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Chapter 41

What is obesity? abnormal increase in proportion of fat cells.
What is a BMI and how is it calculated? Patient is classified as underweight, health (normal), overweight, or obese. Calculated using weight-to-height ratios. Underweight BMI
Normal weight BMI 18.5 – 24.9 kg/m2
Overweight BMI 25 to >30 kg/m2
Morbidly Obese BMI greater than 40 kg/m2
What is waist to hip circumference? Waist to hip circumference describes the distribution of both subcutaneous and visceral adipose tissue. Waist measurement divided by hip measurement. >0.8 increased health risk
Health risks for Gynoid Obesity (Pear Shape) Osteoporosis – Varicose Veins - Cellulite - Subcutaneous fat traps and stores dietary fat - Trappy fatty acids are stored as triglycerides
Health risks for Android Obesity (Apple Shape-Stomach) -Heart disease–diabetes mellitus-breast cancer–Endometrial cancer - Visceral fat is more active causing > decrease insulin secretion > increased triglycerides >decreased HDL cholesterol > Increased BP > increased free fatty acid release into blood
Genetics and Obesity FTO gene found, and strong link between FTO variant and BMI. Strength of genetic depends whether an individual has inherited one or two copies of the FTO gene variant
Environment and obesity -Greater access to foods, particularly prepackaged and fast foods, soft drinks, poor nutritional quality. Increased portion size. – lack of physical exercise – socioeconomic status
Obesity as negative influence on: Psychologic -Depression – Low self esteem – Risk of suicide – Discrimination
Obesity as negative influence on: Metabolic Type 2 diabetes mellitus – Metabolic syndrome – polycystic ovary disease
Obesity as negative influence on: Respiratory - Obesity hypoventilation syndrome – Sleep apnea – Asthma – Pulmonary hypertension
Obesity as negative influence on: Reproductive (women) - Menstrual irregularities – infertility – Gestational diabetes – Overdue births, induced labors, and longer labors
Obesity as negative influence on: Reproductive (men) -Hypogonadism – gynecomastia
Obesity as negative influence on: Musculoskeletal -Osteoarthritis – impaired mobility and flexibility – Gout – Lumbar disk disease – Chronic low back pain
Obesity as negative influence on: Cardiovascular - Hyperlipidemia – sudden cardiac death – right sided heart failure – left ventricular hypertrophy – Coronary artery disease – Deep venous thrombosis – atrial fibrillation – hypertension – Cardiomyopathy – venous stasis
Obesity as negative influence on: Liver/Gallbladder -Nonalcoholic steatohepatitis (NASH) – Gallstones
Obesity as negative influence on: Genitourinary - End-stage renal disease (ESRD) secondary to diabetes and hypertensions – Stress incontinence
Obesity as negative influence on: Cancer - Endometrial, breast, cervical, ovarian, uterine, gallbladder cancer in women – Colorectal cancer in both genders – Prostate cancer in men
What is the nurse's role in relation to assisting patient's in losing weight? Nutritional therapy, exercise, behavior modification, supports groups, drug therapy
How often should patients exercise? Daily- 30 minutes to an hour
What role does motivation play in weight loss? Essential ingredient for successful achievement. - Lack of motivation is huge barrier to change.
What are the two main classes of weight loss medications currently in use today? (1) those that decrease food intake by reducing appetite or increasing satiety or (2) those that decrease nutrient absorption
Appetite suppressing drugs (actions & potential side effects?) -reduce food intake through noradrenergic (Drugs that mimic norepinephrine) or serotonergic mechanisms in the central nervous system. – Palpitations, tachycardia, overstimulation, restlessness, dizziness, insomnia, weakness, fatigue
Nutrient absorption-blocking drugs (action and potential side effects?) -works by blocking fat breakdown and absorption in the intestine, Inhibits the action of intestinal lipases. Undigested fat is excreted in the feces. – Leakage of stool, flatulence, diarrhea, abdominal cramping
Restrictive procedure reduces the size of the stomach, which cause the patient to feel full quicker. Stomach and intestine digest and absorb food normally. Include Vertical Banded Gastroplasty, Adjustable Gastric Banding, & Vertical Sleeve Gastrectomy
Vertical Banded Gastroplasty partitioning the stomach into a small ouch in the upper portion along the lesser curvature of the stomach. – limits capacity
Adjustable Gastric Banding stomach size is limited by an inflatable bad placed around the fundus of the stomach.
Vertical Sleeve Gastrectomy 85% of the stomach is removed leaving a sleeve shaped stomach
Malabsorptive procedures Surgeon will bypass various lengths of the small intestine so that less food is absorbed. Includes Biliopancreatic Diversion & Biliopancreatic Diversion with Duodenal Switch
Biliopancreatic Diversion removing approx. ¾ of the stomach to produce both restriction of food intake & reduction of acid output. Remaining portion stomach is connected to lower portion of small intestine. Most calories & nutrients are routedinto colon where they'r not absorbed.
Billiopancreatic Diversion with Duodenal Switch duodenal switch where surgeons leave a larger portion of the stomach intact and small part of the duodenum. Keeps pyloric valve preventing dumping syndrome.
Describe important pre-operative interventions Interview to obtain past and present patient health information. – Ensure patient understands procedure
Created by: ygwallace