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54 Cards in this Set
- Front
- Back
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How is weight gain characterized?
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Adipocyte hypertrophy/hyperplasia
abnormal increase in size of fat cells |
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What is adipocyte hypertrophy?
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process by which adipocytes can increase thier volume several thousand fold to accommodate a large increase in lipid storage mainly in the visceral and subQ tissue of the body
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What is primary obesity?
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excess caloric intake for the body's metabolic demands
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What is secondary obesity?
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Results from various congenital anomalies, chromosomal anomalies, metabolic problems, or CNS lesions and disorders
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What is a BMI?
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common clinical index of obesity or altered body fat distribution using height to weight ratio
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What is the waist to hip ratio?
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waist measurement/hip measurement = ratio
<0.80 is best people with more visceral fat are at increased risk for CVD and metabolic syndrome |
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What is the Apple-shaped Body?
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fat located in the abdominal area
At a greater risk for obesity related Cx Android obesity |
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What is pear-shaped body?
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fat located in upper legs
Gynoid obesity better prognosis by harder to treat |
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What are the genetic components of obesity?
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FTO gene has link to inc BMI
Appetite is influenced by the hypothalamus and the input is from the periphery hormones and peptides Adipocytes secrete enzymes, adipokines, growth factors, and hormones contributes to development of insulin resistance and atherosclerosis |
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What are the environmental factors influencing obesity?
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Access to food: prepackaged food, fast food, soft drinks, increased portion sizes
Tend to underestimate food and caloric intake Lack of physical exercise: dec at home and work, advances in tech and labor saving devices, and inc time watching TV and video games |
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What is important to understand about take BP in obese patients?
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use an accurate sized cuff or the bp will be increased
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What are the psychosocial factors r/t obesity?
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emotional component of overeating is powerful
social component of eating is developed early in life (bdays, holidays, etc) |
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What are some nursing interventions for obese patients?
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motivation is essential
set realistic goals (1-2lbs/week) slower weight loss offers better cosmetic results |
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What nutritional therapy should be advised with obese patients?
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adequate quantities of fruits and veges, lean meat, fish and eggs
Fad diets should be discouraged (water weight is lost, not fat) |
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What exercise advice should be given to an obese patient?
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its an essential part of weight control
should be done 30mins-1hr daily Use sensible forms of exercise - walking swimming and cycling |
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What are some assumptions about behavior modification in obesity?
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its a learned disorder
critical difference between over weight and under weight is the cues that regulate eating behavior |
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What are some useful techniques in behavior modification?
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Self monitoring: show what and when foods are eaten
Stimulus control: separate events that trigger eating from the act of eating Rewards: incentives for weight loss |
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How can support groups help obesity?
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encouragement can be offered to join an group of other obese persons who are receiving professional counseling to help modify eating habits
Take Off Pounds Sensibly (TOPS) Weight Watchers |
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What are the categories of weight loss drugs?
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Dec food intake by reducing appetite or increasing satiety
Dec nutrient absorption Drugs that increase energy expenditure are not approved by the FDA |
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Name the ways appetite suppressing drugs work?
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1. Decrease food intake through nonadrenergic mechanisms in the CNS (Phentermine, Diethyhpropion, phendimetrazine)
- not recommended r/t abuse 2. Serotonergic Drugs that inc the release of serotonin or dec its uptake (dec metabolism) (Pondimin, Redux, removed from market in 1977) 3. Mixed Non adrenergic serotonergic agents - don't stimulate release of serotonin Meridia |
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How do nutrient absorption blocking agents work?
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blocking fat breakdown and absorption in intestine
inhibits intestinal lipases undigested fat is excreted in feces Alli, Xenical |
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What is the only treatment found to have sucessful lasting impact on weight loss?
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bariatric surgery
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What criteria must be met to be a candidate for bariatric surgery?
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BMI >40 with one or more obese Cx
18 yrs or older Understands risks and benefits obese >5yrs tried and failed at weight loss no serious endocrine problems psychiatric and social stability availability of a team of HC providers Surgery would decrease or eradicate high risk conditions |
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What are the categories of bariatric surgery?
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Restrictive
Malabsorptive Combination of restrictive and malabsorptive |
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How does restrictive surgery work?
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reduces the size of the stomach to 30mL or less
causes the pt to feel more full more quickly normal stomach digestion and intestinal absorption of food (dec risks of anemia and cobalamin deficiency) |
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Name the types of restrictive surgery?
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Vertical banded gastroplasty
Adjustable Gastric Banding (AGB) Vertical Sleeve Gastrectomy |
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How does Vertical Banded Gastroplasty work?
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partitions stomach into a small pouch in upper portion
Small pouch drastically limits capasity stoma opening to rest of stomach is banded to delay emptying of solid foods from proximal pouch |
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How does adjustable gastric banding work?
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aka Lap Band or Realize Band System
Stomach size is limited by inflating band placed around fundus of the stomach Band is connected to subQ port Can be inflated or deflated to change stoma size Can be done laparoscopically and can be modified or reversed better choice for pt with surgical risks weight loss is slower than others |
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What is the Vertical Sleeve Gastrectomy?
