Exam #2 Obesity

Question 1

Metabolic Syndrome Definition

Answer 1

( Insulin Resistance )
Risk factor for CV and Diabetes
Females have a higher risk!
Continues to increase with low physical activity levels!

Question 2

Metabolic Syndrome
( Needs three of these factors )

Answer 2

1. Abdominal Obesity: 40+ Men ( Waist )
   35+ ( Women )
2. Hyperglycemia: Fasting BG above 100 mg/dl
3. Hypertension: 130 mm hg or more, 85 mm hg
4. Hyperlipidemia: Triglyceride level of 150 mg/dl
   - HDL: Less than 40 men, Less than 50 for women

Question 3

Initial Nutrition Screening

Answer 3

Should be done within 24 hours of patients hospital admission!

Question 4

BSA

Answer 4

An estimate of a patients total body surface area. It reflects heat exchange, blood volume and vital organs.

Question 5

Skinfold measurements

Answer 5

Triceps and subscapular skinfolds

Question 6

BMI

Answer 6

Estimates total fat stores within the body by the relationship of weight to height

Question 7

BMI Below 18.5

Answer 7

Underweight

Question 8

BMI 18.5-24.9

Answer 8

Normal

Question 9

BMI 25.0-29.9

Answer 9

Overweight

Question 10

BMI 30.0 and above

Answer 10

Obese

Question 11

Limitations of BMI calculation include…

Answer 11

Physically fit, athletic or muscular patients.

Question 12

Obese Class 1

Answer 12

30-34.99

Question 13

Obese Class 2

Answer 13

35-39.9

Question 14

Obese Class 3

Answer 14

40 kg/m

Question 15

Causes of Obesity

Answer 15

Consuming high fat, high cholesterol diets = Most Common Cause
- Physical Inactivity: 75 mins a week
- Drug Therapy: Meds that cause weight gain = Corticosteroids, Estrogen, NSAIDS, Antihypertensives, Antidepressants, Antiepileptics

Question 16

Obesity Interventions Nutrition

Answer 16

Improving Nutrition: #1
Diet: Short term fasting/ low calorie diets, requires cardiac eval.
- 1200-1800 cal
- Unbalanced low energy diet: Low carb
Nutrition: Low risk high benefit

Question 17

Obesity Interventions Cont

Answer 17

Exercise Program:
-Adding physical activity
- 20 mins of walking daily
- Increasing indurance

Question 18

Lipase Inhibitors
Orlistat

Answer 18

Inhibits gastric and pancreatic lipases and promotes weight loss by decreasing the amount of dietary fat absorbed in intestines
- S/A/E: Oily Stools! , N/V
Admin: Take with meal, MVI daily

Question 19

Amphetamine - Related Anorexigenic Agent
Phentermine

Answer 19

Appetite Suppressant
- Avoid in patients with serious heart rhythm disturbances
- Take 1 hour before breakfast
- CNS: S/A/E: Dizziness, dry mouth, difficulty sleeping, N/V, diarrhea, constipation

Question 20

GLP-1 Analogs
Semaglutide and Liraglutide

Answer 20

-Glucagon like peptide 1
Increases insulin secretion, decreases glucagon release and slows gastric emptying.
- Change injection sites

Question 21

Bariatric Surgery Eligibility

Answer 21

• Does not respond to traditional interventions
• BMI over 40
• 35 or higher w other risk factors

Question 22

Gastric Bypass

Answer 22

Creating a small pouch from the stomach and connecting the newly created pouch directly to small intestine
- Food goes right to SI.
- Bypasses most of stomach.
- After Surgery: Liquids only –> Solids
- Loosing calories and nutrients + affects absorption

Question 23

Adjustable Gastric Band

Answer 23

Sillicon band around the upper part of the stomach which induces weight loss by restricting food intake.
- Lessen feelings of hunger
- Band adjusted w saline
- Digestion and absorption is normal!

Question 24

Sleeve Gastrectomy

Answer 24

Part of the stomach is separated and removed from the body
- tubelike structure
- Can’t hold as much food
- *** produces less appetite regulating hormone ghrelin

Question 25

Operative Procedures PRE OP

Answer 25

Increased risk for DVT, PE, Death - Weight loss prior may be required - Psychological assessment: AMS, Cog, Support

Question 26

Operative Procedures INTRA OP

Answer 26

Gastric restriction allows for normal digestion without the nutrional deficiences - Banding - Vertical Sleeve Biliopancreatic diversion and Gastric Bypass - Fewer cals absorbed - Nutrient loss

Question 27

Operative Procedures POST OP

Answer 27

Monitor ABC's ( Airway and Ventillation ) Additional Personnel Ensure rails are not touching body Pain Clear liquids --> pureed --> soft

Question 28

Marasmus

Answer 28

Body fat and protein are wasted! Serum protien is preserved - Caloric Malnutrition

Question 29

Kwashiorkor

Answer 29

Body weight normal, Serum Protein is low! - Lack of protien

Question 30

Starvation

Answer 30

Complete lack of nutrients

Question 31

Anorexia Nervosa

Answer 31

Self Induced state of starvation resulting from a fear of fatness, even though patient is underweight. - Low body weight, below 85% - BDD, Body Dysmorphic - Preoccupation with food or rituals with food

Question 32

A. N Assessment

Answer 32

Low BP, Yellow Skin, pale, dehydrated, electro imbalances, muscle weakness, no energy, ECG changes

Question 33

A.N Intervetions

Answer 33

1st: Re feeding program - Orally - TPN ?

Question 34

Complications of Total Enteral Nutrition

Answer 34

Refeeding Syndrome = Life threatening complication related to fluids and electrolyte shifts during aggressive nutrition rehab. - Abdominal Distension - Fluid, Electro Imbalance

Question 35

Bulimia Nervosa

Answer 35

Binge eating in which the patient ingests a large amount of food in a short time. - Followed by purging behavior, self induced vomiting, excessive use of laxatives.

Question 36

B.M Characteristics

Answer 36

BMI: 18.5-30 Late adolescent or early adulthood female

Question 37

B.M Assessment

Answer 37

Russells Signs: Calluses or scars on the back of hand Dental erosion and cavities Self induced vomiting Esophageal tears/ruptures

Question 38

B.M Ultimate Goal is to...

Answer 38

Improve Nutrition - Prevent purging - Orally is preferred food route, through GI tract because it enhances the immune system is safer, easier, less expensive and more enjoyable.

Question 39

Binge Eating Disorder

Answer 39

Loss of control over eating - No purging! - HTN = Binge Eating - Binge= Overweight

Question 40

Criteria for acute care treatment ...

Answer 40

Rapid weight loss or greater than 30% of body weight in 6 months Unsuccessful weight gain HR < 400 ECG changes Electo disturbances Severe depression