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Med-Surg > Obesity & Undernutrition > Flashcards

Obesity & Undernutrition Flashcards

1
Q

What is primary obesity ?

A

most prevalent
- excess calorie intake over expenditure for the body’s metabolic demand

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2
Q

What is secondary obesity ?

A

due to a medical problem
- Ex.) endocrine disorders, CNS lesions/disorders/meds, chromosomal/congenital anomalies

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3
Q

What is Leptin ?

A

our appetite suppressant
- increases fat metabolism
- a deficiency or resistance to this can cause obesity

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4
Q

What is the Hypothalamus linked to obesity ?

A

our appetite stimulant
- if there is an imbalance (Neuropeptide Y) then it can cause overeating

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5
Q

What is Ghrelin ?

A

inhibits leptin
- found in the gut
- gastric bypass surgery decreases ghrelin

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6
Q

What can obesity cause ?

A
  • increases fat mass (adipocytes) which increases adipokines
  • increases adipokines contribute to insulin resistance and atherosclerosis, disrupts immune factors and predispose to certain cancers
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7
Q

What are the values for BMI ?

A
  • > 25: overweight
  • > 30: obese
  • > 40: extreme obesity
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8
Q

What are the values for waist circumference for obesity ?

A

> 35 inches in women and >40 in men
- bigger adverse outcomes for heart attacks and other cardiac events

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9
Q

What is the waist-to-hip ratio for determining obesity ?

A

waist measurement/hip measurement
- < 0.8 is optimal and >0.8 indicates truncal fat

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10
Q

What types of diseases can an apple body shape cause ?

A

carries fat more above waist
- heart disease
- DM
- breast cancer
- endometrial cancer
- HTN
- hyperlipidemia

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11
Q

What types of conditions can a pear body shape cause ?

A

carries fat more below waist
- osteoporosis
- varicose veins
- cellulitis

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12
Q

What are some health risks associated with obesity ?

A
  • sleep deprivation from obstructive sleep apnea can lead to overeating (cause of decrease in leptin)
  • reduced chest wall compliance
  • increase work of breathing
  • cancers due to increase estrogen
  • colorectal cancer due to hyperinsulin
  • insulin and adipolines can stimulate cancer call proliferation
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13
Q

What conditions must be met to have medication intervention for weight loss ?

A
  • adults with a BMI 27 or greater with at least 1 weight-related condition
  • BMI of 30 of greater
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14
Q

What are some considerations for a nutrient absorption-blocking med ?

A

Orlistat: Xenical: Alli
- blocks fat breakdown and absorption in the GI tract
- can cause: diarrhea, bloating, flatulence, liver damage, and fatty stools

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15
Q

What are some consideration for use of Bupropion/Naltrexone (Contrave) ?

A

an antidepressant/opioid antagonist
- works on the brain to decrease cravings
- can cause: dry mouth, HA, and constipation

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16
Q

How does Plenity aid in weight loss ?

A

increases volume of stomach and small intestine contents
- gel pieces taken with meals

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17
Q

What are some consideration for use of Qysmia ?

A

Phenermine (sympathomimetic) & Topiramate (anti-seizure/migraine med)
- (phenermine) increases metabolism and (topiramate) decreases appetite
- addictive
- can cause: restlessness, tachycardia, palpations and insomnia

18
Q

What is Semaglutide used for in weight loss ?

A

Wegovy
- induces satiety by slowing gastric motility
- same as Ozempic but a higher dose
- weekly injection
- can cause: hypoglycemia if used with other diabetic meds, gastroparesis and GI distress
- can slow food down so much it can cause paralytic ileus

19
Q

What is the criteria for Bariatric surgery ?

A
  • BMI 40 or greater
  • BMI 35 with 1 or more severe obesity-related medical condition
  • psychological screening to ensure patient can commit to lifelong behavior change and screen for depression and addiction and ability to cope with new body image
  • no advanced cancers, liver and kidney disease and cardiopulmonary disease
20
Q

What is the lap band technique ?

