Nursing Care of Patients with Nutritional Disorders

Question 1

Obesity

Answer 1

An excess of adipose tissue, is one of the most prevalent, preventable health problems in the United States.

Question 2

Bariatrics

Answer 2

The healthcare science that focuses on patients who are extremely obese

Question 3

Body Mass Index

Answer 3

(BMI) An indirect measure of the amount of body fat, or adipose tissue.

Question 4

Nutrients

Answer 4

Substance found in food that are used by the body to promote growth, maintenance, and repair.

Question 5

Basal Metabolic Rate

Answer 5

BMR; the kilocalorie cost of being alive.

Question 6

Triglycerides

Answer 6

Stored excess energy from fats; formed from dietary fats and carbohydrates.

Question 7

Upper Body Obesity

Answer 7

Central obesity; identified by a waste-to-hip ratio of greater than 1 in men or 0.8 in women. People with __________________ tend to have more Indra-abdominal fat and higher levels of circulating free fatty acids._________________ is associated with a greater risk of complications such as hypertension, abnormal blood lipid levels, heart disease, stroke, and elevated insulin levels. Men tend to have more than women, although women develop a central fat distribution pattern after menopause.

Question 8

Lower Body Obesity

Answer 8

Peripheral obesity, the waist to hip ratio is less than 0.8, is more commonly seen in women. The risk for hyperinsulinemia, abnormal lipids, and heart disease is lower in people with peripheral obesity than in people with central obesity; however it is more difficult to treat.

Question 9

Sarcopenic Obesity

Answer 9

Associated with age-related loss of muscle mass and is described as the process of muscle loss combined with increased body fat. Leads to a loss of strength and function, reduced quality of life, and early death. Limited physical activity, disuse syndrome, decreased resting metabolic rate, and changes in dietary requirements.

Question 10

Metabolic Syndrome

Answer 10

A constellation of cardiovascular risk factors, including increased waist circumference, hypertension, elevated blood triglycerides, and fasting blood glucose, and low HDL cholesterol.

Question 11

Very Low Calorie Diets

Answer 11

VLCD, A protein sparing modified fast(400-800 kcal/day or less) under close medical supervision that may be used to treat significant obesity; generally reserved for patients with a BMI greater than 30. Typically use commercially prepared formulas (liquid shakes or bars) to replace all food intake for several weeks or months, resulting in rapid weight loss while maintaining lean body mass.

Question 12

Malnutrition

Answer 12

Results from inadequate intake of nutrients

Question 13

Starvation

Answer 13

Inadequate dietary intake

Question 14

Catabolism

Answer 14

Cell and tissue breakdown

Question 15

Protein-Calorie Malnutrition

Answer 15

Both protein and calories are deficient. Lean body mass is broken down to meet those needs. If untreated, up to half of the body’s protein stores can be used within 3 weeks.

Question 16

Enteral Nutrition

Answer 16

Tube feeding, may be used to meet calorie and protein requirements in patients unable to consume adequate food.

Question 17

Parenteral Nutrition

Answer 17

The intravenous administration of amino acids, often with added carbohydrates, fats, electrolytes, vitamins, and minerals. Usually are administered through central lines, particularly when therapy is prolonged.

Question 18

Anorexia Nervosa

Answer 18

A refusal to maintain a minimally normal body weight, a distorted body image, and a sense of fear of gaining weight or of loss of control over food intake. Affects about 1% of women at some time in their lives.

Question 19

Bulimia Nervosa

Answer 19

Affects 1-3% of women in the United States, is characterized by recurring binge eating followed by purge behaviors such as self-induced vomiting, use of laxatives or diuretics, fasting, or excessive exercise.

Question 20

Binge-Eating Disorder

Answer 20

A subgroup of EDNOS and is believed to affect many more people than either anorexia or bulimia.

Question 21

Obesity is associated with increased ___________ and ____________.

Answer 21

Obesity has serious physiologic and psychological consequences, and is associated with increased morbidity and mortality.

Question 22

What are examples of comorbidities associated with obesity?

Answer 22

Obesity is associated with comorbid conditions such as coronary heart disease, type 2 diabetes, and various types of cancer, gallstones, and disability. These comorbid problems are associated with higher use of healthcare services and costs among patients with obesity.

Question 23

Obesity is associated with an increase risk of death, particularly in what age group?

Answer 23

Obesity is associated with an increased risk for death, particularly in adults younger than 65 years of age.

Question 24

Health-Related Problems Associated with Obesity: Cardiovascular

Answer 24

Atherosclerosis, hypercholesterolemia, coronary heart disease, heart failure, hypertension, stroke, varicosities, and venous thrombosis.

