to a multitude of diseases, including heart disease, hypertension, and type __ diabetes
type 2
vital signs including serial assessments of weight, height, and BMI.
diet and exercise history
assessment of life stressors that may drive dietary habits (ex low self-esteem, impaired body image)
assessment for the presence of comorbidities (diabetes, hypertension, sleep apnea, and dyslipidemia.
These are __ done by the nurse
assessments done to diagnose patient with obesity
treatment of obesity generally includes __ modifications, pharmacological treatment, and nonsurgical or surgical interventions.
lifestyle
There are 5 antiobesity medications that may be prescribed over the long term to assist in decreasing and then maintaining a lower __. Of these only one orlistat (Xenical) was FDA approved.
BMI
depression may contribute to weight __, and treatment of the depression with an antidepressant agent may be helpful
gain
patients may elect to pursue minimally invasive interventions that were approved by the FDA in 2015. These types of interventions include __ blocking or intragastric __ therapy.
vagal
balloon
__ surgery is considered only after medical management has failed.
bariatric
gastric restriction procedures include __ bypass and __ banded gastroplasty
gastric
vertical
body contouring after weight loss involves lipoplasty to remove __ deposits or panniculectomy to remove excess abdominal skinfolds
fat
Patients identified as overweight have body mass indexes BMI of __ to __ kg/m2
those who are considered obese have a BMI greater than __
25-29.9
30
obesity-related mortality rates are __ greater for every gain of 5 kg/m2 of body mass beyond a BMI of 25 kg/m2
30%
Patients with extreme obesity are at higher risk for health complications such as diabetes, heart disease, stroke, hypertension, gall bladder disease, osteoarthritis, sleep apnea and other __ problems, and some forms of cancer
breathing
Most insurance companies will authorize bariatric surgery only after an obese patient tries __ to __ months of a medically supervised diet that fails to reach its weight loss goal.
6-18 months
patient selection for bariatric surgery is critical; therefore, patients need counseling __and after __ surgery.
before
after
bariatric surgical procedures work by restricting a patients ability to __ and interfering with ingested nutrient __
eat
absorption
Different bariatric surgical procedures entail different __ modifications, and patients must be well informed about the specific lifestyle __, eating habits, and bowel habits that may result from a particular procedure.
lifestyle
changes
Roux-en-Y gastric bypass, gastric banding, vertical banded gastroplasty, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch are the current bariatric procedures of __
choice
the Roux-en-Y gastric bypass is a combined restrictive and __ procedure
malabsorption
The sleeve gastrectomy, gastric banding, and vertical- banded gastroplasty are __ procedures
restrictive
biliopancreatic diversion with duodenal switch combines gastric __ with intestinal malabsorption
restriction
for patients undergoing bariatric surgery assess for contraindications to major abdominal surgeries
encourage and support the patient in making plans for lifestyle changes to reduce weight
ensure the patient has been screened for __ and __ disorders that may interfere with postsurgical outcomes.
General postop nursing care is similar to that for a patient recovering from a gastric resection
mental and behavioral disorders
Potential problems that may develop after bariatric surgery include hemorrhage, bile reflux, __ syndrome, dysphagia, bowel or gastric outlet obstruction, venous thromboembolism
dumping
Postoperative planning and goals
relief of __
maintenance of homeostatic fluid balance
absence of __
adherence to prescribed dietary regimen with progression of food and fluid intake
increased knowledge about the necessity of vitamin supplements and the need for lifelong followup
maintenance of __ bowel habits
pain
infection
normal
counsel patient anticipating bariatric surgery to ingest nothing but clear liquids for specified time preoperatively (typically about __ hours)
48
educate patient and family regarding __ limitations postoperatively
dietary
positioning the patient in __ position promotes comfort and promotes emptying of the stomach after any type of gastric surgery which includes bariatric procedures.
low fowler
postoperatively, slowly introduce oral feedings beginning with small volumes (__mL) of sugar free oral fluids every __ mins
30mL
15 mins
__ medications may be prescribed to relieve nausea and prevent vomiting, which may likewise cause strain on the surgical site.
antiemetic
Insertion of __ tubes is contraindicated in the patient after bariatric surgery. This procedure may disrupt the surgical suture line and cause an anastomotic leak or hemorrhage
nasogastric
disruption at the site of anastomosis (surgically resected site) may cause leakage of gastric contents into the peritoneal cavity, causing infection and possible __; older __ patients with greater body mass are at risk.
sepsis
male
signs and symptoms of an anastomotic leak are typically nonspecific; fever, abdominal pain, tachycardia, and leukocytosis and may progress to __
sepsis
if an anastomotic leak is suspected, the patient may have an upper GI series and a follow-up __ with contrast dye
CT
after bowel sounds have returned and oral intake is resumed, __ small feedings consisting of a total of __ to __ calories per day are provided: consumption of fluids between meals is encouraged to prevent dehydration.
6
600 to 800 calories
educate the patient to eat slowly and to stop when feeling __to minimize vomiting or painful esophageal distention
full
common dietary deficiencies include malabsorption of organic __ and a low serum level of vitamin __; the patient may be prescribed monthly vitamin B12 intramuscular injections to prevent pernicious anemia.
iron
B12
the majority of weight loss after bariatric surgery will be in the first __ months
6 months
__ is a more common occurrence after bariatric surgery than is __
diarrhea
constipation
encourage consumption of a nutritious diet high in __, especially if constipation is a problem
fiber
__ also may occur as a result of rapid gastric emptying, which prevents adequate mixing with pancreatic and biliary secretions.
steatorrhea
persistent diarrhea or steatorrhea may warrant further diagnostic testing, such as an __ endoscopy or __. with biopsies to rule out the presence of additional pathology.
upper endoscopy
colonoscopy
assess the patient for complications from bariatric surgery such as __, bile reflux, dumping syndrome, dysphagia venous thromboembolism, and bowel or gastric outlet obstruction
hemorrhage
the patient is usually discharged from the hospital in __ days
(this may be within __ to __ hours for patients who have had laparoscopic procedures) with detailed dietary instructions
4
24 to 72 hours
women of childbearing age who have bariatric surgery are advised to use contraceptives for at least __ months after surgery; patients are urged to avoid pregnancy until weight stabilizes.
18 months
