Nursing Care of Patients with Nutritional Disorders Flashcards
Obesity
An excess of adipose tissue, is one of the most prevalent, preventable health problems in the United States.
Bariatrics
The healthcare science that focuses on patients who are extremely obese
Body Mass Index
(BMI) An indirect measure of the amount of body fat, or adipose tissue.
Nutrients
Substance found in food that are used by the body to promote growth, maintenance, and repair.
Basal Metabolic Rate
BMR; the kilocalorie cost of being alive.
Triglycerides
Stored excess energy from fats; formed from dietary fats and carbohydrates.
Upper Body Obesity
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.
Lower Body Obesity
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.
Sarcopenic Obesity
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.
Metabolic Syndrome
A constellation of cardiovascular risk factors, including increased waist circumference, hypertension, elevated blood triglycerides, and fasting blood glucose, and low HDL cholesterol.
Very Low Calorie Diets
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.
Malnutrition
Results from inadequate intake of nutrients
Starvation
Inadequate dietary intake
Catabolism
Cell and tissue breakdown
Protein-Calorie Malnutrition
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.
Enteral Nutrition
Tube feeding, may be used to meet calorie and protein requirements in patients unable to consume adequate food.
Parenteral Nutrition
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.
Anorexia Nervosa
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.
Bulimia Nervosa
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.
Binge-Eating Disorder
A subgroup of EDNOS and is believed to affect many more people than either anorexia or bulimia.
Obesity is associated with increased ___________ and ____________.
Obesity has serious physiologic and psychological consequences, and is associated with increased morbidity and mortality.
What are examples of comorbidities associated with obesity?
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.
Obesity is associated with an increase risk of death, particularly in what age group?
Obesity is associated with an increased risk for death, particularly in adults younger than 65 years of age.
Health-Related Problems Associated with Obesity: Cardiovascular
Atherosclerosis, hypercholesterolemia, coronary heart disease, heart failure, hypertension, stroke, varicosities, and venous thrombosis.
Health-Related Problems Associated with Obesity-Respiratory
Asthma, sleep apnea
Health-Related Problems Associated with Obesity- Gastrointestinal
Gallbladder disease, hiatal hernia, colon cancer
Health Related Problems Associated with Obesity-Genitourinary
Prostate cancer, stress incontinence
Health Related Problems Associated with Obesity- Musculoskeletal
Low back pain, muscle strains and sprains, and osteoarthritis
Health Related Problems Associated with Obesity-Endocrine and Reproductive
Diabetes mellitus type 2, breast and endometrial cancers, polycyclic ovarian syndrome, complications of pregnancy
Health Related Problems Associated with Obesity- Other
Depression, metabolic syndrome, postoperative complications
When is adipose tissue created?
Adipose tissue is created when energy consumption exceeds energy expenditure.
Overweight
BMI of over 25
Obesity BMI
Obesity is a BMI of 30 or greater. A patient who is obese is also overweight.
True or false (if false, explain): The prevalence of obesity is greatest in men and in economically disadvantaged people of all races.
False; The prevalence of obesity is higher in women and in economically disadvantaged people of all races.
Which is increasing in prevalence in the United States to a greater extent: obesity or overweight?
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.
What age group is of particular concern regarding the obesity epidemic in the United States?
Of particular concern is the increase of obesity in children and young adults.
Place the prevalence of overweight and obesity in women in the United States in order from highest occurrence to lowest occurrence.
Black, Hispanic, and White
Place the prevalence of overweight and obesity in men in the United States in order from highest occurrence to lowest occurrence.
Hispanic, White, and Black
List common risk factors for obesity
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.
What does the body do to excess nutrients? Why?
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.
What is energy primarily stored as?
Energy is primarily stored as fat in adipose tissue.
Which types of adipose cells multiply?
Although mature fat cells (adipocytes) do not multiply, the immature cells in adipose tissue can multiply.
When do immature adipose cells multiply?
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.
When are triglycerides broken down?
The body breaks down triglycerides in fat cells when needed to provide energy.
Which factors can result in obesity?
Obesity occurs when excess calories are stored as fat. It can result from excess energy intake, decreased energy expenditure, or a combination of both.
Energy intake and energy expenditure is regulated by a complex interaction of _____________ and ______________ _____________ .
Energy intake and energy expenditure are regulated by a complex interaction of endocrine and neural signals.
How do regulatory mechanisms influence energy intake and expenditure?
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.
What body system regulates food intake?
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.
Other than hunger and physical signals, what other factors may influence appetite?
Appetite may have little relationship to hunger or physical signals, however; some people eat to relieve anxiety or depression.
What hormones are involved in the regulation of obesity?
Several hormones are involved in regulating obesity, including thyroid hormone, insulin, leptin.
Leptin
A peptide produced by fatty tissues that suppresses appetite and increases energy expenditure. Some studies suggest that leptin suppression is a cause of obesity.
Insulin
Associated with body fat distribution.
Adipose tissue secretes _________ that stimulate the liver to produce _____________, now recognized as a risk factor for CHD.
Adipose tissue secretes cytokines that stimulate the liver to produce C reactive protein (CRP), now recognized as a risk factor for CHD.
How can obesity increase the risk for heart failure?
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.
