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NRS 105 Exam #3 > Obesity > Flashcards

Obesity Flashcards

1
Q

Which common medications can cause weight gain?

A
  • Antihistamines (increase appetite)
  • Beta Blockers
  • Statins
  • Steroids
  • PPIs
  • Hormonal contraceptives
  • SSRIs
  • Mood stabilizing medications
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2
Q

Which two hormones regulate appetite?

A
  • Ghrelin
  • Leptin
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3
Q

How do the antiobesity medications Wegovy/Ozempic (semaglutides) work?

A
  • Mimic a natural gut hormone: glucagon like peptide-1 (GLP-1)
  • Slow digestion/gastric emptying
  • Regulate appetite
  • Improve bloood sugar control by promoting insulin secretion
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4
Q

How do the antiobesity medications Zepbound/Monjouro
(tirzepatides) work?

A
  • Mimic TWO natural gut hormones: glucagon like peptide-1 (GLP-1) AND glucose-dependent insulinotropic polypeptide (GIP)
  • Slow digestion/gastric emptying
  • Regulate appetite
  • Improve bloood sugar control by promoting insulin secretion
  • Yields greater weight loss than semaglutides
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5
Q

What are some side effects unique to antiobesity medication
Orlistat?

A
  • Oily discharge from rectum
  • Flatulence with discharge
  • Increased defecation
  • Fecal incontinence
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6
Q

What are some side effects unique to antiobesity medication
phentermine-topiramate?

A
  • Abnormal sensations
  • Altered Taste

Other side effects: dizziness, constipation, dry mouth, and insomnia

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7
Q

What are some side effects unique to antiobesity medications
Naltrexone-bupropion and phentermine-topiramate?

A
  • Dry Mouth
  • Insomnia

Other side effects of naltrexone-bupropion: N/V/D, constipation, headache, and dizziness

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8
Q

What are some common side effects of antiobesity medications:
liraglutide, semaglutide, and tirzepatide?

A
  • GI issues (N/V/D/C)
  • Headache
  • Dizziness
  • Abdominal pain
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9
Q

What are some side effects unique to Liraglutide?

A
  • Increased HR
  • Renal insufficiency

Other side effects: N/V/D/C, Headache, dizziness, and abdominal pain

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10
Q

What are some side effects unique to semaglutide?

A
  • Heart burn
  • Recurrent fever
  • Fatigue
  • Belching

Other side effects: GI issues, bloating, stomach cramping, dizziness, headache

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11
Q

What are some side effects unique to Tirzepatide?

A
  • Kidney failure
  • Gallbladder problems
  • Pancreatitis
  • Hypoglycemia

Other side effects: constipation, N/V/D, bloating, upset stomach

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12
Q

When are antiobesity medications typically adjusted?

A

If a patient does not see at least a 5% weight loss in body weight after 3-6 months

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13
Q

What must happen with antiobesity medications to help in weight loss sustainability?

A

Diet and exercise management
(Lifestyle modifications)

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14
Q

What is prohibitive about antiobesity medications?

A
  • Monthly cost can range from $900-$1300 w/o insurance
  • Many insurance plans in the US do not currently cover antiobesity medications
  • Leads to inequities in access… further exacerbating health disparities
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15
Q

How does obesity effect mechanics of ventilation and circulation?

A

Anatomic remodeling, including compression of the oropharynx and increased neck circumference and chest diameter predisposes patients with obesity to:
* Obstructive Sleep Apnea
* Respiratory Failure
* Obesity Hypoventilation Syndrom (OHS), characterized by hypercapnia, hypoxemia, and sleep disordered breathing

Central and Peripheral Circulation Compromise:
* Increased risk of Heart Failure and HTN
* Blood flow stasis increasing risk of VTE/DVT/PE
* Increased difficulty finding peripheral access

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16
Q

What are nursing interventions related to how obesity effects Mechanics of Ventilation and Circulation?

A
  • Maintain pt in low fowler’s position to maximize chest expansion
  • Continuous pulse oximetry
  • Supplemental oxygen
  • Frequent respiratory assessments
  • Use appropriately sized BP cuff
  • Monitor for DVT
  • Secure peripheral access if needed - may need US guided insertion
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17
Q

How does obesity effect Pharmacokinetics and Pharmacodynamics?

