Altered Nutrition & Obesity

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foxyt14
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204100
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Altered Nutrition & Obesity
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2013-03-05 00:31:56
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Altered Nutrition and Obesity
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  1. Nutrition Assessment looks at:
    • ABCD
    • Anthropometric
    • biochemical
    • Clinical
    • Dietary data
  2. anthropometric
    measurement of height and weight
  3. biochemical data?
    albumin-tells us about protein status of pt.
  4. clinical data in the nutrition assessment
    signs and symptoms of malnutrition observed in the client
  5. Dietary data in the nutrition assessment
    Asking pt. do you avoid any particular foods? do you watch what you eat in any way?

    Rather than asking if they are on a diet
  6. Nursing dianosis of patient
    • made after assessment data is interpreted....
    • Imbalanced nutrition
    • Risk for imbalanced nutrition
    • Adult failure to thrive
    • Deficient knowledge of nutrition or food..

    NANDAS
  7. Planning outcomes for patient...
    PT. must be a part of this and bite to the plan.  If they arent it wont work....

    Short term goals are good and tailor it around what works for them.  Small meals, 3 meals, skip desserts, leave 1/3 of food on plate....whatever works for them
  8. Nursing interventions
    nutrition therapy- rather than "diet", use terms like eating pattern, food intake, eating style

    client teaching-spend time with a dietician or nutritionist
  9. Monitoring and Evaluation of nursing process for nutrition
    Monitoring is before evaluation and helps you to stay on top of progress or difficulties the client is experiencing

    Evaluating is seeing if interventions have worked
  10. 9 Recommendations to Americans for diet
    • Consume adequate nutrients based on calorie and needs
    • Weight Management
    • Physical Activity
    • Encourage a variety of foods
    • Limit fats
    • Choose carbs wisely
    • Watch sodium and K
    • Watch alcohol consumption
    • Practice food safety
  11. What's meant by DASH
    Dietary Approaches to Stop Hypertension

    • Diet rich in
    • Potassium, calcium, magnesium, fiber and protein
    • with reduced sodium intake
  12. Amount of exercise needed to prevent gradual weight gain?
    60 min a day min of cardio, weight and flexibility
  13. What is meant by encouraging a variety of foods?
    • 2 c of fruit
    • 2.5 c of veggies....dark green
    • 3 + oz of whole grains
    • 3 c of fat free milk
  14. What do you want to limit fats to?
    Cholesterol/Trans fats?
    Total fat intake of total daily calories?
    Less than 10% of calories from saturated fats

    <300 mg/day in cholesterol, trans fats

    TOTAL fat intake btwn 20-35% of total daily calories
  15. Where should most of our fat intake come from
    • Polyunsaturated and monounsaturated fatty acids
    • Nuts, fish and veggie oils
  16. What kind of carbs should I pick?
    fiber rich fruits, vegetables and whole grains

    NOT much high sugar or starch containing products
  17. How much sodium per day?  Where do I find potassium in my diet?
    Sodium less than 2300 mg (1 tsp) daily

    Potassium-eat lots of fruits and veggies
  18. Alcohol??
    Men 2 drinks a day and women 1
  19. obesity definition
    an imbalance between energy expenditure and energy intake from a long term sedentary lifestyle and/or excessive calorie intake
  20. overweight definition
    an increase in body weight for height of approximately 50% and may not always reflect a problem if it is due to muscle mass
  21. What's the new my pyramid?  and it's purpose?
    • -Looking at what changes in our society have lead to this obesity epedimic (sit behind desk, convenience cuz 2 income family, pace of life)
    • -Looking at what healthcare providers can do to combat this issue(education, PSA)
    • -Looking at patients individually and consider what issues must be considered with the patient (NPO, disease, labs, pre hospital nutrition,
  22. What is a diagnostic test for malnutrition?
    • plasma protein levels
    • albumin
    • transferrin total iron binding capacity
    • Hgb
  23. Obesities-
    Mild to moderate
    Severe
    Massive or morbidly obest
    Mild-20-30% over ideal body weight or a BMI >30

    Severe-40-100% over ideal body weight or a BMI> 35

    Massive-greater than 100% over ideal body weight or a BMI >40
  24. How do you figure out BMI?

