Chapter 42 Assessment & Management of Patients w/ Obesity

Question 1

Obesity

Answer 1

Abnormal/excessive fat accumulation that may impair health

Question 2

Prevalence of Obesity

Answer 2

70.9% of American Adults are obese or overweight

Prevalence higher in:
- Women
- African Americans
- Hispanics

Question 3

Diseases/Disorders Associated w/ Obesity

Answer 3

Alzheimer’s
Anxiety & depression
Asthma
Obstructive sleep apnea
Respiratory infections
Non alcoholic fatty liver disease
Liver cancer
Cholecystitis
Cholelithiasis
Gallbladder cancer
Osteoarthritis
Prostate cancer
Thyroid cancer
CAD
MI
HF
HTN
Renal cancer
Type II Diabetes
Pancreatic cancer

Question 4

What does obesity put patients at a higher risk for?

Answer 4

Increased risk for disease, disorders, low self-esteem, impaired body image, depression, and diminished quality of life

Obesity is associated with 6‐ to 20‐year decrease in life expectancy

Risk for cancer increases with increased BMI

Likelihood of type 2 diabetes by 10-fold

Asthma or hypertension by fourfold

Twice as likely to have Alzheimer’s

Question 5

Gerontological Considerations for Bariatric Patients

Answer 5

Prevalence of obesity for adults 60 yrs & up is 42.8% (slightly higher than other population)

As adults age, lean skeletal mass decreases & adipose tissue increases

Basal metabolism drops by 2% for each additional decade of adult life

Greater risk for falls & mobility impairments

Question 6

Adiposopathy

Answer 6

Dysfunction of adipose tissue

Question 7

Obesogenic

Answer 7

Promotes weight gain

Question 8

Satiety

Answer 8

The feeling of having eaten sufficient amounts of food

Question 9

Orexigenic

Answer 9

Hormones that stimulate appetite via CNS pathways that lead to hypothalamus-> signals higher neural pathways-> eating behavior

Question 10

Health History Assessment for Patients w/ Obesity

Answer 10

Recent increase or decrease in body weight
- Determine if it was intentional or not to see if another disease process could be at work

Personal Hx of Obesity (if it started at childhood or after pregnancy, ie)

Family History of Obesity

Any patterns of weight loss over time
- Prior successful or unsuccessful weight loss strategies

Dietary & Exercise Pattern History

Evaluate sleeping habits
-Usually patients w/obesity have:
- Difficulty falling asleep
- Difficulty staying asleep

Smoking habits
- Smoking cessation can cause weight gain

Current list of medications: Certain medications can cause weight gain

Question 11

Body Mass Index (BMI)

Answer 11

Definitive measure used to determine whether or not a patient has obesity
- Based on a ratio of body weight in (kg) & height in meters

Question 12

Overweight/ Preobese BMI Score

Answer 12

25 – 29.9 kg/m^2

Question 13

Class I Obesity BMI Score

Answer 13

30 – 34.9 kg/m^2

Question 14

Class II Obesity BMI Score

Answer 14

35 – 39.9 kg/m^2

Question 15

Severe/ Extreme Obesity BMI Score

Answer 15

Equal to or > 40 kg/m^2

Question 16

Waist Circumference Risk Factor

Answer 16

Women: > 35 inches

Men: > 40 inches

Question 17

Waist-to-Hip Ratio Risk Factor

Answer 17

Women: > 0.80

Men: > 0.90

Presumed to have proportionally more abdomina;

Question 18

Lab Studies for Bariatric Patients

Answer 18

Cholesterol
Triglycerides
Fasting blood
Glucose
HA1c
Liver function tests

Question 19

Nursing Management of Bariatric Patients

Answer 19

Approach patients with obesity with the same respectful, courteous, and empathetic behavior as extended to patients without obesity

Understand the effects of obesity
 Mechanics of ventilation and circulation
 Pharmacokinetics and pharmacodynamics
 Skin integrity
 Body mechanics and mobility

Question 20

Effects of Obesity on Mechanics of ventilation and circulation

Answer 20

Maintain in low Fowler position to maximize chest expansion
* Continuous pulse oximetry
* Supplemental oxygen
* Frequent respiratory assessments

Question 21

Effects of Obesity on Central & Peripheral circulatory compromise

Answer 21

Use appropriately sized BP cuff
* Monitor for DVT
* Correct medication dose
* Pressure injuries

