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Adult Health 2 > Nutrition and Obesity > Flashcards

Nutrition and Obesity Flashcards

1
Q

under or over nutrition

A

malnutrition

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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
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3
Q

describe risk of malnutrition in older adults

A

higher risk for malnutrition and less able to regain weight after it occurs

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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
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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
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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
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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
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8
Q

examples of appetite enhancers

A
  • Megaestrol acetate (Megace)

- Dronabinol (Marinol)

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9
Q

nutritional support for functional GI tract

A

tube feedings -> enteral

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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)
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11
Q

nutritional support for nonfunctional GI tract

A

TPN (parenteral)

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12
Q

reasons to use TPN

A
  • “bowel rest”
  • bowel obstruction
  • acute pancreatitis
  • intractable vomiting
  • short-bowel syndrome
  • malabsorption
  • severe anorexia nervosa
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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
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14
Q

most important precaution for tube feedings

A

aspiration precautions

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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
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16
Q

T/F: you want to put the residual volumes pulled out of a tube feeding back into the patient

A

True

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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

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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
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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
Q

labs done during TPN

A
  • BMP (electrolytes)
  • hepatic functional panel
  • CBC (infection)
  • lipid profile
26
Q

what other factors determines if a patient is obese besides BMI

A
  • age
  • gender
  • body build
27
Q

risk factors for obesity

A
  • 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
Q

health risks associated w/ apple-shaped body

A
  • obesity located in ABD
  • risk of heart disease
  • DM
  • breast and endometrial cancer
29
Q

health risks associated w/ pear-shaped body

A
  • obesity located in hips, thighs and buttocks
  • determined by genetics
  • varicose veins
  • cellulitis
  • osteoporosis
30
Q

nutritional therapy for obesity

A
  • 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
Q

portion sizes for food

A
  • fruits and vegetables (woman’s fist or baseball)
  • meat (human’s palm or deck of cards)
  • cheese (thumb or six dice)
32
Q

nursing implementation for obesity

A
  • 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
Q

criteria for bariatric surgery

A
  • 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
Q

physical and behavioral conditions associated w/ poor surgical outcomes

A
  • 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
Q

describe adjustable gastric banding (AGB)

A
  • 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
Q

describe a sleeve gastrectomy

A
  • 75% of the stomach is removed
  • elimination of hunger producing hormones
  • still allows for normal digestion
  • not reversible
37
Q

describe gastric plication

A
  • folding stomach wall inward and suturing in place
  • minimally invasive
  • decreases stomach volume size by about 70%
38
Q

describe intragastric balloons

A
  • balloon occupies space in stomach

- done via endoscopy then filled w/ saline

39
Q

describe a roux-en-Y

A
  • 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
Q

results of roux-en-Y

A
  • 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
Q

possibly complications of roux-en-y

A
  • anemia and vitamin deficiencies (iron and B12 supplements)
  • dumping syndrome
  • small bowel obstruction
  • excess skin (cosmetic surgery after weight loss stabilized)
42
Q

describe dumping syndrome

A
  • gastric contents empty too rapidly into small intestine -> overwhelms small intestine
  • N/V/D
  • dizziness
  • advised to not eat sweets to prevent
43
Q

collaborative care post op bariatric surgery

A
  • 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
Q

post op long term diet after bariatric surgery

A
  • high protein, low carb
  • low fat and low roughage
  • 6 small meals per day
  • no fluids w/ meals
45
Q

psychologic issues after bariatric surgery

A
  • guilt that weight loss achieved by surgical intervention rather than willpower
  • potential over eating problems that were present before surgery

Adult Health 2 (8 decks)

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