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39 Cards in this Set

  • Front
  • Back
_____________ is defined as a body mass index (BMI) of 25 to 29.9.
Overweight
_________ is defined as a BMI of 30 or more.
Obese
The _________ reflects weight in relation to height and an is a better indicator then weight alone.
BMI
The desirable range for _______ is 18.5 to 24.9
BMI
A large waist circumference (greater than 35" for women and 40" for men) is another risk factor for overweight and __________
Obesity
Schedule IV drug and most commonly prescribed anti obesity drug
Sibutramine (Meridia)
Most frequently prescribed adrenergic anorexiant.
Phentermine (adipex-p)
Decreases absorption of dietary fat from the intestine
Orlistat (Xenical, Alli)
Major source of commercial caffeine; found in weight loss products and many other supplements and other food products.
Guarana
Expands on contact with body fluids
Glucomannan
What is the primary cause of obesity?
Obesity may occur in anyone but is more likely to occur in women, member of minority groups and poor people. It results from consistent ingestion of more calories than are used for energy, and it substantially increases risks for development of numerous health problems.
What is central or visceral obesity?
Most obesity related disorders are attributed mainly to the multiple metabolic abnormalities associated with obesity. Abdominal fat out of proportion to total body fat (also called central or visceral obesity) which ofter occurs in men and postmenopausal women, is considered a greater risk factor for disease and death than lower body obesity. In addition to the many health problems associated with obesity obesity is increasingly being considered a chronic disease in its own right.
What is the prevalence of obesity in the United States?
The prevalence of overweight people and obesity has dramatically increased during the passed 25yrs. Some authorities estimate that 60% of American adults are overweight and obese in the US; and women in lower socioeconomic classes are more likely to be obese than those in higher socioeconomic classes.
What is the etiology of excessive weight gain?
The etiology of excessive weight is thought to involve complex and often overlapping interactions among physiologic, genetic, environmental, psychosocial and other factors.
Explain how energy expenditure influences weight control.
In general increased weight is related to an energy expenditure represents the energy intake (food/calorie consumption) exceeds energy expenditure. Total energy expenditure represents the energy expended at rest (ex. the basal or resting metabolic rate), during physical activity and during food consumption.
Mrs. Romano asks how Orlistat works. How would you respond?
The drug decreases absorption of dietary fat from the intestine. Orlistat (Xenical, Alli) differs from phentermine and sibutramine because it decreases absorption of dietary fat from the intestine by binding to gasteric and pancreatic lipases in the gastrointestinal tract lumen and making them unable to break down dietary fits into absorbable free fatty acids and monoglycerides.
Mrs. Romano want to know whether the drug will lower her cholesterol. what is your understanding of the relationship between weight loss and effects on cholesterol with this drug?
The drug blocks absorption of approximately 30% of the fat ingested in a meal; increasing the dosage does not increase the percentage. Decreased fat absorption leads to decreased caloric intake resulting in weight loss and improved serum cholesterol values (ex decreased total and low density lipoprotein cholesterol levels). The improvement in cholesterol levels is thought to be independent of weight loss effects.
Explain the absorption of the drug. Does it cause any adverse effects? what are the disadvantages of taking orlistat?
Orlistat is not absorbed systemically and its action occurs in the GI tract. Consequently it does not cause systemic adverse effects or drug interactions as phentermine and sibutramine do. Orlistat main disadvantages are the requirement for frequent administraiton (three times daily) and gastrointestinal symptoms (abdominal pain oily spotting, fecal urgency flatulence with discharge, fatty stools fecal incontinence, and increased defecation.) adverse gastrointestinal effects occur in almost all orlistat users but usually subside after a few weeks of continued drug use.
Mrs. Romano asks if there are any other medications or supplements that she should take with the orlistat to remain healthy. What can you suggest?
Patient should consult with her physician about other supplements to take with orlistat. The drug prevents absorption of the fat soluble vitamins A,D,E,K so people taking orlistat should also take a multivitamin containing these vitamins daily. The multivitamin should be taken 2hrs before or after the orlistat dose. If it is taken at the same time the orlistat will prevent absorption of the fat soluble vitamins. High fat foods need to be decreased, because total caloric intake is a major determinant of weight and adverse effects( ex diarrhea, fatty and malodorous stools) worsen with high fat consumption.
Mr. Gibson presents to the physicians office 1yr after losing 50lbs. He complains that is he rapidly regaining his weight and does not know what to do about it. Which of the following should you review? (select all that apply)

a. His lifestyle habits

b. His exercise habits

c. His work habits

d. His eating habits.
a, b, d

Rationale: Many people lose weight by regain it within a few months if they do not change their lifestyle habits toward eating more healthfully and exercising more.
Mrs. Salas presents to the physicians office for a routine physical examination. She is 10 pounds overweight and asks the physician for a prescription for a weight loss drug. She is healthy and her laboratory values are within normal limits. The physician does which of the following?

