Chapter 41
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| What is obesity? | abnormal increase in proportion of fat cells.
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| 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
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| Normal weight BMI | 18.5 – 24.9 kg/m2
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| Overweight BMI | 25 to >30 kg/m2
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| Morbidly Obese BMI | greater than 40 kg/m2
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| 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
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| 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
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| 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
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| 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
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| 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
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| Obesity as negative influence on: Psychologic | -Depression – Low self esteem – Risk of suicide – Discrimination
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| Obesity as negative influence on: Metabolic | Type 2 diabetes mellitus – Metabolic syndrome – polycystic ovary disease
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| Obesity as negative influence on: Respiratory | - Obesity hypoventilation syndrome – Sleep apnea – Asthma – Pulmonary hypertension
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| Obesity as negative influence on: Reproductive (women) | - Menstrual irregularities – infertility – Gestational diabetes – Overdue births, induced labors, and longer labors
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| Obesity as negative influence on: Reproductive (men) | -Hypogonadism – gynecomastia
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| Obesity as negative influence on: Musculoskeletal | -Osteoarthritis – impaired mobility and flexibility – Gout – Lumbar disk disease – Chronic low back pain
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| 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
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| Obesity as negative influence on: Liver/Gallbladder | -Nonalcoholic steatohepatitis (NASH) – Gallstones
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| Obesity as negative influence on: Genitourinary | - End-stage renal disease (ESRD) secondary to diabetes and hypertensions – Stress incontinence
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| Obesity as negative influence on: Cancer | - Endometrial, breast, cervical, ovarian, uterine, gallbladder cancer in women – Colorectal cancer in both genders – Prostate cancer in men
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| What is the nurse's role in relation to assisting patient's in losing weight? | Nutritional therapy, exercise, behavior modification, supports groups, drug therapy
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| How often should patients exercise? | Daily- 30 minutes to an hour
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| What role does motivation play in weight loss? | Essential ingredient for successful achievement. - Lack of motivation is huge barrier to change.
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| 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
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| 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
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| 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
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| 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
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| Vertical Banded Gastroplasty | partitioning the stomach into a small ouch in the upper portion along the lesser curvature of the stomach. – limits capacity
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| Adjustable Gastric Banding | stomach size is limited by an inflatable bad placed around the fundus of the stomach.
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| Vertical Sleeve Gastrectomy | 85% of the stomach is removed leaving a sleeve shaped stomach
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| 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
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| 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.
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| 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.
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| Describe important pre-operative interventions | Interview to obtain past and present patient health information. – Ensure patient understands procedure
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