    Healthy parameters?
    weight in lbs/height in inches x 703

    Healthy is 18.5-24.9
  25. How do you calcuate Ideal body weight?
    It's in %

    Current weight/IBW X 100

    • To figure out IBW...
    • Allow 100 lbs for first 5 ft then add 5lbs for each additional inch.

    Men-allow 106 lbs for first 5 ft, and add 6 lbs for each additional inch.

    Then plug in to above equation
  26. Significance of waist circumfrance and risk status....parameters for men and women

    Waiste hip ratio too?
    When you have abdominal fat out of proportion to total body fat....this is a predictor of disease morbidity

    • Women >35 in
    • Men>40 in

    WHR of >0.8 places the person at risk for health problems
  27. Visceral fat vs. subcutaneous fat
    Visceral is fat in the abdomen which makes you look like an apple

    Subcutaneous fat is in the hips and abdomen and makes you look like a pair, but is better to have than visceral
  28. What are the health risks of obesity?
    • Hypertension
    • cardiac disease
    • PVD
    • sleep apnea
    • chronic back pain
    • DJD
    • certain cancers
  29. What's primary obesity?
    results from the intake of calories in amounts exceeding metabolic needs.  This excess is stored as fat in subcutaneous and viscera layers of the body
  30. In persons of normal weight, fat is deposited by....
    hypertrophy, enlargement of existing fat cells in adipose tissues
  31. When is hyperplasia of fat cells normal?
    In teens when they are growing....if have this at any other time it will condition you to be overweight throughout life
  32. Most important factor required for successful weight loss?
    Patient buying in to plan
  33. How is cholesterol formed?
    by the release of triglycerides
  34. What forms gallstones?
    cholesterol and bile salts
  35. How do you get "secondary obesity"?
    • from congenital anomalies
    • chromosomal abnormalities
    • metabolic problems
    • CNS disorders
  36. Explain genetic predisposition for obesity
    most often causes are polygenetic....related to interaction of both biologic and environmental factors
  37. What part of the brain is responsible for regulation of appetite and satiety?
    hypothalamus
  38. What hormonal problems can cause weight gain?
    • hypothyroid
    • polycistic ovaries
    • cushings
  39. What meds cause weight gain?
    • corticosteroids
    • estrogens
    • NSAIDS
    • anti hypertensives
    • antidepressants-retains fluids
    • insulin-increase appetite
  40. NANDA/Nursing Diagnosis
    Imbalanced Nutrition more than body requirements R/T inappropriate eating patterns, lack of exercise, stress AEB weight at 200% of desirable weight for heigh and body build
  41. Short term goals
    • modify eating patterns
    • begin and continue a regular exercise program
  42. Long term goals
    • achieve desired weight loss to a healthy level
    • maintain weight loss at a healthy level
    • prevent or minimize health problems R/T obesity
  43. Goal of weight loss
    lost 1-2 lbs of adipose tissue per week

    requires a calorie deficit of 500-1000 calories per day to do this cuz  1 lbs of fat =3500 calories
  44. When eating to lose weight what should your calorice intake be mainly made of?
    complex carbs and proteins
  45. Fasting diets?
    require close medical supervision cuz need use high protein liquids....

    So must watch K!!!
  46. Very low calorie diets?
    200-800 calories a day....must be under medical supervision and can only be for short periods of time
  47. Best eating plan for weight loss
    • complex carbs
    • fiber
    • proteins
    • unsaturated fats

    • women-1200 calories/day
    • mens-1500 calories/day

    Total fat 30% or less or total calories

    Count calories NOT FAT!!
  48. Sources of trans fats foods
    • Fried foods
    • Ramen Noodles
    • Cup of Soups
    • Cake mixes
    • Bisquick
    • Margarine/butter
  49. How much water a day to lose weight?
    3-4 glasses 4 x's a day within a 1/2 period and drink water before and with meals
  50. Quick bites under 100 calories
    Dudek list...
  51. Exercise parameters:
    • 30 min a day most days
    • BUT
    • 60 min to prevent weight gain
    • 60-90 min to sustain weight loss
  52. What's the best, safest and easiest form of exercise for all
    brisk walking
  53. Sibutramine (Meridia)
    • Appetite suppressant
    • increases metabolic rate