Question 22

Other Areas to Take BP

Answer 22

Wrist, & Legs

Question 23

Effects of Obesity on Pharmacokinetics and Pharmacodynamics

Answer 23

Understand that some drugs have enhanced effects while others have diminished effects with patients with obesity
- Be cognizant that weight-based calculations of drug dosages
for patients with obesity may need to be altered

Question 24

Behavioral Interventions for Obesity

Answer 24

Set weight goals

Improve lifestyle behaviors: diet habits, physical activity

Addressing barriers to change

Consider adjunct use of pharmacological therapy

Self-monitoring & strategizing ongoing lifestyle changes aimed at a healthy weight

Question 25

Effects of Obesity on Skin integrity and body mechanics

Answer 25

Assess for pressure ulcers * Specialty bariatric equipment

Question 26

Dietary Considerations for Bariatric Patients

Answer 26

Calorie deficit should be between 500-1,000 calories daily from baseline - To achieve 5-10% weight reduction w/in 6 months

Question 27

Foods to be Limited/Eliminated

Answer 27

Processed foods w/ limited nutritional value: packaged cakes, cookies, chips High caloric beverages: sugar-sweetened, juice, cream-enhanced Fast foods Vending machine foods Foods high in sugar (candies) & saturated foods (fried foods, hot dogs)

Question 28

Dietary Habits to Encourage

Answer 28

Reduce portions - Use smaller portions & measure foods Schedule meals & plan snacks & meals in advance for each day Eat more food at home than outside Eat together w/ family to foster healthy eating environment Avoid screen time when eating Eat breakfast Limit snacks Drink plenty of fluids

Question 29

Nursing Interventions to Address the Effects of Obesity on Mechanics of Ventilation & Circulation

Answer 29

Maintain in low Fowler position to maximize chest expansion Continuous pulse oximetry Supplemental oxygen Frequent respiratory assessments

Question 30

Nursing Interventions to Address the Effects of Obesity on Central & Peripheral Circulatory Compromise

Answer 30

Use appropriately sized BP cuff Monitor for DVT Correct medication dose Pressure injuries

Question 31

Nursing Interventions to Address the Effects of Obesity on Pharmacokinetics & Pharmacodynamics

Answer 31

Understand that some drugs have enhanced effects while others have diminished effects w/ patients with obesity Be cognizant that weight-based calculations of drug dosages for patients with obesity may need to be altered

Question 32

Nursing Interventions to Address the Effects of Obesity on Skin Integrity & Body Mechanics

Answer 32

Assess for pressure ulcers Specialty bariatric equipment

Question 33

Bariatric Surgery

Answer 33

Surgery used to treat obesity - Typically performed after nonsurgical interventions have failed

Question 34

Results of Bariatric Surgery

Answer 34

Results in weight loss of 10% to 35% body weight within 2 to 3 years -Improvement in comorbid conditions

Question 35

Bariatric Procedures

Answer 35

Roux-en-Y gastric bypass (RYGB) Gastric banding Sleeve gastrectomy Biliopancreatic diversion with duodenal switch Performed by laparoscopy or by an open surgical technique

Question 36

Inclusion Criteria for Bariatric Surgery

Answer 36

Ability to perform ADLs & self-care Presence of a support network of family & friends Failure of previous nonsurgical attempts at weight loss, including nonprofessional programs Expectation that the patient will adhere to postop care, follow-up visits, & recommended medical management - Includes use of dietary supplements

Question 37

Exclusion Criteria for Bariatric Surgery

Answer 37

Reversible endocrine or other disorders that cause obesity Current substance use disorder Uncontrolled, severe psychiatric illness Lack of comprehension of: - Risks - Benefits - Expected outcomes - Alternatives - Lifestyle changes required w/ bariatric surgery

Question 38

Pre-op Considerations for Bariatric Surgery

Answer 38

Education and counseling Risks and benefits of surgery Complications Post-surgical outcomes Dietary changes Lifelong follow-up Lab testing

Question 39

Post-Op Considerations for Bariatric Surgery

Answer 39

Assess to ensure goals for recovery are met Assess for absence of complications Manage pain Nutritional status: Increase in protein intake Fluid volume balance Decrease anxiety Body image: Excess skin