Obese Patient in Surgery

Question 1

What is the percentage of overweight and obese adults in the United States?

Answer 1

66%

Question 2

What is the BMI for overweight?

Answer 2

25-29.9%

Question 3

What is the BMI for obese

Answer 3

30% and greater

Question 4

What is considered morbidly increased?

Answer 4

40% and greater; more than 100 pounds greater than IBW; high risk for health complications

Question 5

Why do we not use morbidly obese?

Answer 5

Most patients get a higher risk of morbidities before they reach a BMI of 40%

Question 6

What are the post operative complications with obese patients?

Answer 6

• Dehiscence
• Slow healing
• Higher rates of infection
• Anesthesia wears off slower due to the higher fat content

Question 7

What is the number one concern for an obese patient through out the healing process?

Answer 7

Nutrition

Question 8

What is wrong with BMI as a measure?

Answer 8

It tends not to be accurate. If a patient has a large amount of muscle they could still have a high BMI

Question 9

What is central weight obesity?

Answer 9

A waist measured:

women: greater than 35”
men: greater than 40”

Question 10

What is peripheral obesity?

Answer 10

A waist to hip ratio of greater than 0.8

Question 11

Why would you do a thyroid profile on an obese patient?

Answer 11

Hypothyroidism may lead to weight gain.

Question 12

Why would you do a serum glucose profile on an obese patient?

Answer 12

To make sure that they do not have diabetes and if they do make sure they can get it under control.

Question 13

Why would you do a serum cholesterol profile on an obese patient?

Answer 13

To make sure that their cholesterol levels are under control before they go into surgery.

Question 14

Why would you do a lipid profile on an obese patient?

Answer 14

To make sure they do not have fatty liver syndrome

Question 15

Why would you do an ECG on an obese patient?

Answer 15

To see how the obesity is effecting their body.

Question 16

How do genetic factors effect an obese patient?

Answer 16

• Slow metabolism
• Runs in families due to:
• nurture and lifestyle

Question 17

How do psychological factors effect an obese patient?

Answer 17

• low self esteem

- diminished quality of life

Question 18

How do physiological factors effect an obese patient?

Answer 18

• low metabolism
• hypothyroidism
• inability to exercise

Question 19

How does the food supply effect an obese patient?

Answer 19

• cheap unhealthy foods
• increased access to fast food
• advertising for fatty foods

Question 20

How does sociocultural factors effect obese patients?

Answer 20

• not exercising

- food choices (hispanics eat a lot of beans and rice)

Question 21

How does physical inactivity effect obese patients?

Answer 21

This is the most important factor

By not moving you are harming your body

Question 22

How do environmental factors effect obese patients?

Answer 22

If it is too cold then they cannot exercise

-example: alaskan eskomos

Question 23

Is it better to be overweight or to yo-yo and put weight on and off?

Answer 23

It is better to be overweight

Question 24

What types of lifestyle modifications do obese people need to make?

Answer 24

Exercise is the number one!

Change diet!

Question 25

What is important to implement in terms of exercise for an obese patient?

Answer 25

- Aerobic exercise for 30-40 minutes 5 days a week | - Be under physician care

Question 26

What is important to implement in terms of nutrition for an obese patient?

Answer 26

PORTION CONTROL - a diet rich in whole grains, fruits, vegetables and low in fat - 500-1,000 kcal deficit - high in fiber

Question 27

Why is it important to have a diet high in fiber for an obese patient?

Answer 27

To promote stool, prevent an ileus, and prevent constipation.

Question 28

What types of behavior modifications can be made for an obese patient?

Answer 28

- Slow down while eating - Making a food record of everything you eat - Eliminate cues that precipitate eating like sitting in front of the tv - Exam factors that affect eating behaviors like stress - Joining a social support group

Question 29

What is phentermine?

Answer 29

A nonamphetamine appetite suppressant

Question 30

What do amphetamines do for obese patients?

Answer 30

It helps suppress appetites

Question 31

What does Orlistat (Xenical) or Alli do for obese patients?

Answer 31

It is a fat absorption inhibitor

Question 32

How does antidepressants help obese patients?

Answer 32

Many people eat when they are depressed so by treating that issue it helps patients not eat as much.

Question 33

How would bulk-forming agents help obese patients?

Answer 33

It helps promote regular bowel movements.

Question 34

What does IBW stand for?

Answer 34

Ideal body weight

Question 35

When does Bariatric Surgery become an option?

Answer 35

After all nonsurgical methods have failed

Question 36

What happens in a restrictive/malabsorptive procedure?

Answer 36

- bypass portion of small intestine | - rapid weight loss

Question 37

What is good about restrictive procedures?

Answer 37

- It is safer | - Generally less effective in the long term

Question 38

How much weight to patients need to loss before bariatric surgery?

Answer 38

-10% of overall body weight

Question 39

How much weight does the average patient loose after bariatric surgery?

Answer 39

25-35% of body weight in 18-24 months.

Question 40

What type of supplements does a patient who underwent bariatric surgery take?

Answer 40

Multivitamin and B12 supplements

Question 41

What is the postoperative diet for patients who underwent bariatric surgery?

