Post on 31-Dec-2015
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Today’s Objectives…
Explain the potential consequences and complications associated with malnutrition.
Analyze assessment data to determine common nursing diagnoses for the client with malnutrition.
Explain the potential consequences, contributing factors and complications associated with obesity.
Contrast non-surgical vs. surgical management of obesity.
Describe post-op complications of bariatric surgery and lifelong dietary modifications required.
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Nutritional Standards Dietary recommendations
1800 calories/day…0.8 gm protein per kg Risk of malnutrition if <70%
Nutritional assessment includes: Diet history Exam and health history
GI disease/malabsorptionCOPD
Measurement of height and weightAssessment of body mass index-BMI
– Weight (lbs)/height (inches) x703=– 190/72 x703=26.6 BMI– Ideal 20-25
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Malnutrition in Acute Care
Who is at risk?PovertyDrug & ETOH abuseN/V/D
Lab Values Complications
Poor wound healing Increased risk of infectionLethargy
Activity intolerance
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Nursing Considerations: Malnourished
Low protein stores loss of muscle and lean body mass decreased drug binding increase in levels of free circulating drugs
increasing drug toxicity
Drugs given subcutaneous or IM closely monitored adipose tissue has decreased blood supply
delayed action and unpredictable duration IM can inadvertently be given subcutaneous
Cutaneous patches may deliver drugs with erratic action
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Imbalanced Nutrition: Less Than Body Requirements
Enteral Feedings Types
Nursing Considerations Confirm placement Check residuals Change bag qd 4 hours of formula at time Monitor labs
Lytes, albumin, hgb
Complications Aspiration Diarrhea
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Imbalanced Nutrition: Less Than Body Requirements
IV Total Parenteral Nutrition (TPN) Central access Lipids Protein-dextrose-vitamins
Nursing Considerations Monitor daily wt./ I&O Carefully check contents
Complications Fluid imbalance Lyte imbalances
Check labs Liver function
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Obesity
USA Obesity Rates Reach Epidemic Proportions
Data (2003) suggests 6% of population is obese
Eight out of 10 over 25's Overweight
78% of American's not meeting basic activity level recommendations
25% completely Sedentary 76% increase in Type II
diabetes in adults 30-40 yrs old since 1990
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Obesity related diseases
80% of type II diabetes related to obesity
70% of Cardiovascular disease related to obesity
42% breast and colon cancer diagnosed among obese individuals
30% of gall bladder surgery related to obesity
26% of obese people having high blood pressure
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Childhood Obesity
17% children overweight Between 8% - 45% of newly
diagnosed cases of childhood diabetes are type II, associated with obesity. 4% of Childhood diabetes
was type II in 1990 Now 20%
Of Children diagnosed with Type II diabetes, 85% are obese 25% of all white children
overweight 2001 33% African American and
Hispanic children overweight 2001
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Complications of Obesity
Diabetes mellitus Hypertension Hyperlipidemia CAD Obstructive sleep apnea Obesity hypoventilation syndrome Depression and other mental
health/behavioral health problems
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Contributing Factors to Obesity
Diet Physical inactivity Drugs
CorticosteroidsEstrogensNSAIDSAntihypertensivesAntidepressants and psychoactive drugs
Genetics
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Weight Loss Strategies/Education
Goal reduce body weight by 10% of baseline within 6 months loss of 1 to 2 lbs/week Decrease caloric intake 300-500 day
Eat slowly so that the brain gets the message that the stomach is full
Take seconds of vegetables and salads instead of higher calorie foods
Try to eat 3 balanced meals
at regular times Record all food eaten
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Nursing Considerations: Obesity
Skin care high risk for breakdown and delayed wound healing Folds become moist and harbor yeast and bacteria Use of powders discouraged
daily inspection, frequent turning, watch for shearing
Risk for DVT Early mobility
Inability to obtain definitive diagnosis with scans and radiological tests
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Nonsurgical Management of Obesity
Fasting Novelty diets
Atkins
Diet therapy Weight watchers etc.
Exercise program Behavior modification
Food diary Emotional/situational influences
Drug therapy Xenical
Inhibits lipase…fats are partially digested
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Bariatric Surgery
BMI 40 or higher or 35 – 39.9 with related
health problem
Must agree to strict lifestyle/diet regimen
Post op care priorities
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Complications: Bariatric Surgery
DVT-PE Narrowing of the opening between the stomach and small
intestine – strictures can form Gallstones Bleeding ulcers
1 in 100 may develop Altered digestion, long-term nutritional deficiencies
Dumping syndrome tachycardia, nausea, diarrhea, abdominal cramping
Infections