Exam 2 Flashcards
BMI
body mass index using weight and height to determine overweight and obesity ranges.
Overweight
BMI between 25 & 29.9
Obesity
BMI between 30 & 40
Morbid Obesity
BMI of 40 and higher
Overweight in Children
BMI in the 85th percentile and lower than the 95th percentile for children of the same age and sex
Obesity in Children
BMI in or above the 95th percentile for childen of the same age
Indiana
10th highest in obesity rates at 32.5% in 2016
Causes of Obesity
age gender genetics environmental factors physical activity psychological factors illness medication
Comorbid Conditions
Coronary heart disease DM2 cancers (endometrial, breast, colon) HTN HLD CVA Sleep apnea and resp gynecological problems (abnormal menses, infertility) liver and gallbladder disease OA
Childhood Obesity Health Risks
HTN Resp/Asthma DM2 MS GI social/psychological
Metabolic Syndrome
Abdominal Obesity (waist Circumference. >40 inch in men, >35 inch in men) Elevated Triglycerides HDL B/P FBS (DM) Thyroid
Readiness for Change
suggest healthy eating - not diet. What have then done in the past?
identify barriers
goals
plan
1 - 2 pound/week wt loss
500 - 1000 calories less per week
short term goal of 5 - 10% wt loss
6 months
6 month Short Term wt loss goal
5 - 10%
500 - 1000 calories/week
1 - 2 pound/week wt loss
Nutritional Intake Assessment
- Frequency of eating outside the home
- Sweetened beverages
- breads & Pastas
- Portion size/refills
- frequency & quality of breakfast consumption
- energy density foods
- fruits and vegetables
- meal frequency & snacking pattern
LCD
Low Calorie Diet
Low Calorie Diet
recommended for weight loss.
Protein - 4 calories/gram
Cho - 4 calories/gram
Fat - 9 calories/gram
Reduce total body weight
by 8% in 6 months
Very LCD
<800 calories produce greater initial weight loss, but faster is not necessarily better. Long term is better.
Low Calorie Step 1 Diet
Calories 500 - 1000 reduction per day
Physical Activity
- modestly contributes to wt loss
- may decrease abd fat
- increases cardio-respiratory fitness
Benefits of Physical Activity in relation to wt loss
- increases energy expenditure
- protects and builds lean body mass
- improves psychological factors
- reduces risk of mortality and morbidity
Physical Activity Impact of Co-Morbidities
- improves cardio-respiratory
- lower lipids
- lowers b/p
- increases insulin sensitivity
- improves blood glucose control
Behavior Therapy Strategies
- self monitoring
- stress management
- stimulus control
- problem solving
- contingency management
- cognitive restructuring
- social support
Self Monitoring & Stimulus Control
Keep a Diary
Behavior change techniques
Use rewards for specific actions
Keep a Diary
- Amount &types of food eaten
- Frequency, intensity & type of physical activity
- Time, place and feelings
Behavior Change Techniques
- Learn to shop for healthy foods
- Keep high caloir foods out of the home
- Limit the times and places of eating.
Stress Management
- Defuse situations that lead to overeating
- Coping strategies
- Mediation
- Relaxation techniques
Problem Solving
- Self correction of problem areas related to eating and physical activity
- identify wt related prloblems
- brainstorm solutions
- plan and implement healthier alternatives
- evaluate outcomes
- encourage pt reevaluation of “setbacks”.
Cognitive Restructuring
- Rational thoughts designed to replace negative thoughts.
Support
- Maintain motivation and positive reinforcement
- Family, Friends, Colleagues
Drug Therapy
non-drug interventions should be attempted for at least 6 months prior to considering Rx tx
Who is Drug Therapy appropriate for?
