obesity + lower GI Flashcards
1
Q
how is obesity measured
A
BMI (body mass index)
- body weight in kilos/square of height in meters = BMI
2
Q
healthy weight range
A
bmi 18.5 - <25
3
Q
overweight range
A
bmi 25 - <30
4
Q
obesity range
A
bmi >30
5
Q
3 categories of bmi
A
class 1: bmi 30 - <35
class 2: bmi 35 - <40
class 3: bmi >40 (severe obesity)
6
Q
obesity epidemology (%, prevalence, who, increased risk for (6))
A
- 70.9% american adults overweight
- prevalence higher in women, African Americans, and hispanic
- those who are less educated, earn less income, more likely to have obesity, reflecting socioeconomic disparities in the disease burden of obesity
- increased risk for disease, disorders, low self esteem, impaired body image, depression, diminished quality of life
7
Q
causes of obesity (4)
A
multifactorial
- behavioral
- environmental: not habituated to eat healthy foods
- physiologic
- genetic: family
caloric intake, eating more than calorie expenditure
8
Q
obesity associated diseases (5)
A
- 6-20 year decrease in life expectancy
- increased risk cancer: GI, cholerectal
- 10x increase type 2 diabetes
- 4x increase asthma, HTN
- 2x increase alzheimers
tip: CAD, heart, disease, etc. associated with T2DM + HTN
9
Q
obesity assessment (4) + fact
A
1) height and weight to determine BMI
- overweight: BMI 25 - 29.9
- obese: BMI exceeding 30
- severe/extreme obese: BMI exceeding 40
2) waist circumference: >35 women, >40 men = increase risk obesity
3) hip to waist ratio: identifies central adiposity (0.65-0.8) -> leads to T2DM, metabolic syndrome -> insulin resistance -> HTN, CAD
4) lab studies: cholesterol, triglycerides, fasting BG (increase insulin resistance), HA1C, liver function test (fatty liver disease d/t fat infiltrates, alcohol steatosis)
FACT: increase adipose tissue (male) causes increase endogenous estrogen (hypercoaguability), leading to testosterone suppression and lose weight
10
Q
obesity effects: mechanics of ventilation and circulation (5)
A
- maintain lower fowler position to maximize chest expansion
- continuous pulse ox
- supplemental oxygen
- frequent respiratory assessments (monitor on pulse ox, BMI >50 dont do self, safety for everyone)
- flat = hypoventilation, low oxygen
11
Q
obesity effects: central and peripheral circulatory compromise (4)
A
- use appropriately sized BP cuff
- monitor for DVT
- correct medication dose
- pressure injuries
12
Q
obesity effects: pharmacokinetics & pharmacodynamics (3)
A
- change with obesity
- understand that some drugs have enhanced effects while others have diminished effects with patients with obesity
- be cognizant that weight based calculations of drug dosages for patients with obesity may be altered
tip: weight based Coumadin -> 400 ibs = thin blood too much, insulin weight based -> 400 ibs = increase d/t resistance
13
Q
obesity effects: skin integrity and body mechanics (3)
A
- assess for pressure ulcers
- speciality bariatric equipment
- Hoyer lift
14
Q
obesity management (4)
A
- lifestyle modifications
- pharmacologic
- non surgical
- surgical
15
Q
obesity lifestyle modifications (7)
A
- aimed at weight loss and maintenance
- setting weight loss goals -> realistic, long term, difficult to maintain
- improving diet habits -> global health improvement, weight watchers
- increase physical activity
- addressing barriers to change
- self monitoring and strategizing ongoing lifestyle changes aimed at a healthy weight
- health sleep habits
16
Q
obesity pharmacologics (2)
A
- aimed to supplement (NOT REPLACE) det and exercise
- indicated for BMI >30 or BMI >27 with related conditions (T2DM, HTN)
17
Q
obesity pharmacology meds (4 main)
A
1) orlistat (Xenical)
2) phentermine-toprimate (Qysmia)
3) naltrexone-burpion (contrave)
4) lirglutide (saxenda)
18
Q
orlistat (xenical) (function, adr, tip)
A
function: reduces GI absorption of fat (small bowel)
ADRs: diarrhea, gas, stomach pain, liver injury (not common)
19
Q
phentermin-topiramate (Qysmia) (function, adr, tip)
A
function: appetite suppressant
ADR: constipation, dizziness, dry mouth, insomnia
TIP: teratogenic and can exacerbate heart conditions
no HTN, no pregnancy
20
Q
naltrexone-buprion (Contrave) (function, adr, tip)
A
function: increases satiety, reduces appetite (antipsychotic agent, opioid withdrawal)
ADR: constipation, dizziness, dry mouth, insomnia
TIP: may cause suicidal ideation, high BP
no HTN
21
Q
liraglutide (saxenda) (function, adr, tip)
A
function: mimics GLP - 1 (glycogen like peptide 1) to curb appetite
ADR: nausea, diarrhea, constipation, increased HR.
