Exam 2: Chapter 48 - Obesity Flashcards
What is obesity?
abnormal or excessive fat accumulation that may impair health
Obesity is a BMI above
39 mg/m2
Percentage of poeple who are overweight or obese?
68.5%
Who has a higher prevelance for obesity?
Prevelance higher in women, African American, and Hispanic
Increased risk for
disease, disorders, low self-esteem, impaired body image, depression, and diminished quality of life
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 2 diabetes.
Increase in fat stores, or adipose tissue, result in increases in the hormone
leptin, which is secreted by fat cells. Leptin also has the effect of signaling satiety in the hypothalamus.
Treatment of obesity generally includes
lifestyle modifcations, pharmacological management, and nonsurgical or surgical interventions
What lifestyle modications can be done?
Most effective behavioral interventions are those considered high intensity. Having 12-26 sessions annually.
They should also plan to cut 500-1000 calories daily.
Pts who are not successful at meeting weight loss goals from lifestyle modication alone may be prescribed
Antiobesity Medications
These should be used to lower BMI in long term and are meant to supplement diet modification and exercise.
Gastrointestinal Lipase Inhibitor: Mechanism of Action
Diminishes intestinal absorption and metabolism of fats, particularly triglycerides
Gastrointestinal Lipase Inhibitor: Adverse Effects
Diarrhea, Flatus, Oily Stools, Fecal Incontinence Great for those who want to lose weight. People had these symtpoms eating potato chips
How do antiobesity medications work?
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.
Minimally invasive Interventions include
Vagal Blocking (Neurometabolic Modulation) and
Intragastric Balloon Therapy
What does Vagal Blocking Therapy consist of?
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
What is Intragastric balloon therapy
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.
How long does the intragastric balloon stay in place?
3-6 months and then are deflated and removed
How should nurses approach these patients
They should approach patients with obesity with the same respectful, courterous and empathetic behavior as extended to patients without obesity
When is Bariatric surgery typically performed?
After other nonsurgical attempts at weight control have failed
How do Bariatric procedurees work?
By restricting a patients ability to eat , interfering with ingestion, nutrient absopriton, or both
Bariatric surgery typically results in a weight loss of
10-35% of total body weight within 2-3 years postoperatively, with a majority of weight occuring in first yeaar
Bariatric Surgery has what effect on comorbid conditions
Typie 2 Diabetes, Hypertension, and OSA may resolve.
Preliminary Process for Bariatric Surgery?
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.
BMI Range for Bariatric Surgery ?
BMI as low as 30, for those with comorbid conditions
Types of Bariatric Procedures
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
How ar eBariatric Procedures perfored?
Laparoscopy, or by open surgical technique
Most common Bariatric Procedures?
RYGB and the Sleeve Gastrectomy
What kind of procedure is RYGB considerd to be?
COmbined restrictive and malabsorptive procedure
Gastic Banding and Sleeve Gastrectomy are what kind of procedures?
Restrictivev Procedures
Biliopancreatic Diversion with Duodenal Switch is what kind of procedure?
Combines Gastric restriction with intestinal malabsorption
How does a RYGB work?
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.
How does gastic banding work?
Restrict oral intake by creating small pouch of 10 - 15 mL, that empties through narrow outlet into remainder of the stomach
How does sleeve gastrectomy work?
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.
How does a Biliopancreeatic Diversion (Sleeve Gastrectomy) with duodenal switch work?
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
Potential Complications of Bariartic Surgery?
Hemorrhage
Venous Thromboembolism
Bile Reflux
Dumping Syndrome
Dysphagia
Bowel or Gastric Outlet Obstruction
Bariartic Surgery: Ensure Dietary REstrictions
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.
What must be done if pt is suspected of having an anastomotic leak?
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.
How many calories should you have per day after surgery?
600-800 calories per days with six small feedings
Monitoring and Managing Potential Complications: Hemorrhage: What bleeding shows
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
Monitoring and Managing Potential Complications: VTE prevention in those after bariatric surgery?
They should be prescribed mechanical compression and prophylactic anticoagulation with subcutaneous low molecular weight heparin agents.
Monitoring and Managing Potential Complications: Bile reflex can cause what effects to the body?
Inflammation of the stomach or esophagus. Burning epigastric pain and vomiting of bilious material manifest this condition. May be managed with PPI
Monitoring and Managing Potential Complications: Dysphagia: what is this?
Difficulty swallowing. It may occur with patients who had any type of restrictive bariatric procedure.
