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42 terms

Medsurge CH 22 slides

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Obesity-Related Problems Cardiovascular
atherosclerosis, heart failure, hypertension, stroke
Obesity-Related Problems Respiratory
sleep disorders, sleep apnea
Obesity-Related Problems Gastrointestinal
gallbladder disease, hiatal hernia, colon cancer
Obesity-Related Problems Genitourinary
cancer of breast, uterus, prostate, and colon; stress incontinence
Obesity-Related Problems Musculoskeletal
low back pain, osteoarthritis
Obesity-Related Problems Endocrine
diabetes mellitus
Obesity-Related Problems Reproductive
PCOS
Increasing obesity in U.S.
Adult population
Children
Young adults
BMI
Overweight
25-29.9 kg/m2
Obesity
30 kg/m2 or greater
Obesity 1
Caused by excess calories stored as fat
Obesity 2
May also be due to leptin resistance
Obesity 3
Significant risk factor for cardiovascular diseases
Obesity 4
Upper body obesity or central obesity have more abdominal fat and higher free fatty acids circulating; greater risk of hypertension, heart disease, stroke, diabetes
Obesity 5
Diagosis with body mass index- 25-29 overweight; greater than 30 obesity; thyroid profile, serum glucose and cholesterol; lipid profile, ECG
Medications (appetite suppressants)
used in combination with diet and exericse
A combination of diet, exercise, behavior modification
critical component of weight loss
Successful treatment is rarely achieved
treatment focuses on reducing the health risks by changing eating habits and exercise; to lose 1 pound must reduce diet by 500 kcal for 7 days or increase activity to burn the equivalent
Surgery
restrictive procedures include banding which is safer and reversible (band placed around portion of the stomach; malabsorptive/restrictive surgeries include gastric bypass where food bypasses the stomach and goes into pouch created - absorption is limited and procedure is not reversible
Obese Client
Establish realistic weight goals
Identify factors that cause increased food intake
Behavior modification
Exercise
Starvation
inadequate dietary intake; after glucose for energy, protein and fats then used
Hypermetabolism
cell and tissue breakdown
Protein-calorie malnutrition-
both protein and calories are deficient (marasmus); kwashiorkor is when there are adequate calories but not enough protein
Abdominal edema or peripheral edema-
low serum albumin
Diarrhea
low serum albumin; may be below 3 in PCM
Postural hypotension impaired immune function-
cardiac output falls
Malnutrition Possible causes
Inadequate nutrient intake
Impaired absorption and use of nutrients
Loss of nutrients due to diarrhea, hemorrhage, or renal failure
Increased metabolic needs
Malnutrition
1
Higher risk for infection
Malnutrition
2
Affects many components of the immune system
Medication
supplemental vitamins/minerals
Gradual refeeding-
fluids and electrolytes repaired first; initial feedings are limited amounts of liquid to prevent diarrhea; gradual refeeding to prevent electrolyte imabalances
Nutritional supplements-
Ensure, Sustacal; 2 ounces with each medication given may be sufficient to increase calorie and protein intake
Enteral nutrition-
tube feeding in those unable to consume food; tube placement by checking the pH of aspirate; ph less than 4 indicates proper placement; greater than 6 in the jejunum; 1500 ml per day provides recommended daily intake of all vitamins and minerals
TPN hyperalimentatin is IV administration of carbs, protein, electrolytes, vitamins, minerals, and fat emulsions; administered through central line such as subclavian vein
mixed sterile by pharmacy; fluid overload risk in older adults; high glucose formulas can cause hyperglycemia- check glucose every 6 hours; long term use can lead to gallstone formation and liver disease; sterile technique for site and catheter care
Patient with Malnutrition
At great risk for other problems
Should be closely monitored
Have rest periods before and after meals
Hospitalized patient requires an interdisciplinary approach
Anorexia nervosa-
usually begins during adolescence; distorted body image and irrational fear of gaining weight; restricted calorie intake
Bulimia nervosa-
late adolescence or early adulthood; binge eating followed by purging; usually high calorie, high fat, and sweet foods; weight is often normal
Binge-eating disorder-
do not purge; binge eat only; eat even when not hungry and usually occurs when person is alone
Eating Disorders Anorexia nervosa
distorted body image and irrational fear of gaining weight. extreme weight loss
Eating Disorders Bulimia nervosa
following failed attempts to lose weight through dieting. weight stays the same
Eating Disorders Binge-eating disorder
similar to bulimia but without purging
Eating Disorders
Difficult to effectively treat
Community-based care is appropriate for most clients
Hospitalization for some clients may be necessary
A comprehensive treatment plan for eating disorders includes medical care and monitoring, psychosocial interventions, and nutrition counseling
Client with Eating Disorder
Anorexia nervosa, bulimia nervosa, binge eating disorder
Require hospitalization if weight is less than 75% normal; antidepressants my benefit with bulemia such as prozac to prevent relapse
Monitor weight
Observe client during and after meals to prevent disposal of meals; frequent small feedings
Multivitamin or supplements to replace losses