A

band goes around top part of stomach which causes food to go through the stomach but slower
- will feel full longer
- port is under skin

21
Q

What is the gastric sleeve technique ?

A
  • portion of stomach is cut out so causes decreased absorption of food
22
Q

What is the gastric plication ?

A

similar to gastric sleeve
- but stomach is folded and not cut
- reversible

23
Q

What is the intragastric ballon ?

A

ballon is inserted into the stomach that is filled with about 400-700 mL saline
- leads to feeling of fullness

24
Q

What is the Gastric Bypass 1 (with duodenum) ?

A

majority of stomach is cut out and left with a tiny stomach
- food passes through duodenum as usually but smaller stomach leads to feeling full faster

25
Q

What is a Gastric Bypass 2 (bypass duodenum) ?

A

smaller gastric pouch is where food goes and this pouch is surgically connected to the jejunum
- bypass portion of the stomach
- we bypass the duodenum and go straight into the jejunum which reduces absorption
- only the digestive juices go through the duodenum while food though the jejunum

26
Q

What is dumping syndrome ?

A

gastric contents empty too rapidly into the small intestine which decreases absorption
- can cause pt’s to never eat normally again
- not every pt will experience this but some can
- pt’s will follow everything we tell them but they may still get this
- can cause: N/V, weakness, diarrhea

27
Q

What can be done Post-Op to prevent Dumping Syndrome ?

A
  • low sugar, and low carb
  • small meals (6 per day)
  • chew well
  • rest after eating (moving causes foods to move along the GI tract faster and digest faster)
  • drink beverages between meals, not with meals (drinks can cause the food to flush along the GI tract faster and not digest/absorb)
28
Q

How long does a patient need to be NPO after a gastric bypass surgery ?

A

until bowel sounds return

29
Q

How long will a pt remain on a liquid diet after a gastric bypass ?

A

7-10 days

30
Q

When can a pt return to a regular diet after gastric bypass ?

A

4-6 weeks

31
Q

What is Metabolic Syndrome ?

A

collection of risk factors that increase an individual’s chance of developing cardiovascular disease, stroke and diabetes

32
Q

What medications are used to Tx Metabolic Syndrome ?

A

will focus on treating BP, cholesterol, and glucose
- “statin” to decrease cholesterol
- “Metoprolol, or Lisinopril” to decrease BP
- Metformin to increase sensitivity to insulin

33
Q

What is primary/starvation related Protein-Calorie Malnutrition (PCM) ?

A
  • chronic starvation
  • no inflammation (anorexia nervosa)
34
Q

What is secondary/chronic disease-related PCM ?

A

calorie intake should be enough but tissues aren’t met due to disease process
- cancers, RA

35
Q

What is acute disease/injury-related malnutrition ?

A
  • burns
  • trauma
  • major infections
36
Q

What are clinical manifestations of malnutrition ?

A
  • dry, scaly skin rashes
  • crusting/ulceration around the mouth
  • thin hair/loss
  • brittle nails
  • sunken eyes
  • decreased body temp
  • decreased muscle mass
  • mental status changes (difficulty concentrating, irritable, confused)
  • delayed wound healing
  • susceptible to infection
37
Q

What are some expected lab values in malnutrition ?

A
  • low Iron, RBC, Albumin vitamins and WBC
  • BUN will be high at 1st due to dehydration then both will go low
  • in prolonged starvation the Na-K pump stop working so K will increase and Na is low
  • short term malnutrition the K will be low
38
Q

What is Nasogastric (NG) tube used for ?

A
  • temporary
  • good suction/decompress the abdomen
  • good absorption of medications and tube feedings
39
Q

What is a Naso-Jejunal/Duodenal tube used for ?

A
  • temporary
  • goes past the stomach
  • less risk of aspiration
  • cannot be used for suction
40
Q

What is a gastrostomy tube used for ?

A

long term nutritional support

41
Q

What is a Jejunostomy tube used for ?

A

long term nutritional support

42
Q
A

Med-Surg (16 decks)

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