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management of complex patients > week 5 > Flashcards

week 5 Flashcards

1
Q

OBESITY

A
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2
Q

What is adipose tissue?

A

Fatty tissue

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3
Q

Angiotensin is linked to what?

A

Vasoconstriction

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4
Q

What is vasoconstriction?

A

Narrowing of blood vessels, which reduces blood flow and increases blood pressure

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5
Q

What does leptin play a role in?

A

inflammation

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6
Q

What is VEGF (Vascular endothelial Growth factor): involved in?

A

Angiogenesis(the formation of new blood vessels)

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7
Q

Where does adipose tissue accumulate?

A

Organs and Skeletal muscle

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8
Q

How does Adipose tissue accumulate in various regions of the body?

A

accumulates in various regions of the body, leading to different body shapes.

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9
Q

what is considered the largest endocrine system in the body

A

adipose tissue is actually considered the largest endocrine organ in our body

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10
Q

What is the main purpose of adipose tissue

A

energy storage

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11
Q

What is another name for adipose tissue

A

adipocyte

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12
Q

What substances are released by adipocytes?

A

Angiotensin, leptin, and VEGF (vascular endothelial growth factor).

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13
Q

What is the role of angiotensin in the body?

A

It causes vasoconstriction and contributes to cardiovascular conditions related to obesity.

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14
Q

What is the function of leptin in the body?

A

Leptin can lead to inflammation.

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15
Q

Why do obese individuals tend to have high levels of chronic inflammation?

A

Due to the release of leptin from adipose tissue.

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16
Q

Why is angiogenesis necessary as bodies get larger due to obesity?

A

To provide blood supply as the body enlarges.

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17
Q

What happens when fat cells cannot store more calories?

A

Ectopic fat accumulates in other areas, such as around organs or in skeletal muscle.

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18
Q

What is ectopic fat?

A

Fat that accumulates in areas outside of normal fat storage locations, such as in organs or muscles.

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19
Q

What can ectopic fat accumulation in skeletal muscle cause?

A

Muscle cell death and a decrease in lean body mass.

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20
Q

Where can adipose tissue accumulate in the body?

A

All over the body, with few exceptions.

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21
Q

What does an apple-shaped body indicate in terms of fat accumulation?

A

Fat is accumulated around the midsection, indicating central obesity.

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22
Q

What is central obesity?

A

A condition where excess fat is stored primarily around the abdomen and torso.

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23
Q

What risk is associated with fat accumulating around visceral organs?

A

Increased risk for cardiovascular disease.

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24
Q

What are visceral organs?

A

Internal organs located within the body’s cavities, such as the heart, liver, and intestines.

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25
Q

When pertaining to thermo regulation what does help with

A

Brown fats help with regulating body temperatures by producing heat

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26
Q

How can you describe brown fat from infancy to adulthood

A

Brown fat is more abundant in infants and decreases as we age.

Think chunky baby

Brown fat is also more so found in extremities over torso and abdomen.

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27
Q

How can you describe white fat?

A

As a long term energy resevoir: it stores energy in form of fat for later use.

It is more harmful than brown fat

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28
Q

Is white fat long or or short term reservoir

A

It is a long term reservoir meaning it stores energy in the form of fat for later use

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29
Q

What diseases is white fat involved in?

A

cardiovascular(CV) and metabolic diseases: This includes heart disease and diabetes

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30
Q

What kind of responses to the body can white fat cause?

A

Inflammation and immune system responses

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31
Q

Why can the human body store an almost unlimited amount of fat?

A

Because adipose tissue can continue to accumulate and expand in multiple directions, and the skin is flexible and can stretch to accommodate it.

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32
Q

What does obesity involve

A

excessive accumulation of adipose tissue, which contributes to many diseases.

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33
Q

What are the multifactorial causes of obesity

A

Environment: Described as a “socially contagious feature of globalization”

Behavior: Lifestyle choices and habits play a significant role

Epigenetics: Genetic factors and how they interact with the environment

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34
Q

Health impact of obesity

A

obesity is the 2nd leading contributor to preventable death in the united states.

the 1st being smoking.

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35
Q

the prevalence

A

65% of U.S. adults and 40% of U.S. children are overweight or obese.

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36
Q

What is Bariatrics

A

The branch of medicine that deals with obesity management, focusing on treatments and interventions for weight loss and health improvement.

