Bariatrics

Question 1

what is BMI?

Answer 1

A measure of nutritional status that does not depend on frame size. Indirectly estimates total fat stores by a height to weight relationship. Clinical scale used to indicate obesity

Question 2

what does a BMI less than 18.5 indicate?

Answer 2

underweight

Question 3

what does a BMI from 18.5-25 indicate?

Answer 3

normal

Question 4

what does a BMI for 25-29.9 indicate?

Answer 4

Overweight

Question 5

what does a BMI of 30 or higher indicate?

Answer 5

obesity

Question 6

what does a BMI of 40 or higher indicate?

Answer 6

morbidly obese

Question 7

what is another way we predict increased health risk other than BMI?

Answer 7

waist circumference
waist-to-hip ratio

Question 8

what is a healthy waist circumference for men and women?

Answer 8

men- <40 inches
women- <35 inches

Question 9

how is waist to hip ratio calculated?

Answer 9

by dividing waist measurements by hip measurements to obtain a ratio

Question 10

what is an health waist-to-hip ratio for men and women?

Answer 10

men- <0.9
women- <0.8
(greater than these values can indicate increased risk)

Question 11

what are the major complications of obesity?

Answer 11

-Cardiovascular and respiratory systems
-Degeneration of the musculoskeletal system
-Increased risk for infection and infectious diseases
-Slower healing processes

Question 12

almost 80% of obese adults have what diseases?

Answer 12

-DM
-dislipidemia
-CAD
-gallbladder disease
-osteoarthritis
(almost 40% of obese adults have 2 or more of these problems)

Question 13

what are the major (underlined by jenna) risk factors for obesity?

Answer 13

*Eating high-fat and high-cholesterol diets
*Genetics & environment
*Behavioral issues
*Physical inactivity

Question 14

how should blood pressure be taken on a bariatric client?

Answer 14

*Correct size blood pressure cuff (avoid inaccurate readings)
*Consider alternative sites for readings (lower leg or wrist)

Question 15

how should pulse be taken on a bariatric client?

Answer 15

*Carotid & femoral pulses are difficult to access
*Consider alternative sites – radial pulse

Question 16

how should respirations be different for a bariatric client?

Answer 16

*Distant lung sounds
*Unable to tolerate lying flat on back
*Consider Bi-pap or C-pap machine use
*Consider ability to ventilate

Question 17

how should you assess weigh of a bariatric client?

Answer 17

*Assess equipment capabilities before getting starting
*Accurate readings are essential
*Protect client’s dignity

Question 18

what is a concern regarding a bariatric patients skin related to infection?

Answer 18

Moist conditions under skin folds are a great place for yeasts & fungi to grow.
-(Keep skin clean (mild soap and water), rinse well, and dry )

Question 19

what is a concern regarding a bariatric patients skin related to wound care?

Answer 19

-Poor circulation
-co-morbid conditions
-malnutrition
-delayed healing

Question 20

how do you asses a bariatric clients GI/Gu compared to a non-bariatric client?

Answer 20

-Bowel tones are distant.
-Need to assess close to umbilicus for four quadrants.

Question 21

why might a bariatric client be urinary incontinent?

Answer 21

Often r/t decreased mobility due to reluctance or inability to ambulate

Question 22

what are some examples of bariatric equipment?

Answer 22

-Ceiling lifts, portable lifts
-large furniture (beds & commodes)
-plus sized gowns
-Gore-Tex sheets
-hover mats
-adequate staff

Question 23

how should you give an IM injection to a bariatric client?

Answer 23

Use long needle and a muscle close to the skin (Deltoid)

Question 24

what special considerations should be taken for radiologic imaging of a bariatric client?

Answer 24

Always check abdominal girth & weight limits before exams

Question 25

what are the categories of non-surgical treatment options for a bariatric patient?

Answer 25

-diets -exercise -behavior modification -medications -holistic therapies

Question 26

what is important regarding dieting for a bariatric patient?

Answer 26

-Generally do not work. Most weight is regained in about 5 years -Set realistic goals (1 lb./week)

Question 27

what is important regarding exercise for a bariatric patient?

Answer 27

-start slow -make activity an enjoyable habit

Question 28

what is important regarding behavior modification for a bariatric patient?

Answer 28

-Learn to identify what triggers overeating -Lifestyle changes -This could entail keeping a diary or record of foods eaten; exercise patterns; emotional/situational stimuli for overeating. (Use of a reward system or counseling to help modify negative beliefs.)

Question 29

how is bariatric surgery perceived?

Answer 29

-Bariatric surgery is perceived as a last resort to address weight issues, but is the only method with long-term impact on obesity.

Question 30

what are some surgical risks or complications for the bariatric patient?

Answer 30

-Wound healing issues -respiratory issues (PNA) -pulmonary emboli

Question 31

what is the benefits of bariatric surgery?

Answer 31

After bariatric surgery, many patients decrease or eliminate complications of obesity such as DM, HTN, depression, or sleep apnea.

Question 32

what are the two types of bariatric surgery?

Answer 32

-restrictive (minimally invasive) -malabsoptive

Question 33

what are some examples of restrictive or minimally invasive surgery options?

Answer 33

-Laparoscopic Adjustable Gastric Banding (LAGB, also reversible) -Laparoscopic Sleeve Gastrectomy (LSG, can be reversed but not as easily)

Question 34

what is the form of surgery considered malabsorptive?

Answer 34

Roux-en-Y gastric bypass (RNYGB) or “gastric bypass”

Question 35

what are the unique needs and risks for the bariatric client post-op?

Answer 35

-Priority is airway management immediately post-op (encourage IS use, TCDB!) -Abdominal binder (to prevent wound dehiscence) including thorough skin management. Encourage splinting (with pillow) when moving to decrease pain. -Observe for s/s of Dumping Syndrome

Question 36

what is Dumping Syndrome? S/S?

Answer 36

-Common post-op complication for bariatric surgery – food is rapidly emptied from the stomach into the small bowel -----(S/S – tachycardia, nausea, abdominal cramps, and diarrhea 10-30 minutes after eating.) Prevention – eating smaller meals and limiting high-sugar foods.

Question 37

what is important for aftercare of surgery for the bariatric client?

Answer 37

-Continual dietetic guidance -Education is needed regarding limiting or avoiding drinking fluids with meals to increase room for more nutrient-dense foods. -Counseling help with changes in body and relationships -Cosmetic surgeries to remove excess skin

Question 38

what are the common co-morbidities usually with a bariatric patient?

Answer 38

-sleep apnea -TTDM -HTN -CAD -gallbladder issues (cholecystitis) -dislipidemia -osteoarthritis