Exam 2: Chapter 48 - Obesity

Question 1

What is obesity?

Answer 1

abnormal or excessive fat accumulation that may impair health

Question 2

Obesity is a BMI above

Answer 2

39 mg/m2

Question 3

Percentage of poeple who are overweight or obese?

Answer 3

68.5%

Question 4

Who has a higher prevelance for obesity?

Answer 4

Prevelance higher in women, African American, and Hispanic

Question 5

Increased risk for

Answer 5

disease, disorders, low self-esteem, impaired body image, depression, and diminished quality of life

Question 6

Dysfunctional adipose tissue cells release

Answer 6

biochemical mediators that cause chronic inflammatory changes, which can lead to a multitude of diseases, including heart disease, hypertension, and type 2 diabetes.

Question 7

Increase in fat stores, or adipose tissue, result in increases in the hormone

Answer 7

leptin, which is secreted by fat cells. Leptin also has the effect of signaling satiety in the hypothalamus.

Question 8

Treatment of obesity generally includes

Answer 8

lifestyle modifcations, pharmacological management, and nonsurgical or surgical interventions

Question 9

What lifestyle modications can be done?

Answer 9

Most effective behavioral interventions are those considered high intensity. Having 12-26 sessions annually.

They should also plan to cut 500-1000 calories daily.

Question 10

Pts who are not successful at meeting weight loss goals from lifestyle modication alone may be prescribed

Answer 10

Antiobesity Medications

These should be used to lower BMI in long term and are meant to supplement diet modification and exercise.

Question 11

Gastrointestinal Lipase Inhibitor: Mechanism of Action

Answer 11

Diminishes intestinal absorption and metabolism of fats, particularly triglycerides

Question 12

Gastrointestinal Lipase Inhibitor: Adverse Effects

Answer 12

Diarrhea, Flatus, Oily Stools, Fecal Incontinence Great for those who want to lose weight. People had these symtpoms eating potato chips

Question 13

How do antiobesity medications work?

Answer 13

By inhibitin gastrointestinal absorption of fats, or by altering central brain receptors to enhance satiety or reduce cravings

Needs to lose at least 5% of body weight after 12 weeks.

Question 14

Minimally invasive Interventions include

Answer 14

Vagal Blocking (Neurometabolic Modulation) and

Intragastric Balloon Therapy

Question 15

What does Vagal Blocking Therapy consist of?

Answer 15

Involves placement of a pacemaker like device into subcutaneous tissue in the lateral thoracic cavity with two leads that are laparoscopically implanted at the point where the vagus nerve truncates at the gastroesophageal junction

Pulsing signal sent for 12 hours daily. This causes blocking of vagus nerve resulting in diminished gastric contraction and emptying resulting in increased dsatiety and decreased cravings

Question 16

What is Intragastric balloon therapy

Answer 16

involves endoscopic placement of a saline-filled balloon or saline-filled dual ballon into the stomach. Cause increased feelings of satiety and decreased gastric emptying.

Question 17

How long does the intragastric balloon stay in place?

Answer 17

3-6 months and then are deflated and removed

Question 18

How should nurses approach these patients

Answer 18

They should approach patients with obesity with the same respectful, courterous and empathetic behavior as extended to patients without obesity

Question 19

When is Bariatric surgery typically performed?

Answer 19

After other nonsurgical attempts at weight control have failed

Question 20

How do Bariatric procedurees work?

Answer 20

By restricting a patients ability to eat , interfering with ingestion, nutrient absopriton, or both

Question 21

Bariatric surgery typically results in a weight loss of

Answer 21

10-35% of total body weight within 2-3 years postoperatively, with a majority of weight occuring in first yeaar

Question 22

Bariatric Surgery has what effect on comorbid conditions

Answer 22

Typie 2 Diabetes, Hypertension, and OSA may resolve.

Question 23

Preliminary Process for Bariatric Surgery?

Answer 23

Bariatic Surgery extended to carefully select adolescents with severe obesity and comorbity.