a. Orders the medication with a short term prescription.

b. Encourages the client to increase her exercise and eat a healthy diet.

c. Refuses to order the weight loss drugs because her HMO will not pay for them.

d. Order an open prescription for a weight loss drug.
b

Rationale: Weight loss drugs are generally recommended only for people who are seriously overweight or have health problems associated with or aggravated by obesity.
Reducing _________________ and increasing caloric expenditure are part of any successful weight loss program.
Caloric Intake
Mr. Gonzales asks the physician ho to lose weight without drugs. The physician suggests decreasing his intake by 500 calories per day to lose which of the following?

a. 2 pounds per week

b. 4 pounds per week

c. 3 pounds per week

d. 1 pound per week
d

Rationale: Ingesting 500 calories more per day than those used in exercise and physical activity leads to a weight gain of 1 lb per week; decreasing caloric intake or increasing caloric out put of 500 calories per day for 1 week lead to a weight loss of 1lb.
Overweight and obesity are major concerns because of their association with numerous health problems including which of the following? (Select all that apply)

a. Diabetes

b. Hypertension

c. Hypoglycemia

d. Hypokalemia
a, b

Rationale: Overweight and obesity are major concerns because of their association with numerous health problems including diabetes hypertension other cardiovascular disorders and muscle and joint disorders.
You are the home care nurse for Mr. and Mrs. Stanley. Mrs. Stanley states that she found a weight loss program on the internet for $200.00 that will help her lose 50pounds safely in 30 days. She asks you about the program. You do which of the following?

a. Encourage the client to purchase the program because it will improve her blood glucose.

b. Encourage the client to purchase the program because she will eventually decrease her dependence on prescription medications.

c. Discourage the purchase because the diet promises unrealistic weight loss expectations

d. Discourage the purchase because of the cost of the diet is prohibitive.
c

Rationale: The home care nurse should be able to provide accurate information about realistic and successful techniques for losing weight and keeping it off; the health benefits of even modest weight loss; and reasons to avoid fad diets weight loss herbal and dietary supplements and programs that promise rapid and easy weight loss with little effort.
Mr. Wilson is diagnosed with diabetes mellitus hyperlipidemia, obesity, and cirrhosis of the liver. He asked the physician to prescribe sibutramine for weight loss. You would expect the physician to do which of the following?

a. Order the prescription because weight loss will improve the clients overall health

b. Order the prescription because administration of the medication will decrease the clients lipids.

c. Refuse to order the medication because the drug is excreted in the kidneys.

d. Refuse to order the medication because the drug is metabolized in the liver.
d

Rationale: In relation to drugs for obesity little information is available about their use in patients with hepatic impairment. Because sibutramine is metabolized in the liver it is contraindicated in patients with severe hepatic impairment.
Mrs. Fleming is diagnosed with end stage renal disease. She asks they physician to prescribe sibutramine to help her to lose weight. She states that she has friends with renal disease who take the drug and assumes that it is safe. The physician does which of the following?

a. Orders the drug

b. Orders the drug with an increased dosage.

c. Orders the drug with a decreased dosage.

d. Does not order the drug.
d

Rationale: With sibutramine dosage reduction are not recommended with mild to moderate impairment because the drug and its active metabolites are eliminated by the liver. However some inactive metabolites are also formed and these are excreted renal. The drug is contraindicated in patients with severe renal impairments.
With orlistat the manufactureer recommends conservative use and dosage because in older adults which of the following is often decreased? (select all that apply)

a. Renal function

b. cardiac function

c. pancreatic function

d. hepatic function
a, b, d

Rationale: With orlistat the manufaturer recommends conservative use and dosage because older adults often have decreased renal, cardiac and hepatic function.
Mrs. Goodrich brings her overweight child to the pediatricians office. She requests medicatoin to help her child lose weight. The physician does not order medication. You are responsible for the family education plan and focus your teaching on which of the following?

a. Decreasing physical activity

b. Putting the child on a diet

c. Increasing physical activity

d. Decreasing the child's BMI
c

Rationale: Treatment of childhood obesity should focus on healthy eating and increasing physical activity. In general children should not be on diets. For a child who is overweight the recommended goal is to maintain weight or slow the rate of weight gain so that weight for height and BMI gradually decline as the child grows in height.
Mrs. Goodrich's child exceeds optimal adult weight. The goal of the treament plan established with Mrs. Good rich and her child is a weight loss of how many pounds per year until the optimal adult weight is reached?

a. 10 to 12 pounds

b. 6 to 8 pounds

c. 12 to 15 pounds

d. 25 to 30 pounds
a

Rationale: If the child already exceeds the optimal adult weight the goal of treatment should be a slow weight loss of 10 to 20 pounds per year until the optimal adult weight is reached.
Mrs. Lang brings her 16yr old daughter to the physicians office for a weight loss program. The patient is 100 pounds over weight and diets have been unsuccessful in the past. The physician orders which of the following?

