obesity questions ch 20 med surg Flashcards
rn teaches pt who has bmi 39 kg/m2 about weight loss. which dietary change would be most appropriate to recommend?
Decrease fat intake and control portion size.
Rationale:
The safest dietary guideline for weight loss is to decrease caloric intake by maintaining a balance of nutrients and adequate hydration while controlling portion size and decreasing fat intake.
which pt is at risk for developing metabolic syndrome?
A 38-yr-old Native American man who has diabetes and elevated hemoglobin A1C
Rationale:
Blacks, Hispanics, Native Americans, and Asians are at an increased risk for development of metabolic syndrome. Other risk factors include people who have diabetes that cannot maintain a normal glucose level, have hypertension, and secrete a large amount of insulin, or who have survived a heart attack and have hyperinsulinemia.
In developing a weight reduction program with a 45-yr-old female patient who weighs 197 lbs, the nurse encourages the patient to set a weight loss goal of how many pounds in 4 weeks?
4 to 8
Rationale:
A realistic weight loss goal for patients is 1 to 2 pounds/wk, which prevents the patient from becoming frustrated at not meeting weight loss goals.
A 50-yr-old black woman has a body mass index (BMI) of 35 kg/m2, type 2 diabetes, hypercholesterolemia, and irritable bowel syndrome (IBS). She is seeking assistance in losing weight because, “I have trouble stopping eating when I should, but I do not want to have bariatric surgery.” Which drug therapy should the nurse question if it is prescribed for this patient?
Orlistat (Xenical)
Rationale:
Orlistat (Xenical), which blocks fat breakdown and absorption in the intestine, produces some unpleasant gastrointestinal side effects. This drug would not be appropriate for someone with IBS. Lorcaserin (Belviq) suppresses the appetite and creates a sense of satiety that may be helpful for this patient. Phentermine (Adipex-P) needs to be used for a limited period of time (3 months or less). Qsymia is a combination of two drugs, phentermine and topiramate. Phentermine is a sympathomimetic agent that suppresses appetite and topiramate induces a sense of satiety.
The nurse has completed initial instruction with a patient regarding a weight loss program. The nurse determines that the teaching has been effective when the patient makes which statement?
“I will keep a diary of weekly weights to track my weight loss.”
Rationale:
The patient should monitor and record weight once per week. This prevents frustration at the normal variations in daily weights and may help the patient to maintain motivation to stay on the prescribed diet. Weight loss should occur at a rate of 1 to 2 pounds/wk. The diet should be well balanced rather than lacking in specific components that may cause an initial weight loss but is not usually sustainable. Exercise is a necessary component of any successful weight loss program.
The nurse teaches an obese 22-yr-old man with a sedentary job about the health benefits of an exercise program. The nurse evaluates that teaching is effective when the patient makes which statement?
“The goal is to walk at least 10,000 steps every day of the week.”
Rationale:
A realistic activity goal is to walk 10,000 steps a day. Increased activity does not promote an increase in appetite or lead to weight gain. Exercise should be done daily, preferably 30 minutes to an hour a day. Exercise increases metabolic rate.
A patient with morbid obesity has elected to have the Roux-en-Y gastric bypass (RYGB) procedure. The nurse will know the patient understands the preoperative teaching when the patient makes which statement?
“This surgery decreases how much I can eat and how many calories I can absorb.”
Rationale:
The RYGB decreases the size of the stomach to a gastric pouch and attaches it directly to the small intestine so food bypasses 90% of the stomach, the duodenum, and a small segment of the jejunum. The vertical sleeve gastrectomy removes 85% of the stomach but preserves the function of the stomach. Lipectomy and liposuction remove fat tissue from the abdomen or other areas. Adjustable gastric banding can be modified or reversed at a later date.
The nurse cares for a patient after bariatric surgery. The nurse determines that discharge teaching related to diet is successful if the patient makes which statement?
“A high-protein diet that is low in carbohydrates and fat will prevent diarrhea.”