TIP: risk of pancreatitis, marketed at lower dose as Victoza (T2DM treatment)
22
Q
obesity non surgical (2)
A
- minimally invasive interventions
1) vagal blocking
- blocking of vagus nerve via implanted device (thoracic cavity)
- few side effects (decrease BF to gut -> decrease appetite)
2) intragastric balloon therapy (gastric bypass)
- endoscopic placement of saline filled balloon to fill up space in gut
- remains in place for 3-6 months
- adverse effects: N/V, balloon rupture causing obstruction
23
Q
obesity surgical (bariatric surgery) (4)
A
- results in weight loss of 10-35% body weight within 2-3 years
- improvement in comorbid conditions
- selection by multidisciplinary team
- selection criteria has changed to include BMI of 30 for patients with comorbid conditions (types depends on patient)
24
Q
obesity bariatric surgery (4)
A
- roux en-Y gastric bypass
- gastric banding
- sleeve gastrectomy
- bilipancrgatic diversion with duodenal switch
25
roux en-Y gastric bypass (2)
- connecting roux limb of jejunum (small intestine) to pouch in stomach (that is reduced in size to decrease caloric and nutrient absorption)
- not ideal or popular globally due to physiological changes
26
gastric banding (3)
- inflatable silicone band creating false cavity to decrease appetite
- a prosthetic device is used to restrict oral intake by creating a small pouch of 10-15 mL that empties through the narrow outlet into the remainder of the stomach
- 2nd most common, can remove and go back to normal
27
sleeve gastrectomy (3)
- most popular today (80%)
- making smaller stomach to decrease appetite and early satiety
- if overeat, can stretch stomach
28
bariatric surgery - preop considerations (6)
preoperative care: education and counseling
- risks and benefits of surgery
- complications
- post surgical outcomes
- dietary changes (way before surgery)
- lifelong follow up
- lab testing
29
complications of bariatric surgery (6)
- hemorhage
- venous thromboembolism (DVT, PE)
- bile reflux
- dumping syndrome: constant diarrhea due to bypass of normal gut path (electrolytes -> malabsorption)
- dysphagia
- bowel or gastric outlet obstruction
30
bariatric surgery - postop considerations (7)
postoperative care:
- assess to ensure goals for recovery are met
- assess for absence of complications
- manage pain
- nutritional status
- fluid volume balance
- decrease anxiety
- body image changes
31
constipation (what, perceived constipation) (2)
- fewer than 3 bowel movements weekly or bowel movements that are hard, dry, small, or difficult to pass
- perceived constipation: a subjective problem in which the person's elimination pattern is not consistent with what he or she believes is normal
32
constipation causes (9)
- meds
- chronic laxative use
- weakness
- immobility
- fatigue
- inability to increase intradominal pressure
- diet
- ignoring urge to defecate
- lack of regular exercise
33
constipation manifestations (5)
- fewer than three bowel movements per week
- abdominal distention, pain, bloating
- a sensation of incomplete evacuation
- straining at stool
- elimination of small-volume, hard, dry stools
34
constipation diagnostics (7)
- frequency of BM, patient verbalized
- chronic constipation is usually idiopathic (in nature)
- further testing for severe, intractable constipation
- thorough history and physical examination
- barium enema, sigmoidoscopy, stool testing
- defecography and colonic transit studies (slow peristalsis, obstruction -> water absorbed in lower intestine -> hard stool)
- MRI: structural changes
35
constipation complications (6)
- decreased cardiac output
- fecal impaction
- hemorrhoids
- fissures
- rectal prolapse
- megacolon: dilation colon -> aneurysm in colon wall -> peristalsis is stopped -> mucosal toxicity peristalsis, septicemia, perforation, peritonitis (AVOID ALL IF CAN)