Answer 41

Six small feedings 600-800 calories a day Liquids only taken between feedings

Question 42

Signs of Shock

Answer 42

Elevated Heart Rate | Decreased Blood Pressure

Question 43

How common is it for a patient to have dumping syndrome after bariatric surgery?

Answer 43

76% of patients

Question 44

Signs and Symptoms of a bowel/gastric outlet obstruction

Answer 44

Syncope, nausea, vomiting, and diarrhea.

Question 45

What is dysphagia?

Answer 45

trouble swallowing

Question 46

True or False: | The average weight loss after bariatric surgery is 60% of previous body weight.

Answer 46

False | the average is 35%

Question 47

What is important to constantly limit after a patient underwent bariatric surgery?

Answer 47

Limit fluids!

Question 48

What is the most important things to do for psychosocial support of a bariatric patient?

Answer 48

Allow patient to make decisions

Question 49

What do you focus on when doing an abdominal assessment on an obese patient?

Answer 49

Make sure the incision has no bleeding and is well approximated/.

Question 50

What nutritional element is imperative to consume during wound healing?

Answer 50

Protein

Question 51

What are the nursing diagnoses for a patient who underwent a bariatric surgery? *hint- there are 4

Answer 51

- Anxiety - Pain - Deficient knowledge - Imbalanced nutrition

Question 52

What are the potential complications with a bariatric surgery? *hint- there are 4

Answer 52

- Hemorrhage - Dietary deficiencies - Bile reflux - Dumping syndrome

Question 53

Steatorrhea

Answer 53

fatty, oily stools

Question 54

What are the three interventions that can stimulate circulation? *hint- there are 3

Answer 54

- Ambulation activities - Pulmonary care - Leg exercises

Question 55

What is lacking after a patient gets a bariatric surgery that causes them to be deficient in B12?

Answer 55

Intrinsic factor

Question 56

What is the agent that binds with bile acid?

Answer 56

Cholestyramine

Question 57

What happens to the food during dumping syndrome?

Answer 57

It rapidly passes through the GI tract.

Question 58

During Dumping syndrome what happens to the patients glucose levels?

Answer 58

They reach hypoglycemia levels

Question 59

What are the two food sources that patients need to avoid if they have dumping syndrome?

Answer 59

- Fluids with meals | - High carbohydrate and sugar intake.

Question 60

If a patient has steatorrhea what type of food should they reduce?

Answer 60

Fat intake

Question 61

What medication can be administered if a patient has steatorrhea?

Answer 61

loperamide

Question 62

What position should the patient be placed in so dumping syndrome can be avoided?

Answer 62

Low fowlers

Question 63

What class of medications can be administered to prevent dumping syndrome?

Answer 63

antispasmodics

Question 64

Nursing assessment of a 14-year-old reveals a BMI in the 90th percentile and a lifestyle that includes spending 4 hours a day playing video games and eating supper while watching television. The priority nursing diagnosis is: 1. Disturbed Body Image related to distorted perception of body size and shape. 2. Delayed Growth and Development related to inappropriate intake. 3. Imbalanced Nutrition: More Than Body Requirements related to excessive intake and sedentary lifestyle. 4. Fatigue related to malnutrition.

Answer 64

3. Imbalanced Nutrition: More Than Body Requirements related to excess intake and sedentary lifestyle.

Question 65

How does acupuncture aid an obese patient?

Answer 65

It enhances weight loss and improves dyslipidemia

Question 66

How does hypnosis aid an obese patient?

Answer 66

This works for stress reduction and energy intake reduction.

Question 67

What is the draw back to lifestyle modifications?

Answer 67

Many patients don't adhere to them.

Question 68

How does the fat inhibitor Orlistat (Xenical) work?

Answer 68

It reduces caloric intake by binding to gastric and pancreatic lipase to prevent digestion of fats.

Question 69

What are the side effects of fat inhibitors like Orilstat (Xenical)? *hint- there are five

Answer 69

- Frequent bowel movements - Gas with oily discharge - reduced food absorption - Reduced bile flow - Reduced absorption of vitamins

Question 70

How do appetite suppressants like Phentermine work?

Answer 70

They stimulate serotonin in satiety and appetite centers of hypothalamus effectively curbing the appetite.

Question 71

What are the side effects of appetite suppressants like Phentermine? *hint- there are 4

Answer 71

- headaches - dry mouth - fatigue - nausea

Question 72

What is the percentage of patients that rebound with weight gain after bariatric surgeries?

Answer 72

35%

Question 73

True or False: | A patient with a BMI greater than or equal to 40 without excess surgical risk qualifies for a bariatric surgery.

Answer 73

True

Question 74

True or False: | A patient with a BMI of 30 or greater automatically qualifies for bariatric surgery?

Answer 74

False. | A patient with a BMI of 30 or greater needs to have one or more obesity-associated comorbidity to qualify.

Question 75

Aside from BMI what are the two other qualification a patient has to meet before they will do a bariatric surgery?

Answer 75

- Failure of previous nonsurgical attempts at weight loss. | - Adherence to post operative care.