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85% of the stomach is removed
not reversible stomach Fx is preserved |
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Name the malabsorptive surgeries
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Biliopancreatic diversion (BPD)
Biliopancreatic diversion with duodenal switch |
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How does the Biliopancreatic diversion work?
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Removes 3/4 of the stomach to dec food intake and dec acid output
Remaining 1/4 is connected to the lower portion of the small intestine Pancreatic enzymes and bile enter final segment of intestine and nutrients pass without being digested |
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How does the BPD with duodenal switch work?
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variation of BPD by including duodenal switch, surgeons leave a larger portion of the stomach intact
Helps prevent dumping syndrome |
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Name the Combination surgeries
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Roux-en-Y
has low Cx rates and inc pt tolerance Stomach size is dec with a gastric pouch anastomosis that empties directly into jejunum |
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What are the variations of Roux-en-Y?
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1. Stapling stomach without transection to create small 20-30 mL gastric pouch
2. Creating an upper and lower gastric pouch and totally disconnecting the pouches 3. Creating an upper gastric pouch and completely removing the lower pouch |
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What are the cosmetic surgeries and who are candidates?
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Lipectomy
Liposuction Candidates: Achieved weight loss Excess skin folds or fat |
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What other co-morbidity's do obese pts suffer from?
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DM
altered cardiorespiratory Fx Abnormal metabolic fx Atherosclerosis |
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What is nursing care pre-operatively?
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Have rm ready:
Larger BP cuff Larger gown Bariatric wheel chair (or chair with removable arms) Strongly reinforced trapeze bar over bed for movement and positioning |
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What is important to educate the pt about r/t breathing?
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Obesity can make breathing shallow and rapid
Instruct pt proper: coughing techniques Deep, diaphragmatic breathing Methods of turning and positioning to prevent pulmonary Cx |
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What is important to understand about IV access in obese pts?
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Mark the spot of insertion with sterile skin marker when vein is found
If pt has excess fat, edema, hold a firm finger over the spot with pressure Multi tourniquets should be removed as soon as it is no longer needed to avoid edema Need longer catheter to traverse overlying tissue (>1in) Important that cannula is far enough into vein that it is not dislodged or infiltrated |
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What is important to understand about obese pts and ventilation?
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have inc risk of failing to wean from mechanical vents because they have more tissues that need support
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What is the post-op care for obese pts?
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Trained staff should assist with transfer - Maintain Airway and pain during
In severly obese pts, its important to monitor rapid oxygen desaturation (pulse ox) Early ambulation is essential Inc ambulation after initial move (3-4x/day) Pneumatic compression devices, Elastic compression stockings, or elastic wraps are used (prevent DVT) Abdominal pain is great - give meds as frequently as necessary during immediate post op |
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How can you prevent Cx post op in bariatric pts?
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Preventing Pneumonia:
Encourage incentive spirometer (to expand lungs) C&DB Ambulation |
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What is important to educate the obese pts after surgery r/t nutrition?
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Hard to maintain prescribed diet
Pt has reduced intake b/c of anatomic changes Must learn to adjust intake r/t nutrition and maintain a stable weight |
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What diet is prescribed post-bariatric surgery?
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High protein
Low CHO Low Fat Low roughage Six small feedings/day Fluids not to be ingested with meals <1000mL/day |
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What are the possible Cx of surgery?
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Anemia
Vitamin Deficiencies Diarrhea Psychiatric pbms Peptic ulcer formation Dumping Syndrome Small Bowel Obstruction |
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What are the S/S and tx with dumping syndrome?
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Weak
Dizzy Diaphoresis Diarrhea Need Fluids with low carbs and high protein |
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What are the expected outcomes with bariatric surgery?
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Long term weight loss
Improvement in obesity related co-morbidities Integration of healthy practices into lifestyle Improved self image Must monitor for possible A/E (with exercise) |
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What are the gerontologic considerations?
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Number of older obese pt risen
More common in women than men Dec energy expenditure and loss of muscle mass are important contributors Exacerbates age related pbms |
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What is metabolic syndrome?
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collection of risks that inc an individuals chance of developing CVD and DM
aka: Syndrome X, insulin resistance syndrome, dysmetabolic syndrome |
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How is metabolic syndrome diagnosed?
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if pt has 3 or more of these:
Waist circumference >40in (m) or >35in (w) Triglycerides >150 or being tx HDL cholesterol <40 (m) or <50 (w) BP >130/>85 Fasting glucose is >100 |
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What are the main risk factors for Metabolic syndrome?
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Insulin Resistance
Abdominal Obesity (HTN, abnormal cholesterol, PT tendencies, Hormonal imbalances, aging, genetic or ethnic) |
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What are the symptoms of metabolic syndrome?
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none
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What are the complications of Metabolic syndrome?
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Heart disease
Stroke DM Renal Disease |
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What is the tx for metabolic syndrome?
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Lifestyle therapy is the first line
Reduce LDL cholesterol Stop smoking Lower BP Reduce glucose levels Lose weight Inc physical activity Healthy dietary habits nurse assists by providing information |