36
constipation teaching (6)
- normal variations of bowel patterns
- establishment of normal pattern
- dietary fiber and fluid intake (increase)
- responding to the urge to defecate
- exercise and activity (increase)
- laxative use (LAST resort)
37
constipation laxatives (4)
1) electrolyte/ostomic agents
- polyethylene glycol (miralax, golytely) -> pulls fluid into gluten of gut to evacuate waste
2) stimulants
- Bisacodyl, Senna (Docolax): mild, combo with something else, post op analgesia
3) stool softener
- docusate (Senna with solace): gentle, combo with Senna, post op analgesia
4) saline agents: magnesium hydroxide
38
diarrhea (3)
- increased frequency of bowel movements (more than 3 per day) with altered consistency (increased liquidity) of stool
- usually associated with urgency, perianal discomfort, incontinence, or a combination of these factors
- may be acute, persistent, or chronic
39
diarrhea causes (5)
- infections
- medications
- tube feeding formulas
- metabolic and endocrine disorders
- various disease processes (wide)
40
diarrhea manifestations (6)
- increased frequency and fluid content of stools
- abdominal cramps
- distention
- borborygmus: hear someones bowels
- anorexia and thirst
- painful spasmodic contractions of the anus
41
diarrhea diagnostics (5)
- CBC with Diff
- serum chemistries
- urinalysis
- stool examination (parasites, c diff, functional cause) -> common
- endoscopy or barium enema
42
diarrhea complications (3)
1) fluid and electrolytes imbalances
- cardiac dysrhythmias
2) dehydration
3) chronic diarrhea can result in skin care issues related to irritant dermatitis d/t increase pH
43
diarrhea teaching (8)
- recognition of need for medical treatment
- rest
- diet and fluid intake
- avoid irritating foods, including caffeine, carbonated beverages, very hot and cold foods
- perianal skin care
- medications
- may need to avoid milk, fat, whole grains, fresh fruit, vegetables
- lactose intolerance
44
fecal incontinence causes (8)
- anal sphincter weakness
- traumatic (eg post surgical procedures involving the rectum), non traumatic (eg. scleroderma)
- neuropathies of both peripheral (eg pudendal), generalized (eg diabetes)
- disorders of pelvic floor (eg rectal prolapse)
- inflammation (radiation proctitis, IBD)
- central nervous system disorders (dementia, stroke, spinal cord injury, multiple sclerosis)
- diarrhea, fecal impaction with overflow (ankle paresis)
- behavioral disorders
45
fecal incontinence diagnostics (4) and teaching (3)
*diagnostics*
- history to determine etiology
- rectal examination
- endoscopic examinations
- radiography studies
*teaching*
- bowel training program
- skin care
- emotional support
idiopathic or CNS disordersi
46
irritable bowel syndrome (what, who, triggers)
- chronic functional disorder characterized by recurrent abdominal pain associated with disordered bowel movements, which may include diarrhea, constipation, or both
- 15% adults in the US report symptoms of IBS; women>men
- triggers: chronic stress, sleep deprivation, surgery, infections, diverticulitis, some foods
- exaggerated sympathetic response of the gut
- multifactorial (xanax > laxative)
47
irritable bowel syndrome clinical manifestations (4)
- alteration in bowel patterns
- pain
- bloating
- abdominal distention
48
irritable bowel syndrome diagnostics (7)
- stool studies
- contrast radiography studies (obstructions)
- proctoscopy (hyperperistalisis)
- barium enema
- colonoscopy
- manometry (strength peristalsis gut)
- electromyography
49
irritable bowel syndrome teaching (7)
- medication management
- complimentary medicine
- dietary changes (no caffeine)
- food diary
- adequate fluid intake
- avoid alcohol and smoking
- relaxation techniques
50
malabsorption (function, conditions (5))
