Obese Patient in Surgery Flashcards
What is the percentage of overweight and obese adults in the United States?
66%
What is the BMI for overweight?
25-29.9%
What is the BMI for obese
30% and greater
What is considered morbidly increased?
40% and greater; more than 100 pounds greater than IBW; high risk for health complications
Why do we not use morbidly obese?
Most patients get a higher risk of morbidities before they reach a BMI of 40%
What are the post operative complications with obese patients?
- Dehiscence
- Slow healing
- Higher rates of infection
- Anesthesia wears off slower due to the higher fat content
What is the number one concern for an obese patient through out the healing process?
Nutrition
What is wrong with BMI as a measure?
It tends not to be accurate. If a patient has a large amount of muscle they could still have a high BMI
What is central weight obesity?
A waist measured:
women: greater than 35”
men: greater than 40”
What is peripheral obesity?
A waist to hip ratio of greater than 0.8
Why would you do a thyroid profile on an obese patient?
Hypothyroidism may lead to weight gain.
Why would you do a serum glucose profile on an obese patient?
To make sure that they do not have diabetes and if they do make sure they can get it under control.
Why would you do a serum cholesterol profile on an obese patient?
To make sure that their cholesterol levels are under control before they go into surgery.
Why would you do a lipid profile on an obese patient?
To make sure they do not have fatty liver syndrome
Why would you do an ECG on an obese patient?
To see how the obesity is effecting their body.
How do genetic factors effect an obese patient?
- Slow metabolism
- Runs in families due to:
- nurture and lifestyle
How do psychological factors effect an obese patient?
- low self esteem
- diminished quality of life
How do physiological factors effect an obese patient?
- low metabolism
- hypothyroidism
- inability to exercise
How does the food supply effect an obese patient?
- cheap unhealthy foods
- increased access to fast food
- advertising for fatty foods
How does sociocultural factors effect obese patients?
- not exercising
- food choices (hispanics eat a lot of beans and rice)
How does physical inactivity effect obese patients?
This is the most important factor
By not moving you are harming your body
How do environmental factors effect obese patients?
If it is too cold then they cannot exercise
-example: alaskan eskomos
Is it better to be overweight or to yo-yo and put weight on and off?
It is better to be overweight
What types of lifestyle modifications do obese people need to make?
Exercise is the number one!
Change diet!
What is important to implement in terms of exercise for an obese patient?
- Aerobic exercise for 30-40 minutes 5 days a week
- Be under physician care
What is important to implement in terms of nutrition for an obese patient?
PORTION CONTROL
- a diet rich in whole grains, fruits, vegetables and low in fat
- 500-1,000 kcal deficit
- high in fiber
Why is it important to have a diet high in fiber for an obese patient?
To promote stool, prevent an ileus, and prevent constipation.
What types of behavior modifications can be made for an obese patient?
- Slow down while eating
- Making a food record of everything you eat
- Eliminate cues that precipitate eating like sitting in front of the tv
- Exam factors that affect eating behaviors like stress
- Joining a social support group
What is phentermine?
A nonamphetamine appetite suppressant
What do amphetamines do for obese patients?
It helps suppress appetites
What does Orlistat (Xenical) or Alli do for obese patients?
It is a fat absorption inhibitor
How does antidepressants help obese patients?
Many people eat when they are depressed so by treating that issue it helps patients not eat as much.
How would bulk-forming agents help obese patients?
It helps promote regular bowel movements.
What does IBW stand for?
Ideal body weight
When does Bariatric Surgery become an option?
After all nonsurgical methods have failed
What happens in a restrictive/malabsorptive procedure?
- bypass portion of small intestine
- rapid weight loss
What is good about restrictive procedures?
- It is safer
- Generally less effective in the long term
How much weight to patients need to loss before bariatric surgery?
-10% of overall body weight
How much weight does the average patient loose after bariatric surgery?
25-35% of body weight in 18-24 months.
What type of supplements does a patient who underwent bariatric surgery take?
Multivitamin and B12 supplements
What is the postoperative diet for patients who underwent bariatric surgery?