A
  • Understand that some drugs have enhanced effects while others have diminished effects
  • Patients with obesity who require opioid agents to treat pain frequently require higher dosages to achieve pain relief, but are also more likely to have serious adverse effects of sedation and respiratory depression
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18
Q

What are nursing interventions related to how obesity effects Pharmacokinetics and Pharmacodynamics?

A
  • Be cognizant that weight based calculations of drug dosages for patients with obesity may need to be altered.
  • Consult with pharmacy as needed to ensure appropriate dosing
  • Record/document accurate weights
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19
Q

How does obesity effect Skin Integrity and Mobility?

A

Vulnerable for developing pressure injuries secondary to:
* diminished supply of blood, oxygen, and nutrients to peripheral tissue
* Increased skin moisture and increased skin friction

Decreased mobility

20
Q

What are nursing interventions related to how obesity effects Skin Integrity and Mobility?

A
  • Assess for pressure ulcers
  • Strict Q2H turns
  • Use specialty bariatric equipment (bed, commode, walker, lifts…)
  • Utilize proper body mechanics when assisting bariatric patients
21
Q

What are some general nursing interventions related to patients with obesity?

A
  • Encourage healthy eating and exercise habits
  • Consult with dietitian to ensure nutrition needs are maximized
  • Encourage patient to develop a food diary
  • Encourage patient to set realistic diet and exercise goals
  • Encourage patient to eat at scheduled times and to slowly cut down on food portions
  • Educate about weight loss drug side effects
  • Educate about bariatric surgery if needed
22
Q

Which bariatric surgeries are malabsorptive and restrictive?

A
  • Biliopancreatic diversion
  • Roux-En-Y Gastric Bypass
23
Q

Which bariatric surgeries are only restrictive?

A
  • Laparoscopic stomach band (Gastic Banding)
  • Sleeve Gastrectomy
24
Q

What are pre-operative considerations for bariatric surgeries?

A

Weigh risks and benefits of surgery

Consider post surgical outcomes

Dietary changes:
* Pre-op 24-48 hrs: Clear liquids (NPO at midnight)
* Post Op up to 48 hours: Clear liquids only
* Slowly advance to full liquids, then pureed diets, soft foods, and finally solid foods by 8 weeks