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37
Q

In BMI what is considered overweight

A

BMI ≥ 25kg/m2

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38
Q

In BMI obesity is is defined as what?

A

Defined as a BMI ≥ 30 kg/m²

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39
Q

Waist Circumference: This measurement helps assess?

A

abdominal fat.

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40
Q

What is Waist-to-Hip Ratio (WHR):

A

A ratio that compares the circumference of the waist to the hips, used as a measure of fat distribution.

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41
Q

In children how is BMI diagnosed?

A

by comparing BMI to reference population percentiles.

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42
Q

What is the most commonly used tool to measure obesity?

A

BMI (Body Mass Index).

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43
Q

What is the BMI range for the “Overweight” classification?

A

25.0-29.9 kg/m²

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44
Q

What is the classification for a BMI of 30.0-34.9 kg/m²?

A

Class I Obesity

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45
Q

What is another term for Class I Obesity?

A

Obese

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46
Q

What is the BMI range for Class II Obesity?

A

35.0-39.9 kg/m²

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47
Q

What is another term for Class II Obesity?

A

Severely Obese

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48
Q

What classification is given for a BMI of 40.0 kg/m² or higher?

A

Class III Obesity

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49
Q

What is another term for Class III Obesity?

A

Morbidly Obese

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50
Q

What is the BMI threshold for being classified as “Super Obese” or “Super Morbidly Obese”?

A

50.0 kg/m² or higher

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51
Q

What are some issues with BMI as a tool for measuring obesity?

A

It may classify fit, muscular individuals as obese, even if they have little adipose tissue.

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52
Q

Why is BMI still commonly used despite its problems?

A

It is simple, quick, and the most clinically reported measure.

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53
Q

What are some ethnic differences in waist circumference risk?

A

Women of Asian descent may be at elevated risk at a smaller waist circumference than white or black women.

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54
Q

At what percentile is a child considered overweight?

A

At the 85th percentile or greater.

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55
Q

At what percentile is a child considered obese?

A

At or above the 95th percentile.

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56
Q

What do plus sized people look like

A

apple shaped

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57
Q

What is an apple-shaped body associated with?

A

Central obesity and increased health risks.

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58
Q

What conditions might cause a firm abdomen in an apple-shaped individual?

A

Cardiac disease, liver disease, or just the person’s natural shape.

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59
Q

How does central obesity affect mobility in an apple-shaped person?

A

It throws off their center of gravity and may limit their tolerance for supine or prone positions.

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60
Q

What is a Panis?

A

An overhang of subcutaneous fat tissue.

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61
Q

What can sometimes be present in a Panis besides skin and fat?

A

Bowel contents from a hernia.

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62
Q

Why is the Panis prone to infection?

A

Because the areas under it can easily become infected due to trapped moisture and friction.

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63
Q

What is an infection of the Panis called?

A

Panniculitis.

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64
Q

What is a surgical procedure to remove the Panis called?

A

Panniculectomy.

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65
Q

What does plus shaped body shape pear look like?

A

Most adipose tissue is carried around the hips, with lower health risks than central obesity.

66
Q

How is pear Abduction characterized?

A

by excessive tissue on the inside of the thighs

A condition where excessive adipose tissue on the inside of the thighs forces the legs to abduct while walking or sitting.

Their legs must be kept far apart, making it difficult to find an adequate chair.

67
Q

What can be challenging with pear Abduction?

A

Positioning in chairs due to the inward distribution of tissue

Their legs must be kept far apart, making it difficult to find an adequate chair.

68
Q

How is pear Adduction characterized?

A

by excessive tissue on the outside of the thighs?

69
Q

When it comes to Pear adduction what do individuals typically require when it comes to dealing with seats?

A

They require a wider seat for comfort.

A condition where excessive adipose tissue is located on the outside of the thighs, making it hard to find a seat that accommodates their hip width.

70
Q

What do both pear abduction and adduction body types tend to avoid?

A

Log rolling due to the difficulty in moving due to their tissue distribution

It can be uncomfortable for their hips and thighs.

71
Q

For pear plus body can you explain visceral fat and the health risks associated with it?

A

The don’t have as much visceral fate associated with it so the health risks tend to be lower.

