Altered Nutrition & Obesity
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Nutrition Assessment looks at:
- Dietary data
measurement of height and weight
albumin-tells us about protein status of pt.
clinical data in the nutrition assessment
signs and symptoms of malnutrition observed in the client
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
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..
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
nutrition therapy- rather than "diet", use terms like eating pattern, food intake, eating style
client teaching-spend time with a dietician or nutritionist
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
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
What's meant by DASH
Dietary Approaches to Stop Hypertension
- Diet rich in
- Potassium, calcium, magnesium, fiber and protein
- with reduced sodium intake
Amount of exercise needed to prevent gradual weight gain?
60 min a day min of cardio, weight and flexibility
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
What do you want to limit fats to?
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
Where should most of our fat intake come from
- Polyunsaturated and monounsaturated fatty acids
- Nuts, fish and veggie oils
What kind of carbs should I pick?
fiber rich fruits, vegetables and whole grains
NOT much high sugar or starch containing products
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
Men 2 drinks a day and women 1
an imbalance between energy expenditure and energy intake from a long term sedentary lifestyle and/or excessive calorie intake
an increase in body weight for height of approximately 50% and may not always reflect a problem if it is due to muscle mass
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,
What is a diagnostic test for malnutrition?
- plasma protein levels
- transferrin total iron binding capacity
Mild to moderate
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
How do you figure out BMI?
weight in lbs/height in inches x 703
Healthy is 18.5-24.9
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
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
WHR of >0.8 places the person at risk for health problems
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
What are the health risks of obesity?
- cardiac disease
- sleep apnea
- chronic back pain
- certain cancers
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
In persons of normal weight, fat is deposited by....
hypertrophy, enlargement of existing fat cells in adipose tissues
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
Most important factor required for successful weight loss?
Patient buying in to plan
How is cholesterol formed?
by the release of triglycerides
What forms gallstones?
cholesterol and bile salts
How do you get "secondary obesity"?
- from congenital anomalies
- chromosomal abnormalities
- metabolic problems
- CNS disorders
Explain genetic predisposition for obesity
most often causes are polygenetic....related to interaction of both biologic and environmental factors
What part of the brain is responsible for regulation of appetite and satiety?
What hormonal problems can cause weight gain?
- polycistic ovaries
What meds cause weight gain?
- anti hypertensives
- antidepressants-retains fluids
- insulin-increase appetite
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
Short term goals
- modify eating patterns
- begin and continue a regular exercise program
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
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
When eating to lose weight what should your calorice intake be mainly made of?
complex carbs and proteins
require close medical supervision cuz need use high protein liquids....
So must watch K!!!
Very low calorie diets?
200-800 calories a day....must be under medical supervision and can only be for short periods of time
Best eating plan for weight loss
- complex carbs
- unsaturated fats
- women-1200 calories/day
- mens-1500 calories/day
Total fat 30% or less or total calories
Count calories NOT FAT!!
Sources of trans fats foods
- Fried foods
- Ramen Noodles
- Cup of Soups
- Cake mixes
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
Quick bites under 100 calories
- 30 min a day most days
- 60 min to prevent weight gain
- 60-90 min to sustain weight loss
What's the best, safest and easiest form of exercise for all
- Appetite suppressant
- increases metabolic rate
Side effect increase in BP, HR, insomnia and constipation
blocks 1/3 of fat absorption
Side effect: abdominal cramps, loos stools, anal leakage, decrease in absorption of fat soluble vitamins
Who can have bariatric surgery?
- Been obese for over 5 years
- MORBIDLY OBESE
- BMI of >35
- NO endocrine problems
- Psychiatric and social stability
Gastric Banding or Partitioning is what kind of procedure?
Restrictive-stomach stapling or vertical banded gastroplasty
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
Details of gastric banding
- 15-30mLs or less
- No fluids with meals
- Typical gastric volume afterwards is 2-6 oz
Malabsorptive Bariatric Surgery
facilitates weight loss through a reduction in calorie absorption, usually in conjunction with a restrictive procedure
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
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
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
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
What causes dumping syndrome?
cuz food enters directly in to the jejunum without undergoing usual changes and dilution in the stomach.
CHYME is HYPEROSMOLAR
What's weakness of dumping syndrome caused by?
Increase in BP and immediate decrease in BP
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
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
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
Gastri Bypass/RNY post care
high protein shakes
Classic sign of perforate stomach staples
- upper abdominal pain
- should and back as well
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
How much do you lose with gastric surgery?
60-70% of excess weight....quickly gone!!
Complications of bariatric surgery
- vitamin deficienty
- psychiatric problems
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
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
Key for successful gastric surgery?
- psychiatric evaluation
- lifestyle modifications
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