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Health Assessment > Obesity > Flashcards

Obesity Flashcards

1
Q

How do you calculate ideal body weight?

A

Male: 105 lb + 6 lb for each inch over 5ft
Female: 100 lb + 5 lb for each inch over 5 ft

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2
Q

How do you calculate BMI?

A

weight (kg)/ height (meters) ^2

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3
Q

What BMI is considered overweight? Obese? Morbidly obese? Super-obese?

A

Overweight: 25-29
Obese: 30 or greater
Morbidly obese: 40 or greater
Super-obese: 50 or greater

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4
Q

What are some negative outcomes associated with obesity?

A
  • Increased incidence of diabetes and cardiovascular disease
  • Difficult tracheal intubation
  • Decreased PaO2
  • Increased gastric volume
  • Decreased gastric pH
  • Increased post-op would infection
  • Increased risk of pulmonary embolism
  • Increased risk of sudden death
  • Worse 30 day outcomes
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5
Q

What are some side effects of obesity on the respiratory system?

A
  • Obstructive sleep apnea
  • Obesity hypoventilation syndrome
  • Restrictive lung disease
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6
Q

What are some side effects of obesity on the cardiovascular system?

A
  • Systemic hypertension
  • Cardiomegaly
  • Congestive heart failure
  • Ischemic heart disease
  • Cerebrovascular disease
  • Peripheral vascular disease
  • Pulmonary hypertension
  • Deep vein thrombosis
  • Pulmonary embolism
  • Hypercholesterolemia
  • Hypertriglyceridemia
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7
Q

What are some side effects of obesity on the endocrine system?

A
  • Diabetes mellitus
  • Cushing syndrome
  • Hypothyroidism
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8
Q

What are some side effects of obesity on the GI system?

A
  • Hiatal hernia
  • Gallstones
  • Fatty liver infiltration
  • GERD
  • Increased gastric volume and intra-gastric pressure
  • Gastric acidity
  • Gastric emptying delays-greater residual volumes
  • High risk for aspiration pneumonitis when gastric volumes are greater than 25 ml or pH is less than 2.5
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9
Q

What are some side effects of obesity on the musculoskeletal system?

A
  • Osteoarthritis of weight-bearing joints

- Back pain

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10
Q

What are some malignancies associated with obesity?

A
  • Breast
  • Prostate
  • Cervical
  • Uterine
  • Colorectal
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11
Q

What respiratory changes occur as a result of obesity?

A
  • FRC reduced
  • ERV reduced
  • TV may fall close to closing capactity
  • Increased O2 consumption and CO2 production
  • High minute ventilation
  • Reduced chest wall compliance
  • Increased respiratory resistance-restrictive lung pattern
  • As obesity worsens you will see lung disease and pulmonary hypertension. PFTs may remain normal until this occurs
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12
Q

In the obese patient in what positions are respiratory changes exaggerated and what effects are seen?

A
  • Supine and trendelenberg
  • V/Q mismatch
  • hypoxemia
  • Increased right to left shunt
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13
Q

What are some difficulties cased by abundant soft tissue in the upper airway?

A
  • Obstruction of the airway
  • Impairment of mandible and cervical mobility
  • Difficulty maintaining mask airway
  • Difficult laryngoscopy and intubation (consider riber optic intubation)
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14
Q

What cardiovascular changes occur as a result of obesity?

A
  • Cardiac output is increased
  • Increase in circulating blood volume (can cause strain on myocardium)
  • Arterial hypertension risk is doubled
  • Risk of CAD is doubled and presents with angina, CHF, acute MI and sudden death
  • Increased left-sided heart pressures and left ventricular hypertrophy
  • Limited reserve for hypotension, hypertension, tachycardia, fluid overload
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15
Q

What can hyperlipidemia lead to?

A
  • Increased LDL/Decreased HDL linked to atherosclerosis
  • Premature coronary artery disease
  • Premature vascular disease
  • Pancreatitis
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16
Q

How is obstructive sleep apnea characterized?