72
Q

Individuals with plus sized body shapes: Gluteal shelf have noticeable accumulation of fat where?

A

In the gluteal region

73
Q

What is altered due to the plus size body shape: gluteal shelf?

A

Center of Gravity: the additional tissue in the buttocks area shifts the bodys center of gravity, potentially affecting posture and movement

74
Q

What do people with plus sized body shapes have difficulty finding when it comes to sitting?

A

Finding a comfortable seated position: due to the distribution of excess tissue in the buttocks, it can be challenging to sit comfortably for extended periods?

75
Q

Why can getting out of bed be challenging for individuals with a gluteal shelf?

A

It can be hard to tell how securely they are sitting on the bed due to the amount of tissue behind them.

76
Q

What seating issue is common for individuals with a gluteal shelf?

A

Their low back may not contact the seat, leaving them unsupported in a chair.

77
Q

How can seating be made more comfortable for individuals with a gluteal shelf?

A

Supporting them with pillows or a towel roll may help.

78
Q

What are some risk factors of obesity

A

Black adolescent girls,

hispanic boys

79
Q

Children of obese parents are at higher or lower risk of obesity?

A

higher risk

80
Q

What does being overweight or obese increase the likelihood of?

A

being obese in adulthood

81
Q

what is a primary cause of obesity?

A

Imbalance between energy intake and energy expenditure

82
Q

Genetic and environmental factors both contribute to what?

A

development of obesity

83
Q

What is Neuroendocrine dysfunction?

A

Hormonal imbalances in the nervous system that affect body weight.

84
Q

Hormonal dysfunction affecting the HPA (hypothalamic-pituitary-adrenal) axis:

A

This axis regulates stress responses and metabolism, which can influence obesity.

85
Q

Energy regulation:

A

How the body controls energy storage and expenditure.

86
Q

What are some common risk factors for obesity?

A

Sedentary lifestyle, certain medications, underlying diseases like hypothyroidism, and genetic conditions such as Prader-Willi syndrome.

87
Q

What is Prader-Willi syndrome?

A

A genetic condition, often in children, where there is a strong desire to eat everything, including non-edible objects.

88
Q

Why does the statement “calories in, calories out” not fully explain obesity?

A

Energy expenditure varies based on genetic, environmental, and social factors.

89
Q

What are some theories about the pathogenesis of obesity?

A

Neuroendocrine dysfunction, hormonal dysfunction, and energy regulation.

90
Q

What is neuroendocrine dysfunction in relation to obesity?

A

Genetic mutations may disrupt food intake and fat distribution, indicating obesity is central nervous system-mediated.

91
Q

What role does hormonal dysfunction play in obesity?

A

It affects the hypothalamic-pituitary-adrenal axis, leading to cortisol secretion abnormalities, insulin resistance, and visceral fat accumulation

92
Q

Complications Associated with Obesity

A

Metabolic syndrome
Type 2 diabetes mellitus
Liver diseases
Osteoarthritis
Sleep apnea
Atherosclerosis, hypertension, cardiovascular diseases
Stroke
Asthma
Cancer
Menstrual disorders and infertility
Lymphedema
Impaired mobility
Gallbladder disease
Psychological disturbances such as irritability, loneliness, depression, binge eating, and tension
Premature death

93
Q
A
94
Q

to prevent obesity what are some things you should focus on

A

Prevention such as understanding how personal, family, community, and social influences can affect your obesity.

You can do more exercise and and have less screen time

You can eat better because nutrition is key to prevention efforts

95
Q

for obesity diagnosis recognizes what?

A

BMI has its limitations in assessing obesity.

Waist circumference should be used in more comprehensive evaluations

96
Q

What is the primary goal in treatment for obesity

A

The primary goal is for energy expenditure to exceed intake.

97
Q

What are common treatments for obesity?

A

Exercise, nutrition, behavioral modification, support groups, and surgery.

98
Q

What is crucial for long-term success in managing obesity?

A

Behavioral change is imperative.

99
Q

What is a limitation of BMI for diagnosing obesity?

A

It does not account for visceral fat, which is important for assessing disease risk.

100
Q

What additional measurement should physical therapists include in obesity diagnosis?

A

Waist circumference.

101
Q

Why is visceral fat important in assessing disease risk?

A

Visceral fat is the most important in determining disease risk related to obesity.

