Nutrition and Obesity Flashcards
1
Q
under or over nutrition
A
malnutrition
2
Q
causes of malnutrition
A
- lower socioeconomic status
- illness (physical or psychological)
- impaired swallowing
- impaired GI absorption
- inadequate diet
- drug-nutrient interactions
- drug and alcohol use
- older adults
3
Q
describe risk of malnutrition in older adults
A
higher risk for malnutrition and less able to regain weight after it occurs
4
Q
clinical manifestations of malnutrition
A
- dry skin, hair, and nails and hair loss
- delayed wound healing
- weakness and decreased muscle mass
- prominence of bony structures
- amenorrhea
- increased risk of infeciton
- confusion and irritability
5
Q
diagnostic tests for malnutrition
A
- diet Hx
- albumin (lags 2 weeks behind malnutrition)
- prealbumin (more up to date -> 2 day half life)
- transferrin (protein that carries iron -> decreases w/ lack of protein)
- RBC, Hgb and Hct (decreased if lack of iron and folic acid)
- liver enzymes (liver damage due to malnutrition)
- anthropometric measurements (thickness of skin folds to measure fat) and BMI
6
Q
BMI levels
A
- <18.5 is underweight
- 18.5-24.9 is normal
- 25-29.9 is overweight
- > 30 is obese
- > 40 is morbidly obese
7
Q
nursing management of malnutrition
A
- multiple small high calorie/high protein meals
- registered dietitian (RD) referral
- daily weights
- diet diary for several days
- dietary supplement (Ensure or Boost) between meals -> don’t replace meals
- appetite enhancers
- Tube feeding and TPN
- understand what is preventing older adults from getting nutrition
8
Q
examples of appetite enhancers
A
- Megaestrol acetate (Megace)
- Dronabinol (Marinol)
9
Q
nutritional support for functional GI tract
A
tube feedings -> enteral
10
Q
types of enteral tube feedings
A
- long term: G-tube or J-tube (surgically placed)
- short term: NG, nasoduodenal, or nasojejunal tube
- intermittent (stable)
- continuous (critical care)
11
Q
nutritional support for nonfunctional GI tract
A
TPN (parenteral)
12
Q
reasons to use TPN
A
- “bowel rest”
- bowel obstruction
- acute pancreatitis
- intractable vomiting
- short-bowel syndrome
- malabsorption
- severe anorexia nervosa
13
Q
reasons to need enteral tube feedings with functional GI tract
A
- inability to eat or take in enough nutrients
- anorexia nervosa
- head or neck cancer
- facial fractures
- ALS
- chemo/radiation
- burn patient
14
Q
most important precaution for tube feedings
A
aspiration precautions
15
Q
tube feeding procedures
A
- increase HOB during and for 1 hour after feeding (at least 30 degrees)
- tube patency and position
- residual volumes (orders based on amount pulled back -> wether to continue feeds or not)
- water flushes before and after feeding and meds
- correct formula (given at room temp)
- increased gradually first 24-48 hours (prevent diarrhea)
- bag and tubing change (every 24 hours)
- assess bowel sounds before feedings
- use liquid meds rather than pills -> if use pills, dissolve well
16
Q
T/F: you want to put the residual volumes pulled out of a tube feeding back into the patient
A
True
17
Q
how much of the feedings should you put in a tube feeding bag a time
A
no more than 8 hours worth -> prevent bacteria growth
18
Q
what is included in total parenteral nutrition (TPN)
A
- hypertonic solution
- calories (dextrose and fat)
- amino acids (protein)
- fat emulsion (lipids)
- minerals, electrolytes, and trace elements
- vitamins
19
Q
what type of line is TPN given in
A
- usually central line or PICC line
- can be difficult on peripheral veins
20
Q
what are patients getting TPN at increased risk for
A
infection due to central line and large amounts of sugar in feedings
21
Q
procedures for TPN
A
- ordered daily and prepared by pharmacist
- bag is only good for 24 hours (remove if not finished after 24 hours)
- keep refrigerated
- don’t add drugs or IV piggybacks to the feeding - has its own port in central line
22
Q
TPN complications
A
- infection
- hyperglycemia or hypoglycemia
- increase BUN and Cr (too much protein)
- electrolyte excess/deficits
- hyperlipidemia
- embolus or phlebitis around central line site
- refeeding syndrome
23
Q
describe refeeding syndrome
A
- caused by patient being fed too fast after period of malnutrition
- fluid retention
- decreased K
- decreased phosphorus
- decreased Mg
- increased glucose
24
Q
nursing management of TPN
A
- check label on bag w/ order
- 24 hours infusion time (stop when time period is over)