Lifelong follow up:
* Vitamin B-12 injections and iron supplements

Lab testing:
* CBC, CMP, BUN, Cr, Vit. Levels

25
What are post-operative considerations for bariatric surgeries?
**Post-operative care** **Assess for complications:** * Anastomotic leakage: fever, Abdominal pain, tachycardia, leukocytosis ==> can lead to sepsis **Manage pain** **Fluid volume balance** **Nutritional status:** * 6 small meals/day 600-800 cal/day total **Decrease anxiety** * education, support groups **Support body image changes** * loose skin * weight loss rate
26
What are some potential complications of Bariatric surgery?
**Changes in bowel pattern** * Diarrhea * Constipation **Hemorrhage** * Assess for oral/rectal bleeding * Hemorrhagic shock: tachycardia, hypotension, syncope **Venous thromboembolism** * Anticoagulation therapy * SCDs * Early ambulation **Bile reflux** * Protein Pump Inhibitors **Dumping Syndrome** * Within 2 hours of eating: Tachycardia, dizziness, sweating, N/V/D, abd. cramping * Hypoglycemia: pallor, diaphoresis, palpitations, HA, dizziness, drowsiness * Give smaller portions, drink fluids between instead of with meals **Dysphagia** * Eat slowly, chew thoroughly **Bowel or gastric outlet obstruction**
27
What is the selection criteria for bariatric surgery?
**BMI > 40kg/m2 without excessive surgical risk** **BMI > 35 kg/m2 and one or more severe obesity associated comorbid conditions** * e.g. HLD, OSA, OHS, Non-alcoholic fatty liver disease, HTN, asthma, debilitating arthritis, considerably impaired quality of life **BMI > 30kg/m2 with Type 2 diabetes with poor glycemic control despite optimal medical treatments and lifestyle changes**
28
What is the **inclusion criteria** for bariatric surgery?
* Ability to perform ADLs and self care * Presence of support network of family and/or friends * Failure of previous nonsurgical attempts at weight loss, including nonprofessional programs * Expectation that patient will adhere to postoperative care, follow up visits, and recommended medical management, including use of dietary supplements
29
What is the **exclusion criteria** for bariatric surgery?
* Reversible endocrine or other disorders that can cause obesity * Current substance abuse disorder * Uncontrolled, severe psychiatric disorder * Lack of comprehension of risks, benefits, expected outcomes, alternatives, and lifestyle changes required with bariatric surgery
30
What are the dietary guidelines for post- bariatric surgery?
* Eat smaller, but more frequent meals that contain protein and fiber * Each meal should not exceed 1 cup * Eat foods high in nutrients * Consume fat as tolerated * Ensure low carbohydrate intake * Eat two protein snacks daily *(animal protein may be poorly tolerated after gastric bypass)* * Assume a low-fowler's position during mealtime and remain in that position for 20-30 minutes after *(delays gastric emptying and decreases risk of dumping syndrome)* * Antispasmodic agents also may aid in delay of gastric emptying * Avoid drinking fluid with meals - consume fluids 30 minutes before or 60 minutes after meals * Drink plenty of water * Refrain from drinking calories * Take prescribed dietary supplements and medium chain triglycerides * Follow up with primary provider for monthly injections of Vitamin B12 and iron
31
What is the expected outcome of Bariatric Surgery?
* 10-35% loss of excess weight within 2 years * Majority of weight lost within 5 years * 20-25% of patients experience weight gain after reaching their lowest rate
32
What are common causes of weight regain after bariatric surgery?
* Continued hormone imbalances * Dietary non-adherence * Physical inactivity * Mental health conditions * Surgical failure *(i.e. pouch distention, dilation of gastric pouch)*
33
How can weight regain be prevented after bariatric surgery?
* Cognitive behavioral therapy * Lifestyle counseling * Counseling with dietitian * Pharmacological therapy * Surgical conversion *(if one bariatric surgery fails, a surgeon may be able to convert it to another type)*
34
What are the causes of obesity?
**Behavioral** * Eating habits, limited physical activity, psychosocial disorders **Environmental/Socioeconomic** * Access to healthy food, places to be active **Physiologic** * Hormone imbalances/hypothyroidism * Leptin, ghrelin, cortisol imbalances **Genetic predisposition** * can affect appetite and fat storage
35
What are the complications of having obesity?
* Anxiety and depression * Heart disease and stroke * Diabetes, Type 2 * Cancer * Osteoarthritis * Sleep apnea and respiratory disorders * HTN * Pregnancy complications * Fatty Liver Disease * Urinary incontinence
36
What is the pathophysiology of metabolic syndrome?
* Obesogenic foods with excessive intake & low energy expenditure can lead to increased adipocyte accumulation * Dysfunction of adipose tissue cells release biochemical mediators that cause inflammation * This promotes development of various diseases
37
What physical indicators are looked at to determine obesity?
* BMI * Waist to hip ratio * Waist circumference
38
What BMI indicates pre-obesity (overweight)?
25 - 29.9 kg/m2
39
What BMI indicates Class I obesity?
30 - 34.9 kg/m2
40
What BMI indicates Class II obesity?
35 - 39.9 kg/m2
41
What BMI indicates Class III obesity? | *Severe obesity*
Greater than or equal to 40 kg/m2
42
What waist cirumference indicates obesity?
Females: > 35 inches Males: > 40 inches
43
What is an Android body shape and what does it signify?
**Apple shape** * Excess fat in the abdomen * Common in men * Significant correlation with Metabolic Syndrome
44
What is a Gynoid body shape?
**Pear Shape** * Excess fat in the thighs and buttocks * Common in women * No significant correlation with Metabolic syndrome
45
What is Vagal Blocking?
* Nonsurgical medical management intervention for obesity * Uses an implanted device to intermittently block the vagus nerve
46
What is Intragastric Balloon Therapy?
* Non-invasive medical intervention for obesity * Endoscopic placement of an inflatable balloon in the stomach * Remains in place for 3-6 months * Adverse effects: balloon rupture causing obstruction, N/V
47
What is Bariatric embolization?
* Non-invasive medical intervention for obesity * Embolized arteries supplying the gastric fundus to decrease ghrelin production/secretion

NRS 105 Exam #3 (14 decks)

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