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Preoperative Nursing Management > Obese Patient in Surgery > Flashcards

Obese Patient in Surgery Flashcards

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1
Q

What is the percentage of overweight and obese adults in the United States?

A

66%

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2
Q

What is the BMI for overweight?

A

25-29.9%

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3
Q

What is the BMI for obese

A

30% and greater

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4
Q

What is considered morbidly increased?

A

40% and greater; more than 100 pounds greater than IBW; high risk for health complications

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5
Q

Why do we not use morbidly obese?

A

Most patients get a higher risk of morbidities before they reach a BMI of 40%

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6
Q

What are the post operative complications with obese patients?

A
  • Dehiscence
  • Slow healing
  • Higher rates of infection
  • Anesthesia wears off slower due to the higher fat content
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7
Q

What is the number one concern for an obese patient through out the healing process?

A

Nutrition

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8
Q

What is wrong with BMI as a measure?

A

It tends not to be accurate. If a patient has a large amount of muscle they could still have a high BMI

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9
Q

What is central weight obesity?

A

A waist measured:

women: greater than 35”
men: greater than 40”

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10
Q

What is peripheral obesity?

A

A waist to hip ratio of greater than 0.8

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11
Q

Why would you do a thyroid profile on an obese patient?

A

Hypothyroidism may lead to weight gain.

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12
Q

Why would you do a serum glucose profile on an obese patient?

A

To make sure that they do not have diabetes and if they do make sure they can get it under control.

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13
Q

Why would you do a serum cholesterol profile on an obese patient?

A

To make sure that their cholesterol levels are under control before they go into surgery.

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14
Q

Why would you do a lipid profile on an obese patient?

A

To make sure they do not have fatty liver syndrome

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15
Q

Why would you do an ECG on an obese patient?

A

To see how the obesity is effecting their body.

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16
Q

How do genetic factors effect an obese patient?

A
  • Slow metabolism
  • Runs in families due to:
  • nurture and lifestyle
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17
Q

How do psychological factors effect an obese patient?

A
  • low self esteem

- diminished quality of life

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18
Q

How do physiological factors effect an obese patient?

A
  • low metabolism
  • hypothyroidism
  • inability to exercise
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19
Q

How does the food supply effect an obese patient?

A
  • cheap unhealthy foods
  • increased access to fast food
  • advertising for fatty foods
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20
Q

How does sociocultural factors effect obese patients?

A
  • not exercising

- food choices (hispanics eat a lot of beans and rice)

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21
Q

How does physical inactivity effect obese patients?

A

This is the most important factor

By not moving you are harming your body

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22
Q

How do environmental factors effect obese patients?

A

If it is too cold then they cannot exercise

-example: alaskan eskomos

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23
Q

Is it better to be overweight or to yo-yo and put weight on and off?

A

It is better to be overweight

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24
Q

What types of lifestyle modifications do obese people need to make?

A

Exercise is the number one!

Change diet!

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25
Q

What is important to implement in terms of exercise for an obese patient?

A
  • Aerobic exercise for 30-40 minutes 5 days a week

- Be under physician care

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26
Q

What is important to implement in terms of nutrition for an obese patient?

A

PORTION CONTROL

  • a diet rich in whole grains, fruits, vegetables and low in fat
  • 500-1,000 kcal deficit
  • high in fiber
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27
Q

Why is it important to have a diet high in fiber for an obese patient?

A

To promote stool, prevent an ileus, and prevent constipation.

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28
Q

What types of behavior modifications can be made for an obese patient?

A
  • 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
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29
Q

What is phentermine?

A

A nonamphetamine appetite suppressant

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30
Q

What do amphetamines do for obese patients?

A

It helps suppress appetites

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31
Q

What does Orlistat (Xenical) or Alli do for obese patients?

A

It is a fat absorption inhibitor

32
Q

How does antidepressants help obese patients?

A

Many people eat when they are depressed so by treating that issue it helps patients not eat as much.

33
Q

How would bulk-forming agents help obese patients?

A

It helps promote regular bowel movements.

34
Q

What does IBW stand for?

A

Ideal body weight

35
Q

When does Bariatric Surgery become an option?

A

After all nonsurgical methods have failed

36
Q

What happens in a restrictive/malabsorptive procedure?

A
  • bypass portion of small intestine

- rapid weight loss

37
Q

What is good about restrictive procedures?

A
  • It is safer

- Generally less effective in the long term

38
Q

How much weight to patients need to loss before bariatric surgery?

A

-10% of overall body weight

39
Q

How much weight does the average patient loose after bariatric surgery?

A

25-35% of body weight in 18-24 months.

40
Q

What type of supplements does a patient who underwent bariatric surgery take?

A

Multivitamin and B12 supplements

41
Q

What is the postoperative diet for patients who underwent bariatric surgery?