Six small feedings
600-800 calories a day
Liquids only taken between feedings
Signs of Shock
Elevated Heart Rate
Decreased Blood Pressure
How common is it for a patient to have dumping syndrome after bariatric surgery?
76% of patients
Signs and Symptoms of a bowel/gastric outlet obstruction
Syncope, nausea, vomiting, and diarrhea.
What is dysphagia?
trouble swallowing
True or False:
The average weight loss after bariatric surgery is 60% of previous body weight.
False
the average is 35%
What is important to constantly limit after a patient underwent bariatric surgery?
Limit fluids!
What is the most important things to do for psychosocial support of a bariatric patient?
Allow patient to make decisions
What do you focus on when doing an abdominal assessment on an obese patient?
Make sure the incision has no bleeding and is well approximated/.
What nutritional element is imperative to consume during wound healing?
Protein
What are the nursing diagnoses for a patient who underwent a bariatric surgery?
*hint- there are 4
- Anxiety
- Pain
- Deficient knowledge
- Imbalanced nutrition
What are the potential complications with a bariatric surgery?
*hint- there are 4
- Hemorrhage
- Dietary deficiencies
- Bile reflux
- Dumping syndrome
Steatorrhea
fatty, oily stools
What are the three interventions that can stimulate circulation?
*hint- there are 3
- Ambulation activities
- Pulmonary care
- Leg exercises
What is lacking after a patient gets a bariatric surgery that causes them to be deficient in B12?
Intrinsic factor
What is the agent that binds with bile acid?
Cholestyramine
What happens to the food during dumping syndrome?
It rapidly passes through the GI tract.
During Dumping syndrome what happens to the patients glucose levels?
They reach hypoglycemia levels
What are the two food sources that patients need to avoid if they have dumping syndrome?
- Fluids with meals
- High carbohydrate and sugar intake.
If a patient has steatorrhea what type of food should they reduce?
Fat intake
What medication can be administered if a patient has steatorrhea?
loperamide
What position should the patient be placed in so dumping syndrome can be avoided?
Low fowlers
What class of medications can be administered to prevent dumping syndrome?
antispasmodics
Nursing assessment of a 14-year-old reveals a BMI in the 90th percentile and a lifestyle that includes spending 4 hours a day playing video games and eating supper while watching television. The priority nursing diagnosis is:
- Disturbed Body Image related to distorted perception of body size and shape.
- Delayed Growth and Development related to inappropriate intake.
- Imbalanced Nutrition: More Than Body Requirements related to excessive intake and sedentary lifestyle.
- Fatigue related to malnutrition.
- Imbalanced Nutrition: More Than Body Requirements related to excess intake and sedentary lifestyle.
How does acupuncture aid an obese patient?
It enhances weight loss and improves dyslipidemia
How does hypnosis aid an obese patient?
This works for stress reduction and energy intake reduction.
What is the draw back to lifestyle modifications?
Many patients don’t adhere to them.
How does the fat inhibitor Orlistat (Xenical) work?
It reduces caloric intake by binding to gastric and pancreatic lipase to prevent digestion of fats.
What are the side effects of fat inhibitors like Orilstat (Xenical)?
*hint- there are five
- Frequent bowel movements
- Gas with oily discharge
- reduced food absorption
- Reduced bile flow
- Reduced absorption of vitamins
How do appetite suppressants like Phentermine work?
They stimulate serotonin in satiety and appetite centers of hypothalamus effectively curbing the appetite.
What are the side effects of appetite suppressants like Phentermine?
*hint- there are 4
- headaches
- dry mouth
- fatigue
- nausea
What is the percentage of patients that rebound with weight gain after bariatric surgeries?
35%
True or False:
A patient with a BMI greater than or equal to 40 without excess surgical risk qualifies for a bariatric surgery.
True
True or False:
A patient with a BMI of 30 or greater automatically qualifies for bariatric surgery?
False.
A patient with a BMI of 30 or greater needs to have one or more obesity-associated comorbidity to qualify.
Aside from BMI what are the two other qualification a patient has to meet before they will do a bariatric surgery?
- Failure of previous nonsurgical attempts at weight loss.
- Adherence to post operative care.