    Side effect increase in BP, HR, insomnia and constipation
  54. Orlistat (Xenecal)
    blocks 1/3 of fat absorption

    Side effect:  abdominal cramps, loos stools, anal leakage, decrease in absorption of fat soluble vitamins
  55. Who can have bariatric surgery?
    • Been obese for over 5 years 
    • MORBIDLY OBESE
    • BMI of >35
    • NO endocrine problems
    • Psychiatric and social stability
  56. Gastric Banding or Partitioning is what kind of procedure?
    Restrictive-stomach stapling or vertical banded gastroplasty
  57. How does gastric banding work?
    stomach is partitioned and stomach volume is reduced by placement of sutures horizontally or vertically creating a small pouch.

    Limits intake by increaseing feeling of fullness
  58. Details of gastric banding
    • 15-30mLs or less
    • No fluids with meals
    • Typical gastric volume afterwards is 2-6 oz
  59. Malabsorptive Bariatric Surgery
    facilitates weight loss through a reduction in calorie absorption, usually in conjunction with a restrictive procedure

    Gastric Bypass
  60. Gastric Bypass (RNY)
    Stomach is stapled completely horizontally with a small opening for food to sit in.

    jejunum is resected from the duodenum and connected to the stomach entrance and the distal duodenal stump is connected to the jejunum
  61. How does Gastric Bypass work?
    food passes from the stomach pouch directly to the jejunum BYPASSING most of the stomach and duodenum.

    Advantage is higher weight loss and more successful keeping weight off than Gastric banding
  62. Complications of Gastric Banding and Gastric Bypass
    • Uncontrolled vomitting and pain if too much intake
    • leaks from gut to abdomonal cavity...causing peritinitis
    • GERD and heartburn
    • Nutritional deficits
    • Anemia
  63. What's dumping syndrome?
    Only with Gastric Bypass or RNY

    occurs a few weeks after surgery

    When during a meal or 5-30 min after the meal person becomes weak, syncope, pallor, vertigo, palpitations, diaphoresis, tachy
  64. What causes dumping syndrome?
    cuz food enters directly in to the jejunum without undergoing usual changes and dilution in the stomach.

    CHYME is HYPEROSMOLAR
  65. What's weakness of dumping syndrome caused by?
    Increase in BP and immediate decrease in BP
  66. 2-3 hours after eating another part of dumping syndrome is....
    pt. feels full, discomfort, distention, diarrhea, abdominal cramping, nausea, hyperactive bowel sounds

    Caused by intense gastrocolic reflex and excessive amounts of insulin
  67. Collaberative Interventions post gastric surgery
    • Besides usual post op care
    • HOB 30-45
    • Medicate for pain...very painful procedure
    • N/G tube on low continuous suction (LCS)
    • Avoid blockage by eating slow and chewing well
    • Watch for perforation of stomach staples
  68. Diet after gastric surgery
    • Day 1-4 clear liquid
    • Day 5 Pureed
    • Then blenderized for 8 weeks, introducing soft bland foods

    NO MORE THAN 1oz of total food and fluids at first

    Take vitamin and mineral supplements
  69. Gastri Bypass/RNY post care
    high protein shakes
  70. Classic sign of perforate stomach staples
    • upper abdominal pain
    • should and back as well
  71. Home diet after gastric surgery
    • high protein for healing
    • low carb to prevent dumping
    • low roughage cuz cant digest
    • low fat for gas
    • 6 small meals

    FLUID between meals, not with meals so dont stretch the pouch
  72. How much do you lose with gastric surgery?
    60-70% of excess weight....quickly gone!!
  73. Complications of bariatric surgery
    • INFECTION
    • anemia
    • vitamin deficienty
    • diarrhea
    • psychiatric problems
  74. How does fat heal, and what's the consequence?
    Hard to heal fat....so it is common for dehisence.  Need to get pt. lots of proteins and make sure they dont stretch the abdomen
  75. Panniculus
    seen after gastric surgery and is a dense layer of fatty tissue growth consisting of subcutaneous skin-"apron of fat" that hangs down/over

    Found in lower abdominal area
  76. Key for successful gastric surgery?
    • psychiatric evaluation
    • counseling
    • lifestyle modifications

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