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Nur 3010 exams > obesity + lower GI > Flashcards

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

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2
Q

healthy weight range

A

bmi 18.5 - <25

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3
Q

overweight range

A

bmi 25 - <30

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4
Q

obesity range

A

bmi >30

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5
Q

3 categories of bmi

A

class 1: bmi 30 - <35
class 2: bmi 35 - <40
class 3: bmi >40 (severe obesity)

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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
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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

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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

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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

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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
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11
Q

obesity effects: central and peripheral circulatory compromise (4)

A
  • use appropriately sized BP cuff
  • monitor for DVT
  • correct medication dose
  • pressure injuries
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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

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13
Q

obesity effects: skin integrity and body mechanics (3)

A
  • assess for pressure ulcers
  • speciality bariatric equipment
  • Hoyer lift
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14
Q

obesity management (4)

A
  • lifestyle modifications
  • pharmacologic
  • non surgical
  • surgical
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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
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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)
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17
Q

obesity pharmacology meds (4 main)

A

1) orlistat (Xenical)
2) phentermine-toprimate (Qysmia)
3) naltrexone-burpion (contrave)
4) lirglutide (saxenda)

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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)

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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

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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

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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)

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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

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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)
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24
Q

obesity bariatric surgery (4)

A
  • roux en-Y gastric bypass
  • gastric banding
  • sleeve gastrectomy
  • bilipancrgatic diversion with duodenal switch
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25
Q

roux en-Y gastric bypass (2)

A
  • 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
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26
Q

gastric banding (3)

A
  • 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
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27
Q

sleeve gastrectomy (3)

A
  • most popular today (80%)
  • making smaller stomach to decrease appetite and early satiety
  • if overeat, can stretch stomach
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28
Q

bariatric surgery - preop considerations (6)

A

preoperative care: education and counseling
- risks and benefits of surgery
- complications
- post surgical outcomes
- dietary changes (way before surgery)
- lifelong follow up
- lab testing

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29
Q

complications of bariatric surgery (6)

A
  • 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
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30
Q

bariatric surgery - postop considerations (7)

A

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
Q

constipation (what, perceived constipation) (2)

A
  • 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
Q

constipation causes (9)

A
  • meds
  • chronic laxative use
  • weakness
  • immobility
  • fatigue
  • inability to increase intradominal pressure
  • diet
  • ignoring urge to defecate
  • lack of regular exercise
33
Q

constipation manifestations (5)

A
  • 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
Q

constipation diagnostics (7)

A
  • 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
Q

constipation complications (6)

A
  • 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
Q

constipation teaching (6)

A
  • 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
Q

constipation laxatives (4)

A

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
Q

diarrhea (3)

A
  • 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
Q

diarrhea causes (5)

A
  • infections
  • medications
  • tube feeding formulas
  • metabolic and endocrine disorders
  • various disease processes (wide)
40
Q

diarrhea manifestations (6)

A
  • increased frequency and fluid content of stools
  • abdominal cramps
  • distention
  • borborygmus: hear someones bowels
  • anorexia and thirst
  • painful spasmodic contractions of the anus
41
Q

diarrhea diagnostics (5)

A
  • CBC with Diff
  • serum chemistries
  • urinalysis
  • stool examination (parasites, c diff, functional cause) -> common
  • endoscopy or barium enema
42
Q

diarrhea complications (3)

A

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
Q

diarrhea teaching (8)

A
  • 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
Q

fecal incontinence causes (8)

A
  • 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
Q

fecal incontinence diagnostics (4) and teaching (3)

A

diagnostics
- history to determine etiology
- rectal examination
- endoscopic examinations
- radiography studies
teaching
- bowel training program
- skin care
- emotional support

idiopathic or CNS disordersi

46
Q

irritable bowel syndrome (what, who, triggers)

A
  • 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
Q

irritable bowel syndrome clinical manifestations (4)

A
  • alteration in bowel patterns
  • pain
  • bloating
  • abdominal distention
48
Q

irritable bowel syndrome diagnostics (7)

A
  • stool studies
  • contrast radiography studies (obstructions)
  • proctoscopy (hyperperistalisis)
  • barium enema
  • colonoscopy
  • manometry (strength peristalsis gut)
  • electromyography
49
Q

irritable bowel syndrome teaching (7)

A
  • medication management
  • complimentary medicine
  • dietary changes (no caffeine)
  • food diary
  • adequate fluid intake
  • avoid alcohol and smoking
  • relaxation techniques
50
Q

malabsorption (function, conditions (5))

A

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
Q

malabsorption clinical manifestations (hallmark, sx, manifested)

A
  • 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
Q

malabsorption diagnostics (8)

A
  • 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
Q

malabsorption teaching (5)

A
  • vitamin replacement
  • dietary therapy
  • probiotics (bacteria in gut can facilitate absorption)
  • consider fluid and electrolyte imbalance
  • risk of osteoporosis
54
Q

celiac disease (what, where, prevalence, who, other disorders)

A
  • 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
Q

Celiac disease manifestations (6)

A
  • diarrhea
  • steatorrhea
  • abdominal pain
  • abdominal distention
  • flatulence
  • weight loss with malabsorption
56
Q

celiac disease management (5)

A
  • 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
Q

appendicitis (4) + translocation -> + tx

A
  • 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
Q

diverticulum

A
  • sac like herniation of the lining of the bowel that extends through a defect in the muscle layer
59
Q

diverticulosis facts (4)

A
  • 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
Q

diverticulosis

A

multiple diverticula without inflammation

61
Q

diverticulitis

A

infection and inflammation of diverticula (cramping, bleeding)

62
Q

diverticulosis nursing management (6)

A
  • 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
Q

intestinal obstruction (3)

A
  • 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
Q

intestinal obstruction nursing management (5)

A
  • 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
Q

inflammatory bowel disease (2)

A
  • ulcerative colitis
  • Crohn’s disease
66
Q

ulcerative colitis (location, gi damage, main complications, treatment)

A
  • 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
Q

Crohn’s disease (location, gi damage, main complications, treatment, similar)

A
  • 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
Q

inflammatory bowel disease assessment (4)

A
  • 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
Q

inflammatory bowel disease complications (4)

A
  • electrolyte imbalance
  • cardiac dysrhythmias
  • gi bleeding with fluid loss
  • perforation of the bowel
70
Q

inflammatory bowel disease nursing interventions (5)

A

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
Q

colorectal cancer (fact, RF, important, tx) + manifestations (6)

A
  • 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
Q

colorectal cancer assessment (7)

A
  • 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
Q

colorectal cancer complications (5)

A
  • intraperitoneal infection
  • complete large bowel obstruction
  • GI bleeding
  • bowel perforation
  • peritonitis, abscess, and sepsis

Nur 3010 exams (13 decks)

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