102
Q

Why is short-term dieting not effective in treating obesity?

A

Long-term solutions are needed to address the root causes of obesity.

103
Q

Why are weight-loss medications controversial?

A

In the past, they caused cardiac problems, but newer drugs are being introduced, particularly for diabetes, which may also aid in weight loss.

104
Q

What is a potential drawback of weight-loss medications?

A

They may need to be taken over a lifetime to remain effective.

105
Q

What is a vertical sleeve gastrectomy?

A

A procedure where a portion of the stomach is removed, used for weight loss or conditions like cancer and peptic ulcer disease.

106
Q

What is a gastric band?

A

A small adjustable band placed around a portion of the stomach, with an access port under the skin for inflating or deflating the band to regulate the size of the stomach pouch.

107
Q

What is the Roux-en-Y procedure?

A

A gastric bypass surgery that forms a pouch and bypasses the stomach, often done laparoscopically for quicker recovery.

108
Q

Why are surgical procedures for obesity becoming more common?

A

Behavioral change has historically been ineffective, and surgery can prevent complications like type 2 diabetes.

109
Q

Why might there have been a stigma around obesity surgery in the past?

A

It was seen as “the easy way out,” but this perception may be changing as surgery becomes more accepted.

110
Q

Why are gastric bypass procedures being performed more often in children?

A

To limit the development of complications like type 2 diabetes early on.

111
Q

What does it mean when they say obesity is a complex disease

A

Obesity is a multifaceted condition requiring comprehensive management

112
Q

What doe they mean when they say obesity is a comorbid condition?

A

It often exists with other health issues

113
Q

What do they mean when they say obesity is a risk factor for many conditions

A

obesity contributes to various medical problems

114
Q

What is patient education essential for

A

promoting lifestyle changes and self management

115
Q

when it comes to mobility and balance limitations what can obesity hinder

A

balance and stability

116
Q

what does sedentary behavior lead to

A

cycle of obesity and more sedentary behavior

117
Q

How do you combat sedentary behavior

A

Find safe and feasible exercise options.
Avoid high-impact activities.
Exercise intensity may feel “high” even at lower levels.

118
Q

What are the considerations when dealing wit obesity

A

Exercise testing: Recommended due to elevated risks.
Malnutrition is still possible, even in obese individuals.
Awareness of exercise-related complications

Create a welcoming, non-judgmental environment for patients.

119
Q

What is the significance of obesity as a diagnosis for physical therapists (PTs)?

A

Obesity is a complex disease that PTs may increasingly see as a primary diagnosis rather than just a comorbid condition.

120
Q

How can PTs play a role in addressing obesity?

A

By engaging in prevention efforts throughout the spectrum of care and helping patients manage obesity directly.

121
Q

Why is patient education important in managing obesity?

A

Education empowers patients to understand their condition and make informed decisions about lifestyle changes.

122
Q

What are some physical limitations associated with obesity?

A

Changes in center of gravity, mobility limitations, and balance issues.

123
Q

How does sedentary behavior relate to obesity?

A

Sedentary behavior contributes to obesity, and obesity can lead to increased sedentary behavior due to difficulty exercising.

124
Q

Why should high-impact activities be avoided for patients with obesity?

A

They can lead to joint problems due to increased stress on the joints.

125
Q

Why is monitoring exercise intensity important for patients with obesity?

A

Because what seems like low intensity to a therapist may be moderate or high intensity for the patient.

126
Q

What tools can PTs use to monitor exercise intensity in patients with obesity?

A

Checking vital signs and asking about Rate of Perceived Exertion (RPE).

127
Q

What types of exercises are beneficial for patients with obesity?

A

Activities that offload the joints like stationary cycling, aerobics, and resistance training.

128
Q

How can circuit-style resistance training benefit these patients?

A

It combines resistance training with aerobic exercise, providing a multifaceted approach.

129
Q

Why is it important to help patients celebrate small wins?

A

Focusing on positive changes can motivate patients and improve adherence to treatment.

130
Q

What should be considered before starting an exercise program for patients with obesity?

A

Conducting exercise testing due to the elevated risk of comorbid conditions.

131
Q

Can patients with obesity be malnourished?

A

Yes, they can be obese but still malnourished depending on their diet.

132
Q

Why is malnutrition a concern after bariatric surgery?