function: the inability of the digestive system to absorb one or more of the major vitamins, minerals, or nutrients
conditions:
- mucosal (transport) disorders
- infectious disease
- luminal disorders
- posteropative malabsorption
- disorders that cause malabsorption of specific nutrients (ETOH intake, affects folic acid, vitamin B12 absorption)
51
malabsorption clinical manifestations (hallmark, sx, manifested)
- hallmark finding is diarrhea or frequent, loose, bulky, foul-smelling stools, high fat content, and often grayish (similar to dumping syndrome)
- symptoms similar to irritable bowel syndrome
- manifested by weight loss and vitamin and mineral deficiency
52
malabsorption diagnostics (8)
- fat analysis
- lactose tolerance tests
- D-xylose absorption tests (food acid sensitivity) (decreased if mucosa damaged)
- schilling tests (B12 deficiency)
- hydrogen breath test (bacterial overgrowth or intolerance to glucose)
*r/o*
- endoscopy with biopsy (r/o)
- ultrasound, CT, radiography (r/o)
- CBC, pancreatic function tests (r/o)
53
malabsorption teaching (5)
- vitamin replacement
- dietary therapy
- probiotics (bacteria in gut can facilitate absorption)
- consider fluid and electrolyte imbalance
- risk of osteoporosis
54
celiac disease (what, where, prevalence, who, other disorders)
- disorder of malabsorption caused by an autoimmune response to consumption of products that contain the protein gluten (of wheat)
- gluten is most commonly found in wheat, barley, rye, and other grains malt, dextrin, and brewer's yeast
- more common in the past decade, with an estimated prevalence of 1% in the US
- women are afflicted twice as often as men (T1DM, Down syndrome)
- types 1 diabetes (autoimmune) , Down syndrome, turner syndrome
55
Celiac disease manifestations (6)
- diarrhea
- steatorrhea
- abdominal pain
- abdominal distention
- flatulence
- weight loss with malabsorption
56
celiac disease management (5)
- celiac disease is chronic, noncurable, lifelong
- no meds to treat
- refrain from exposure to gluten in foods (no cookies, crackers, bread, etc.)
- consult with dietician
- gluten intolerance = not autoimmune disease etiology sometimes (bloating, no gluten, refined carbohydrates + starch -> post prandial spike in glucose)
57
appendicitis (4) + translocation -> + tx
- most frequent cause of acute abdomen (abd. infection/perforation) in the US, most common reason for emergency abdominal surgery
- appendix becomes inflamed and edematous as a result of becoming kinked or occluded by a fecalith or lymphoid hyperplasia
- inflammatory process increases intraluminal pressure, causing edema and obstruction of the orifice
- once obstructed, appendix becomes ischemic, bacterial overgrowth occurs, and eventually gangrene or perforation occurs
- translocation -> peritonitis -> septicemia
- tx: surgery (LAP) to remove appendix, antibiotics to reduce inflammation
58
diverticulum
- sac like herniation of the lining of the bowel that extends through a defect in the muscle layer
59
diverticulosis facts (4)
- may occur anywhere in the intestine but most common in sigmoid colon
- diverticulum, diverticulosis, diverticulitis
- diverticular disease increases with age, associated with low fiber diet (processed diet increases)
- diagnosis is usually by colonoscopy (visualize diverticular sacs in colon)
60
diverticulosis
multiple diverticula without inflammation
61
diverticulitis
infection and inflammation of diverticula (cramping, bleeding)
62
diverticulosis nursing management (6)
- encourage fluid intake of at least 2L/day
- soft foods with increased fiber, such as cooked vegetables
- individualized exercise program
- bulk laxatives (psyllium) and stool softeners (fiber)
- sometimes avoid stimulants
- increase fiber in diet -> prevent diverticulitis