a. Phentermine

b. Orlistat

c. Glucomannan

d. Sibutramine
b

Rationale: Although drug therapy has not been generally recommended for treatment of childhood obesity orlistat is approved for use in children aged 12 to 16yrs and is considered safe and effective for weight reduction in overweight adolescents. as with adults common adverse effects in clinical trials were gastrointestinal effects (diarrhea, flatulence) and reduced concentration of fat soluble vitamins.
Mrs. Inserra asks you which commercial program will offer her psychological support and positive reinforcement for weight loss. She knows what is available in her community but is concerned about the success rates of the programs. You state that reviews suggest that which of the following programs has the best success rates?

a. OPTIFAST

b. Jenny Craig

c. Weight Watchers

d. LA Weight Loss
c

Rationale: For any patients following a weight loss regimen provide psychological support and positive reinforcement for efforts toward weight management. Programs or support groups involving supervision or regular participation within a social group appear to be more successful over time. However, systematic review that evaluated major commercial weight loss programs found few high quality studies. In general where were more evidence of success with the Weight Watchers program than with Health management resources.
Mrs Rose takes orlistat for weight loss. The weight loss is not progressing as quickly as she would like and she asks her physician to order sibutramine for her. She hopes that the combination will decrease her appetite and foster quicker weight loss. The physician does which of the following?

a. Orders the medication combination

b. Orders a low dose of sibutramine to use with orlistat

c. Does not order the combination due to possible adverse reactions

d. Does not order the combination because it does not improve weight loss.
d.

Rationale: The National Institutes of Health do not recommend combing weight loss medication except in the context of clinical trials. Thus far studies indicate that combining sibutramine and orlistat has not additional benefit over using one of the drugs alone.
Mr. Devens is diagnosed with diabetes type 2. He presents to the physicians office after a weight loss of 25 pounds. You would expect the physician to do which of the following?

a. Tell the client that his diabetes is cured

b. Decrease his diabetic medications

c. Increase his diabetic medications

d. Diagnosis the client with hypoglycemia.
b

Rationale: For people who already have type 2 diabetes weight loss reduces blood levels of glucose and glycosylated (a1c) hemoglogin. These effects make the diabetes easier to manage reduce complication of diabetes and may allow smaller doses of anti diabetic medications.
For a client with cardiovastcular disease the benefits of weight loss include which of the following? (select all that apply)

a. Lower blood pressure

b. Decreased HDL cholesterol

c. Increased HDL cholesterol

d. Lower serum triglycerides
a, c, d

Rationale: Emphasize health benefits of weight reduction. There is strong evidence that weight loss reduces risk factors for cardiovascular disease including blood pressure serum triglycerides and total and LDL cholesterol.
Ms. Adler is 35 pounds overweight. She asks the physician for a referral to a surgeon for bariatric surgery. You would expect the physician to do which of the following?

a. Make the referral

b. Decline to make the referal

c. Refer the client to a psychologist

d. Refer the client to a pharmacologist for an OTC diet supplement.
b

Rationale: Drug therapy and bariatric surgery are recommended only for seriously overweight people with major medical problems that an be improved by weight loss. In addition neither of these treatments is a substitute for the necessary changes in eating and physical activity patterns.
Ms. Kay presents to the physicians office with complaints of weakness dizziness and heart palpitaitions. She takes over the counter super dieters tea. You expect the physician to order which of the following?

a. Serum electrolytes

b. Hemoglobin and hematocrit

c. Serum albumin

d. CO2
a

Rationale: Laxative and diuretic herbs ex. aloe rhubarb root buckthorn cascara senna parsley juniper dandelion leaves are found in several products such as super dieters tea trim maxx tea and water pill. these products cause significant loss of body fluids and electrolytes not fat. Adverse effects may include low serum potassium levels, with subsequent cardiac disrrhythmia and other heart problems.
Ms. Kelly present to the physicians office with complaints of abdominal pain. During the interview you discover that the clients is using guar gum as a weight loss product. In addition she limits her fluid intake to reduce retention. Ms. Kelly is at risk for which of the following?

a. pancreatitis

b. Peptic ulcer disease

c. Intestinal obstruction

d. Esophageal varices
c

Rationale: Guar gum is a dietary fiber that is included in weight loss products because its is bulk forming and produces feeling of fullness. several small studies indicated that it is know more effective than placebo for weight loss. It may cause esphegeal or intestinal obstruction if not taken with an adequate amount of water and may interfere with the absorption of the other drugs if taken at the same time. Adverse effects include nausea, diarrhea, flatulence, and abdominal discomfort.
Products containing glucomannan should not be used in people with ____________
Diabetes