- BMI 30+ w/o co-morbities
- BMI 27+ w/ co-morbitieis (HTN, HLD, CHD, DM, Sleep apnea)
Orlistat
Xenical
- 120 mg TID AC meals (>12)
- decreases fat absorption
- can be taken up to 4 years
- SE: GI
- 5% loss of body weight w/ diet & exercise
- OTC
Adipex
amphetamine
- 37.5 mgp day X 4 weeks
- resting EKG & Lipids prior to initiation
- weekly wts w/ diet & exercise (script for 1 week only)
- SE: HTN, tachycardia, insomnia, palpitations, anxiety
Osymia
Pentermine & Tompiramate
- phentermine: appetite suppressant
Topiramate: stimulant, promote saiety
SE: Phen: insomnia, palpitations, anxiety, risk of birth defects. Topiramate: drowsiness
Contrave
bupropion & naltrexone
- bupropion - antidepressant that decreases hunger but also increases certain opioids in the brains that block satiety.
Naltrexone - opiod inhibitor-blocks affects of buproprion on opioids in brain.
SE: nausea, increase suidcide resk w/ bupropion and lowers seizure threshold.
Criteria for Wt Loss Surgery
- BMI > 40 or >35 w/ co-morbid conditions
- for pt whom medical therapy has failed
- gastric restriction or gastric bypass
Gastric Bypass Surgery Complications
Vit B 12 deficiency incisional hernia dpression gastritis cholecystitis dehydration malnutirition dilated pouch
Who Smokes?
- more people quitting
- not fewer people starting
- highest rate is black males
- 26% of all Americans >18 years of age smoke (2007)
Why Start Smoking?
- alleviate stress
- peer pressures
- family hx, parental modeling
- poor
- want to appear mature
- risk takers
- extroverted peeps
- alleviation of depression
- substance abuse (ETOH)
Child & Adolescent Smokers
3000 teens start smoking everyday
Women & Smoking
- smoking helps w/ depression and appetite suppression
- typically gain 5 - 10 pounds w/ cessation
- easier to control from the beginning of cessation
Smoking Cessation
- 50% of smokers want to quite
- –it is expensive, $3, 391/yr
- discuss previous attempts
- –2/3 unsuccessful w/ 1st try
- –what went well?
- –why relapse
- success rates are low
5 A’s,
Smoking Cessation Steps
1) ask about tobacco use
2) advise to quit
3) assess willingness to quit
4) assist in quit attempt
5) arrange for f/u
Pack years
of years X # of packs/day
5 R’s
Assist w/ motivation
1) Relevance
- —kids
2) Risks
- —COPD, smell, walls
3) Rewards
- —better health, more money
4) Roadblocks
- —wt gain, depression, routine is changed
5) Repetition
- —enforce every visit and encourage
Health Belief Model & Smoking Cessation
- more likely to quit if…
- –believe they could get smoking-related disease
- —believes they can make an honest attempt
- —believes the benefits of quitting outweigh the benefits of smoking
- —know someone who has health problems from smoking
Transtheoretical Model & Smoking Cessation
- Pr-contemplator
- —not ready
- contemplator
- —excuses but thinking about it
- Preparation
- —seriously intend to quit in the next month
- Action
- —first 6 months of not smoking
- Maintenance
- —6 months to 5 years for relapse
Quitting Advice
- pick a quit date
- tell family and friends
- prepare
- —gum, healthy snacks
- pick a strategy
- —patch, gum, vaper
- find support
Types of Nicotine Replacement
- transdermal
- gum
- nicotine nasal spray
- inhalers
- oral agents
Nicotine Patch
- measured dose through the skin
- no prescription needed
- start full-strength 15 - 22 mg QD for 4 weeks
- then 5 - 14 mg QD for 4 weeks
- FDA recommends 3 - 5 months. some show 8 wks is sufficient
Nicotine Gum
- fast acting
- OTC
- 2 - 4 mg doses
- no more than 20 mg/day
- use for up to 6 months
- can form long term dependence
- also have Commit lozenge
Nicotine Nasal Spray & Inhalers
- fast acting
- prescription only
- FDA says addictive 3 - 6 months only
- do not use for asthmatics and/or sinus problems
Bupropion
for smoking cessation
- wellbutrin/zyban
- can be used w/ nicotine replacement
- higher quit rates
- can’t take if hx of seizure, anorexia, ETOH use or head injury
Bupropion
for smoking cessation
dosing
- take 7 - 12 weeks
- take 10 - 14 days prior to stopping smoking
- 150 mg q day x 3 days then 150 mg bid
Chantix
for smoking cessation
- set stop date start one week prior to stop date - take after eating and w/ full glass of water - contradicted in unstable depression - 0.5 mg QD X 3 days - 0.5 mg BID X 7 days - 1 mg BID X 12 weeks
Cephalcaudal Growth Pattern
- a child’s pattern of growth
- head-to-toe direction
Proximodistal Growth Pattern
- also a child’s growth pattern
- an inward to outward direction
Domains Assessed in Child development assessment
cognitive motor language social/behavioral adaptive
Gross Motor Skills
- precedes fine motor skills
occurs in cephalocaudal fasion (head-to-toe direction)
—-head contorl preceding arm and hand control
—-followed by leg and foot control
Gross Motor Development of 6 Month old
easily lifts head, chest and upper abd and can bear weight on arms.