Rationale:
The diet generally prescribed is high in protein and low in carbohydrates, fat, and roughage and consists of 6 small feedings daily. Fluids should not be ingested with the meal, and in some cases, fluids should be restricted to less than 1000 mL/day. Fluids and foods high in carbohydrate tend to promote diarrhea and symptoms of the dumping syndrome. Calorically dense foods, such as foods high in fat, should be avoided to permit more nutritionally sound food to be consumed.
In developing an effective weight reduction plan for an overweight patient who expresses willingness to try to lose weight, which factor should the nurse assess first?
The patient’s social, emotional, and behavioral influences on obesity
Rationale:
Eating patterns are established early in life and eating has many meanings for people. To establish a weight reduction plan that will be successful for the patient, the nurse should first explore the social, emotional, and behavioral influences on the patient’s eating patterns. The duration of obesity, current physical activity level, and current anthropometric measurements are not as important for the weight reduction plan.
The nurse is caring for a patient who is 5 ft, 5 in tall and weighs 186 lb. The nurse has discussed reasonable weight loss goals and a low-calorie diet with the patient. Which statement made by the patient indicates a need for further teaching?
“I will limit intake to 500 calories a day.”
Rationale:
Limiting intake to 500 calories per day is not indicated for this patient, and the severe calorie energy restriction would place this patient at risk for multiple nutrient deficiencies. The other options show understanding of the teaching.
The nurse is caring for a patient with a herniated lumbar disc. The patient realizes that weight loss is necessary to lessen back strain. The patient is 5 ft, 6 in tall and weighs 186 lbs (84.5 kg) with a body mass index (BMI) of 28 kg/m2. The nurse explains this measurement places her in which weight category?
Overweight
Rationale:
A normal BMI is 18.5 to 24.9 kg/m2, and a BMI of 25 to 29.9 kg/m2 is considered overweight. A BMI of 30.0 to 39.9 kg/m2 is considered obese, and a BMI of 40 kg/m2 or greater is severely obese.
In the immediate postoperative period, a nurse cares for a severely obese patient who had surgery for repair of a lower leg fracture. Which assessment is most important?
Oxygen saturation
Rationale:
After surgery, an older or severely obese patient should be closely monitored for oxygen desaturation. The body stores anesthetics in adipose tissue, placing patients with excess adipose tissue (e.g., obesity, older) at risk for resedation. As adipose cells release anesthetic back into the bloodstream, the patient may become sedated after surgery. This may depress the respiratory rate and decrease oxygen saturation.
A community health nurse is conducting an initial assessment of a new patient. Which assessments should the nurse include when screening the patient for metabolic syndrome? (Select all that apply.)
Blood pressure
Waist circumference
Fasting blood glucose
Rationale:
The diagnostic criteria for metabolic syndrome include elevated blood pressure, fasting blood glucose, waist circumference, and triglycerides, and low high-density lipoprotein cholesterol. Resting heart rate and physical endurance are not part of the diagnostic criteria.
The nurse is caring for a patient after bariatric surgery. What should be included in the plan of care? (Select all that apply.)
Assist with early ambulation as needed.
Maintain elevation of the head of bed at 45 degrees.
Monitor for vomiting as it is a common complication.
Assess for incisional pain versus an anastomosis leak.
Rationale:
After bariatric surgery, the nurse needs to assess for incisional pain versus anastomosis leak. Because vomiting is a common postoperative complication, maintain elevation of the head of bed to reduce the risk of vomiting and aspiration. Dietary recommendations include 6 small meals that are high in protein and low in carbohydrates and fat. Fluids should be avoided during meals to prevent dumping syndrome. Early ambulation with assistance is recommended.
who greatest risk morbidity risk?
Female 5 ft, 10 in tall; obesity class III Rationale: The patient in class III obesity has the risk for disease because class III denotes severe obesity or a BMI greater than 40 kg/m2. The patient with the waist circumference of 46 in has a high risk for disease, but without the BMI or obesity class, a more precise determination cannot be made. The female who is 5 ft, 6 in tall has a normal weight for her height. The male patient who is over 6 ft tall is overweight, which increases his risk of disease, but a more precise determination cannot be made without the waist circumference.