A

Because of lower vitamin and mineral absorption due to reduced transit time through the GI system.

133
Q

What are signs of malnutrition to watch for?

A

Dry skin and brittle nails.

134
Q

Why is creating a welcoming, non-judgmental environment important?

A

It encourages patients to engage openly in their care and reduces stigma.

135
Q

How should PTs approach language when discussing obesity?

A

Use sensitive language to help change the conversation and acknowledge obesity as a medical condition.

136
Q

What underlying system is implicated in obesity?

A

The endocrine system, indicating an underlying pathophysiologic cause.

137
Q

When managing obesity what are some limitations

A

Lack of equipment: There may be limitations with:

Imaging machines (weight limits or size constraints)

Chairs and seating options

Beds designed for higher weight capacities

138
Q

Higher operative and hospital-related complications:

A

Obesity increases the risk of complications during and after surgeries.

139
Q

Body mechanics and why they are important?

A

Proper techniques are essential when moving or assisting obese patients.

140
Q

Whay are mechanical lifts important

A

Useful for safe patient transfers.

141
Q

What is egress test?

A

A method used to assess a patient’s ability to move and transfer safely.

142
Q

Why is Nursing and staff education important

A

Ensuring that healthcare providers are trained to work with obese patients effectively.

143
Q

Know equipment weight limits:

A

It is crucial to be aware of the weight limits of medical equipment to avoid accidents or injuries.

144
Q

Why are individuals with obesity at a disadvantage in the medical system?

A

Medical equipment, such as imaging machines, may not be large enough to accommodate them.

145
Q

What is an example of how hospitals might manage imaging for patients with obesity?

A

Patients may be transferred to a larger hospital with extra-large CT or MRI scanners.

146
Q

What issue can arise during emergency surgery for patients with obesity?

A

Sometimes surgery is done without prior imaging due to equipment limitations, leading to uncertainty about the condition.

147
Q

Why might patients with obesity be less active in the hospital?

A

Nurses may be afraid to help them out of bed, or there may not be chairs or equipment to accommodate their size.

148
Q

How can PTs help patients with obesity stay mobile in the hospital?

A

By problem-solving around equipment limitations and facilitating mobility to prevent debility.

149
Q

Why are patients with obesity more likely to develop debility in the hospital?

A

Because of increased inactivity and difficulty managing mobility independently.

150
Q

What is the egress test?

A

A simple test nursing staff can use to assess if a patient is safe to progress mobility.

151
Q

What should PTs consider when working with patients with obesity in terms of body mechanics?

A

Use proper body mechanics and consider using mechanical lifts to assist with mobility.

152
Q

Why is it important for PTs to know equipment weight limits?

A

To ensure they are not using equipment that is unsafe or inadequate for the patient’s needs.

153
Q

What type of equipment failure might affect patients with obesity, as described in the example?

A

Toilets or other fixtures may break due to weight limits, leading to potential injury and embarrassment.

154
Q

How might negative experiences in the hospital affect future care for patients with obesity?

A

Embarrassing or distressing events may make patients less likely to seek appropriate healthcare in the future.

155
Q

Mechanical life quipment

A

Mechanical Lift Equipment
* Many different types available
* Reduce injuries to healthcare providers
* Increase ability of patients, esp. bariatric ones, to safely get out of bed
* Some can be used to facilitate PT.
* If you do not have a lift device with high enough weight limit, talk with nursing management.
 

156
Q

What is the purpose of mechanical lifts for patients with obesity?

A

To reduce injuries to healthcare providers and help patients with obesity be more mobile without risk of injury.

157
Q

How can mechanical lifts increase the mobility level of patients with obesity?

A

By assisting with mobility to prevent complications related to an inpatient stay.

158
Q

What types of activities can mechanical lifts facilitate besides dependent transfers?

A

They can assist with more active tasks like gait training in a safe environment.

159
Q

Why are mechanical lifts useful in gait training for patients with obesity?

A

They improve safety, especially if the patient is too large for the therapist to safely catch in the event of a fall.

160
Q

What should you do if the right type of equipment for a patient with obesity is not available?

A

Speak with nursing management or a clinical nurse specialist to problem solve and find the appropriate equipment.

161
Q

Week 5 Obesity complete

A

management of complex patients (15 decks)

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