Question 25

Health-Related Problems Associated with Obesity-Respiratory

Answer 25

Asthma, sleep apnea

Question 26

Health-Related Problems Associated with Obesity- Gastrointestinal

Answer 26

Gallbladder disease, hiatal hernia, colon cancer

Question 27

Health Related Problems Associated with Obesity-Genitourinary

Answer 27

Prostate cancer, stress incontinence

Question 28

Health Related Problems Associated with Obesity- Musculoskeletal

Answer 28

Low back pain, muscle strains and sprains, and osteoarthritis

Question 29

Health Related Problems Associated with Obesity-Endocrine and Reproductive

Answer 29

Diabetes mellitus type 2, breast and endometrial cancers, polycyclic ovarian syndrome, complications of pregnancy

Question 30

Health Related Problems Associated with Obesity- Other

Answer 30

Depression, metabolic syndrome, postoperative complications

Question 31

When is adipose tissue created?

Answer 31

Adipose tissue is created when energy consumption exceeds energy expenditure.

Question 32

Overweight

Answer 32

BMI of over 25

Question 33

Obesity BMI

Answer 33

Obesity is a BMI of 30 or greater. A patient who is obese is also overweight.

Question 34

True or false (if false, explain): The prevalence of obesity is greatest in men and in economically disadvantaged people of all races.

Answer 34

False; The prevalence of obesity is higher in women and in economically disadvantaged people of all races.

Question 35

Which is increasing in prevalence in the United States to a greater extent: obesity or overweight?

Answer 35

While the prevalence of overweight has been increasing since 1960, the prevalence of obesity is increasing to a greater extent, particularly during the past 10-15 years.

Question 36

What age group is of particular concern regarding the obesity epidemic in the United States?

Answer 36

Of particular concern is the increase of obesity in children and young adults.

Question 37

Place the prevalence of overweight and obesity in women in the United States in order from highest occurrence to lowest occurrence.

Answer 37

Black, Hispanic, and White

Question 38

Place the prevalence of overweight and obesity in men in the United States in order from highest occurrence to lowest occurrence.

Answer 38

Hispanic, White, and Black

Question 39

List common risk factors for obesity

Answer 39

Physical inactivity, reliance on the automobile for transportation, increased time using the computer, increased time spent watching television, increased access to inexpensive and obesogenic types of food, abundant and readily accessible food supply, fast food restaurants, advertising, vending machines, increased consumption of restaurant meals, overeating at family meals, rewarding behavior with food, religious and family gatherings that promote food intake, sedentary lifestyles, women, and low incomes.

Question 40

What does the body do to excess nutrients? Why?

Answer 40

The body stores excess nutrients and energy (measured as kilocalories) to meet the body’s needs when required nutrients are unavailable. This ability to store and release energy is important to maintaining body function.

Question 41

What is energy primarily stored as?

Answer 41

Energy is primarily stored as fat in adipose tissue.

Question 42

Which types of adipose cells multiply?

Answer 42

Although mature fat cells (adipocytes) do not multiply, the immature cells in adipose tissue can multiply.

Question 43

When do immature adipose cells multiply?

Answer 43

The immature cells in adipose tissue can multiply, particularly when exposed to estrogen during puberty, in late adolescence, during breast-feeding, and in middle age adults who are overweight.

Question 44

When are triglycerides broken down?

Answer 44

The body breaks down triglycerides in fat cells when needed to provide energy.

Question 45

Which factors can result in obesity?

Answer 45

Obesity occurs when excess calories are stored as fat. It can result from excess energy intake, decreased energy expenditure, or a combination of both.

Question 46

Energy intake and energy expenditure is regulated by a complex interaction of _____________ and ______________ _____________ .

Answer 46

Energy intake and energy expenditure are regulated by a complex interaction of endocrine and neural signals.

Question 47

How do regulatory mechanisms influence energy intake and expenditure?

Answer 47

In the absence of external influences, these regulatory mechanisms increase appetite and reduce energy expenditure when weight loss occurs, and suppress appetite and increase energy expenditure after over feeding.

Question 48

What body system regulates food intake?

Answer 48

Appetite, which affects food intake, is regulated by the central nervous system (CNS). The hunger center in the hypothalamus stimulates appetite in response to stimuli. The satiety center of the hypothalamus sends a message to stop eating as nutrient levels rise.

Question 49

Other than hunger and physical signals, what other factors may influence appetite?

Answer 49

Appetite may have little relationship to hunger or physical signals, however; some people eat to relieve anxiety or depression.

Question 50

What hormones are involved in the regulation of obesity?

Answer 50

Several hormones are involved in regulating obesity, including thyroid hormone, insulin, leptin.

Question 51

Leptin

Answer 51

A peptide produced by fatty tissues that suppresses appetite and increases energy expenditure. Some studies suggest that leptin suppression is a cause of obesity.

Question 52

Insulin

Answer 52

Associated with body fat distribution.

Question 53

Adipose tissue secretes _________ that stimulate the liver to produce _____________, now recognized as a risk factor for CHD.

Answer 53

Adipose tissue secretes cytokines that stimulate the liver to produce C reactive protein (CRP), now recognized as a risk factor for CHD.

Question 54

How can obesity increase the risk for heart failure?

Answer 54

Obesity increases the risk for heart failure. Left ventricular muscle mass increases, and the ventricle dilates in individuals with obesity, possibly related to increased blood volume and cardiac output.