Development Assessment, Sitting Up
- 2 mo: needs assist
- 6 mo: can sit alone in tripod position
- 8 mo: can sit w/o support and engage in play
Development Assessment,
Ambulation
9 mo: crawl
1 yr: stand independently from a crawl position
13 mo: walk and toddle quickly
15 mo: able to run
Development Assessment,
Fine Motor of an Infant
- objects involuntarily grasped and dropped w/o notice
- 6 mo: palmar grasp, uses entire hand to pick up an object
- 9 mo: pincer grasp, can grasp small objects using thumb and forefinger
Development Assessment,
Speech Milestones
1-2 months: coos
2-6 months: laughs and squeals
8-9 months babbles: mama/dada as sounds
10-12 months: “mama/dada specific
18-20 months: 20 to 30 words – 50% understood by strangers
22-24 months: two word sentences, >50 words, 75% understood by strangers
30-36 months: almost all speech understood by strangers
Development Assessment,
Hearing
BAER hearing test done at birth
Ability to hear correlates with ability enunciate words properly
Always ask about history of otitis media – ear infection, placement of PET – tubes in ear
Early referral to MD to assess for possible fluid in ears (effusion)
Repeat hearing screening test
Speech therapist as needed
Development Assessment,
Red Flags in infant development
- unable to sit alone by 9 mo
- unable to transfer ojects from hand to hand by 1 year
- abnormal pincer grip by age 15 mo
- unable to walk alone by 18 mo
- failure to speak recognizable words by 2 years
Development Assessment,
Fine Motor
Toddler
- 1 yr: trasfer objects from hand to hand
- 2 yr: able to hold a crayon and color vertical strokes
- —turn the page of a book
- —build a tower of six blocks
- 3 yr: copy a circle and a cross
- 4 yr: use scissors, color within the borders
- 5 yr: write some letters and draw a person w/ body parts
Development Assessment,
issues in parenting toddlers
- stranger anxiety
- —dissipate by age 2.5 - 3 yr
- temper tantrum
- —dissipate by age 3 yr
- sibling rivalry
- thumb sucking
- toilet training
Development Assessment,
Fine Motor Skills
Pre-School
- buttoning clothing
- holding a crayon/pencil
- building with small blocks
- using scissors
- playing a board game
- draw a picture of themselves
Development Assessment,
Red Flags in Pre-School development
- inability to perform self-care tasks (hand washing, simple dressing)
- lack of socialization
- unable to play w/ other children
- able to follow directions during an exam
- performance eval of pre-school teacher for kindergarten readiness
Development Assessment,
Fine Motor Skills
School Age Children
- writing skills improved
- refined fine motor skills
- —building
- —sewing
- —musical instrument
- —painting
- —typing skills
- —technology: computers
Development Assessment,
Red Flags in School Age Child development
- school failure
- lack of firends
- social isolation
- aggressive behavior
- —fights, fire setting, animal abuse
Incidence of Illicit drug use
- 6.1% of Americans >12 yr have used in previous month
- 1 in 20 HS seniors use marijuana QD
Incidence of OTC Prescription drug abuse
- sleeping medications
- health care professionals are at higher risk for prescription drug abuse
Screening Tools for Substance Abuse
- CAGE
- AUDIT
- —ETOH abuse