A

Six small feedings
600-800 calories a day
Liquids only taken between feedings

42
Q

Signs of Shock

A

Elevated Heart Rate

Decreased Blood Pressure

43
Q

How common is it for a patient to have dumping syndrome after bariatric surgery?

A

76% of patients

44
Q

Signs and Symptoms of a bowel/gastric outlet obstruction

A

Syncope, nausea, vomiting, and diarrhea.

45
Q

What is dysphagia?

A

trouble swallowing

46
Q

True or False:

The average weight loss after bariatric surgery is 60% of previous body weight.

A

False

the average is 35%

47
Q

What is important to constantly limit after a patient underwent bariatric surgery?

A

Limit fluids!

48
Q

What is the most important things to do for psychosocial support of a bariatric patient?

A

Allow patient to make decisions

49
Q

What do you focus on when doing an abdominal assessment on an obese patient?

A

Make sure the incision has no bleeding and is well approximated/.

50
Q

What nutritional element is imperative to consume during wound healing?

A

Protein

51
Q

What are the nursing diagnoses for a patient who underwent a bariatric surgery?
*hint- there are 4

A
  • Anxiety
  • Pain
  • Deficient knowledge
  • Imbalanced nutrition
52
Q

What are the potential complications with a bariatric surgery?
*hint- there are 4

A
  • Hemorrhage
  • Dietary deficiencies
  • Bile reflux
  • Dumping syndrome
53
Q

Steatorrhea

A

fatty, oily stools

54
Q

What are the three interventions that can stimulate circulation?
*hint- there are 3

A
  • Ambulation activities
  • Pulmonary care
  • Leg exercises
55
Q

What is lacking after a patient gets a bariatric surgery that causes them to be deficient in B12?

A

Intrinsic factor

56
Q

What is the agent that binds with bile acid?

A

Cholestyramine

57
Q

What happens to the food during dumping syndrome?

A

It rapidly passes through the GI tract.

58
Q

During Dumping syndrome what happens to the patients glucose levels?

A

They reach hypoglycemia levels

59
Q

What are the two food sources that patients need to avoid if they have dumping syndrome?

A
  • Fluids with meals

- High carbohydrate and sugar intake.

60
Q

If a patient has steatorrhea what type of food should they reduce?

A

Fat intake

61
Q

What medication can be administered if a patient has steatorrhea?

A

loperamide

62
Q

What position should the patient be placed in so dumping syndrome can be avoided?

A

Low fowlers

63
Q

What class of medications can be administered to prevent dumping syndrome?

A

antispasmodics

64
Q

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:

  1. Disturbed Body Image related to distorted perception of body size and shape.
  2. Delayed Growth and Development related to inappropriate intake.
  3. Imbalanced Nutrition: More Than Body Requirements related to excessive intake and sedentary lifestyle.
  4. Fatigue related to malnutrition.
A
  1. Imbalanced Nutrition: More Than Body Requirements related to excess intake and sedentary lifestyle.
65
Q

How does acupuncture aid an obese patient?

A

It enhances weight loss and improves dyslipidemia

66
Q

How does hypnosis aid an obese patient?

A

This works for stress reduction and energy intake reduction.

67
Q

What is the draw back to lifestyle modifications?

A

Many patients don’t adhere to them.

68
Q

How does the fat inhibitor Orlistat (Xenical) work?

A

It reduces caloric intake by binding to gastric and pancreatic lipase to prevent digestion of fats.

69
Q

What are the side effects of fat inhibitors like Orilstat (Xenical)?
*hint- there are five

A
  • Frequent bowel movements
  • Gas with oily discharge
  • reduced food absorption
  • Reduced bile flow
  • Reduced absorption of vitamins
70
Q

How do appetite suppressants like Phentermine work?

A

They stimulate serotonin in satiety and appetite centers of hypothalamus effectively curbing the appetite.

71
Q

What are the side effects of appetite suppressants like Phentermine?
*hint- there are 4

A
  • headaches
  • dry mouth
  • fatigue
  • nausea
72
Q

What is the percentage of patients that rebound with weight gain after bariatric surgeries?

A

35%

73
Q

True or False:

A patient with a BMI greater than or equal to 40 without excess surgical risk qualifies for a bariatric surgery.

A

True

74
Q

True or False:

A patient with a BMI of 30 or greater automatically qualifies for bariatric surgery?

A

False.

A patient with a BMI of 30 or greater needs to have one or more obesity-associated comorbidity to qualify.

75
Q

Aside from BMI what are the two other qualification a patient has to meet before they will do a bariatric surgery?

A
  • Failure of previous nonsurgical attempts at weight loss.

- Adherence to post operative care.

Preoperative Nursing Management (15 decks)

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