63
intestinal obstruction (3)
- exists when blockage prevents the normal flow of intestinal contents through the intestinal tract
- mechanical obstruction: intraluminal obstruction or mural obstruction from pressure on the intestinal wall (mass in gut, tumor in colon or outside intestinal wall)
- function or paralytic obstruction: intestinal musculature cannot propel the contents along the bowel, blockage temporary, results of the manipulation of bowel during surgery (paralytic ileum)
64
intestinal obstruction nursing management (5)
- maintaining the function of the nasogastric tube (intestinal obstruction can cause nausea so decompress)
- assessing and measuring the nasogastric output
- assessing for fluid and electrolyte imbalance
- monitoring nutritional status (ongoing -> parenteral)
- assessing for manifestations consistent with resolution (eg. return of bowel sounds, decreased abdominal distention, subjective improvement in abdominal pain and tenderness, passage of flatus or stool) -> pt. will verbalize
KEY: ambulate patient, chewing gum
65
inflammatory bowel disease (2)
- ulcerative colitis
- Crohn's disease
66
ulcerative colitis (location, gi damage, main complications, treatment)
- location: colon
- GI damage: mucosal, submucosal involvement, continuous lesions
- main complications: deep ulceration, GI bleeding, colitis, toxic megacolon, peritonitis, colorectal cancer
- treatment options: immunosuppressants, biologic agents (-umabs), surgery (alter autoimmune response. total resection large colon, ostomy required, won't have UC again)
67
Crohn's disease (location, gi damage, main complications, treatment, similar)
- location: whole GI tract
- GI damage: skip lesions
- main complications: strictures, bowel obstructions, fistulas, perianal abscesses, colorectal cancers
- treatment options: immunosuppressants, biologic agents (-umabs), surgery (not curative), immunomodulators
similar to ulcerative colitis
68
inflammatory bowel disease assessment (4)
- health history to identify onset, duration, characteristics of pain, diarrhea, urgency, tenesmus, nausea, anorexia, weight loss, bleeding, family history
- discuss dietary patterns, alcohol, caffeine, nicotine use
- assess bowel elimination patterns and stool
- abdominal assessment
69
inflammatory bowel disease complications (4)
- electrolyte imbalance
- cardiac dysrhythmias
- gi bleeding with fluid loss
- perforation of the bowel
70
inflammatory bowel disease nursing interventions (5)
maintaining normal elimination patterns
- identify relationship between diarrhea and food, activities, or emotional stressors
- provide ready access to bathroom or commode
- encourage bed rest to reduce peristalsis
- administer medications as prescribed
- record frequency, consistency, character, and amount of stools
71
colorectal cancer (fact, RF, important, tx) + manifestations (6)
- third most common site of new cancer cases in the US
- risk factors: IBD, processed foods, H. pylori
- importance of screening procedures: age 50, colposcopy, continuous screening
- treatment: depends on the stage of the disease (isolated -> ideal, colon vascular)
*manifestations*
- change in bowel habits
- blood in stool-occult, tarry, bleeding
- tenesmus
- symptoms of obstruction
- pain, either abdominal or rectal
- feeling or incomplete evacuation
72
colorectal cancer assessment (7)
- health history
- fatigue and weakness (present)
- abdominal and rectal pain (present)
- nutritional status and dietary habits (present)
- elimination patterns (present)
- abdominal assessment (nurse, palpate -> perforation vs. masses)
- characteristics of stool
73
colorectal cancer complications (5)
- intraperitoneal infection
- complete large bowel obstruction
- GI bleeding
- bowel perforation
- peritonitis, abscess, and sepsis