A
  • Apnea for longer than 10 seconds despite respiratory effort against a closed glottis
  • Hypopnea partial or intermittent closure or narrowing of the upper airway during sleep resulting in a 4% decrease in arterial oxygen saturation
17
Q

How is OSA diagnosed?

A

-At least 5 episodes of apnea, hypopneas, or both during 1 hour

18
Q

How is OSA graded?

A

Mild: greater than 5 but less than 15 episodes of apnea and/or hypopnea an hour
Moderate: 15 to 30 an hour
Severe: greater than 30 an hour

19
Q

What are risk factors for OSA?

A
  • Middle age
  • Male
  • Obesity (BMI > 30)
  • ETOH use
  • Drug induce sleep aids
  • Abdominal fat distribution
  • Neck girth (41cm) (greater than 17 inches for men or greather than 16 inches for women)
20
Q

What does OSA result in?

A
  • Hypoxemia
  • Right heart failure
  • Hypercapnea
  • Pulmonary and systemic vasoconstriction
  • Polycythemia
  • Respiratory acidosis during sleep
  • Arterial hypoxemia
  • Systemic hypertension
  • Pulmonary hypertension
21
Q

What pre-op questions should be asked to screen for OSA?

A
  • Sleeping patterns?
  • Snoring?
  • Daytime somnolence?
22
Q

What is obesity hypoventilation syndrome/Pickwickian syndrome?

A
  • Long term consequence of OSA

- As OHS develops you get nocturnal central apnic events

23
Q

What are the characteristics of obesity hypoventilation syndrome?

A
  • Obesity
  • Hypercapnia
  • Daytime hyper-somnolence
  • Arterial hypoxemia
  • Pulmonary hypertension
  • Respiratory acidosis
  • Right sided heart failure
  • Airway difficulty
24
Q

What are some thromboembolic characteristics associated with obesity?

A
  • Risk of DVT is doubled
  • Polycythemia
  • Increased intra-abdominal pressure
  • Immobility
25
Q

What are some hepatic characteristics associated with obesity?

A
  • Fatty liver
  • Abnormal LFTs
  • Fluorinated volatile anesthetics
26
Q

What are some metabolic characteristics of obese patients?

A
  • Resistant to the effects of insulin

- Adult onset diabetes

27
Q

What are the components of the airway pre-op assessment of the obese patient?

A
  • Does patient have a hx of previous difficult airway?
  • Obstructive sleep apnea?
  • Assess ROM of atlantoaxial joint and cervical spine
  • Mouth opening
  • Thyromental distance
  • Interior of mouth
  • Mallampati classification
  • Neck size single best predictor of problematic intubation (5% with neck circumference of 40 cm compared to 35% with a neck circumference of 60cm)
  • Identify symptoms of severe respiratory disease: orthopnea, sleep apnea, obesity hypoventilation syndrome, previous history of upper airway obstruction especially regarding a past anesthetic
28
Q

What respiratory tests should be performed pre-op for the obese patient?

A
  • Chest x-ray
  • Room air SaO2
  • ABGs
  • PFTs
29
Q

What should be included in the pre-op cardiovascular assessment of the obese patient?

A
  • Venous access
  • EKG
  • Chest x-ray
  • ECHO
  • LV ejection fraction
  • cardiac clearance if needed
  • Previous diet aids
  • Signs of hypertension
  • Signs of RV/LV hypertrophy
  • Signs of pulmonary hypertention
30
Q

What are the parts of the endocrine, metabolic and GI pre-op assessment for the obese pt?

A
  • Fasting blood sugar
  • Diabetes non-insulin or insulin dependent
  • Dos the pt have a hx of reflux?
31
Q

What pre-op lab values should be obtained for the obese pt?

A
  • Hepatic function
  • Albumin level
  • Glucose
  • Consider clotting studies if they have risk factors
32
Q

What is the max weight for a regular OR table?

A

205kg

33
Q

What position provides the longest safe apnea period for the obese patient?

A

Head up reverse trendelenberg

34
Q

What medications can be given for GI prophylaxis?

A
  • H2 receptor antagonists
  • Sodium citrate (Bicitra)
  • Metoclopramide
  • Omeprazole

Health Assessment (5 decks)

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