May necessitate months of counsseling, education, and evaluation by a wide range of team members.

Question 24

BMI Range for Bariatric Surgery ?

Answer 24

BMI as low as 30, for those with comorbid conditions

Question 25

Types of Bariatric Procedures

Answer 25

Roux-en-Y Gastric Bypass (RYGB) (Most Common)

Gastric Banding

Sleeve Gastrectomy (Most Common)

Billiopancreated Diversion with DUodenal Switch (Results in greatest weight loss, so typically used for those with high BMI)

These may be performed by laparoscopy or by an open surgical technique

Question 26

How ar eBariatric Procedures perfored?

Answer 26

Laparoscopy, or by open surgical technique

Question 27

Most common Bariatric Procedures?

Answer 27

RYGB and the Sleeve Gastrectomy

Question 28

What kind of procedure is RYGB considerd to be?

Answer 28

COmbined restrictive and malabsorptive procedure

Question 29

Gastic Banding and Sleeve Gastrectomy are what kind of procedures?

Answer 29

Restrictivev Procedures

Question 30

Biliopancreatic Diversion with Duodenal Switch is what kind of procedure?

Answer 30

Combines Gastric restriction with intestinal malabsorption

Question 31

How does a RYGB work?

Answer 31

Horizontal row of staples across the fundus creates pouch with capacity of 20 to 30 mL. Jejunum is divided and anastomosed to the new pouch

The proximal end is anastomosed to the jejenum.

Question 32

How does gastic banding work?

Answer 32

Restrict oral intake by creating small pouch of 10 - 15 mL, that empties through narrow outlet into remainder of the stomach

Question 33

How does sleeve gastrectomy work?

Answer 33

Stomach is incised vertically and up to 85% of the stomach is removed leaving a “sleeve”-shaped tube that retains intact nervous innervation and does not obstruct or decrease the size of the gastric outlet.

Question 34

How does a Biliopancreeatic Diversion (Sleeve Gastrectomy) with duodenal switch work?

Answer 34

Half Stomach removed leaving a small area that holds about 60 mL. Entire jejunum excluded from the rest of the tract. duodenum is didsconnected and sealed off.

Ileum is divided above the ileocecal junction and the distal end of the jejenum is anastomosed to the first portion of the duodenum. The distal end of the biliopancreatic limb is anastomosed to the ileum

Question 35

Potential Complications of Bariartic Surgery?

Answer 35

Hemorrhage

Venous Thromboembolism

Bile Reflux

Dumping Syndrome

Dysphagia

Bowel or Gastric Outlet Obstruction

Question 36

Bariartic Surgery: Ensure Dietary REstrictions

Answer 36

Ingest nothing but clear liquids before and after surgery from 24-48 hours.

Progression from clear liquids to full liquids to soft solids to evantually solid foods can occur after.

Question 37

What must be done if pt is suspected of having an anastomotic leak?

Answer 37

May have an upper GI series that includes CT scan with contrast dye which may find leaking contrast dye. Treatment may include CT guided drainage of the area.

Question 38

How many calories should you have per day after surgery?

Answer 38

600-800 calories per days with six small feedings

Question 39

Monitoring and Managing Potential Complications: Hemorrhage: What bleeding shows

Answer 39

First 72 hours is likely caused by disruption in a staple or suture Bleeding 72 hours - 30 days most likely from gastric or duodenal ulcer

Question 40

Monitoring and Managing Potential Complications: VTE prevention in those after bariatric surgery?

Answer 40

They should be prescribed mechanical compression and prophylactic anticoagulation with subcutaneous low molecular weight heparin agents.

Question 41

Monitoring and Managing Potential Complications: Bile reflex can cause what effects to the body?

Answer 41

Inflammation of the stomach or esophagus. Burning epigastric pain and vomiting of bilious material manifest this condition. May be managed with PPI

Question 42

Monitoring and Managing Potential Complications: Dysphagia: what is this?

Answer 42

Difficulty swallowing. It may occur with patients who had any type of restrictive bariatric procedure.