- tubing is changed every 24 hours and dressing is changed every week or is soiled or non-occlusive
- accuchecks every 6 hours (even if not diabetic)
- assess signs of infection or pheblitis
25
labs done during TPN
- BMP (electrolytes)
- hepatic functional panel
- CBC (infection)
- lipid profile
26
what other factors determines if a patient is obese besides BMI
- age
- gender
- body build
27
risk factors for obesity
- genetic predisposition
- prepackaged food, fast food, soft drinks, and increased portion sizes
- sedentary lifestyle, lack of physical activity/exercises
- low SES
- psychosocial factors (food as comfort, overeating habits, socialization around food) -> usually develops at early age
28
health risks associated w/ apple-shaped body
- obesity located in ABD
- risk of heart disease
- DM
- breast and endometrial cancer
29
health risks associated w/ pear-shaped body
- obesity located in hips, thighs and buttocks
- determined by genetics
- varicose veins
- cellulitis
- osteoporosis
30
nutritional therapy for obesity
- 800-1200 calories (low calorie diet)
- <800 calories: very low calorie diet -> not recommended long term
- avoid skipping meals
- avoid fad diets
- focus on fruits, vegetables, whole grains, and seafood
- fat free and low fat dairy products
- consume less Na, trans fats, and refined sugars
- bake, broil, or steam instead of frying
31
portion sizes for food
- fruits and vegetables (woman's fist or baseball)
- meat (human's palm or deck of cards)
- cheese (thumb or six dice)
32
nursing implementation for obesity
- 1-2 lbs per week
- slower weight loss -> better cosmetic results
- weigh once/week (same time of day and same clothes)
- exercise
- weight reduction programs and support groups
33
criteria for bariatric surgery
- BMI > 40 or > 35 plus one or more obesity-related complications
- tried or failed other ways to lose weight
- must be screened for physical and behavioral conditions associated w/ poor surgical outcomes
34
physical and behavioral conditions associated w/ poor surgical outcomes
- untreated depression
- binge eating disorders
- drug and alcohol abuse
- advanced cancer
- ESRD, liver disease, or cardiopulmonary disease
- severe coagulopathy
- inability to comply w/ nutritional recommendations
35
describe adjustable gastric banding (AGB)
- inflatable band around the stomach to create a small pouch -> help the patient feel full quicker
- subcutaneous port allows band to be inflated or deflated
- least invasive surgery and reversible
36
describe a sleeve gastrectomy
- 75% of the stomach is removed
- elimination of hunger producing hormones
- still allows for normal digestion
- not reversible
37
describe gastric plication
- folding stomach wall inward and suturing in place
- minimally invasive
- decreases stomach volume size by about 70%
38
describe intragastric balloons
- balloon occupies space in stomach
| - done via endoscopy then filled w/ saline
39
describe a roux-en-Y
- most common procedure (gold standard)
- reduce stomach size to 20-30 mL
- bypass most of stomach, all of duodenum and part of jejunum
- new small gastric pouch anastomosis to jejunum (non-reversible)
40
results of roux-en-Y
- sustains long term weight loss
- can result in loss of DM, decreased BP, and decreased total cholesterol and triglyceride levels
- also lessens GERD and sleep apnea
41
possibly complications of roux-en-y
- anemia and vitamin deficiencies (iron and B12 supplements)
- dumping syndrome
- small bowel obstruction
- excess skin (cosmetic surgery after weight loss stabilized)
42
describe dumping syndrome
- gastric contents empty too rapidly into small intestine -> overwhelms small intestine
- N/V/D
- dizziness
- advised to not eat sweets to prevent
43
collaborative care post op bariatric surgery
- most are laparoscopic
- assess for increased pain and anastomosis leak
- 1st 24 hours -> water and sugar free clear liquids 30 mL every 2 hours
- high protein liquid diet before discharge
- eat slowly and stop when full
- eat several small meals throughout the day
- no liquids w/ solid food (can cause them to feel full quickly and cause vomiting and malnutrition)
44
post op long term diet after bariatric surgery
- high protein, low carb
- low fat and low roughage
- 6 small meals per day
- no fluids w/ meals
45
psychologic issues after bariatric surgery
- guilt that weight loss achieved by surgical intervention rather than willpower
- potential over eating problems that were present before surgery
