Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Care of Patients with Malnutrition and Obesity

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Increased number of women are overweight, especially black and Hispanic women  Lower-income men and women are more likely to be overweight  Increasing number of American children are overweight

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  BMI   calculator/NU calculator/NU00597  There are many areas that will calculate this for you!

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. With obesity comes an increased risk of developing chronic diseases – Type 2 diabetes – Gallbladder disease – Heart disease – Increased blood pressure – Some cancers – Sleep apnea – Respiratory problem – Hernia Reduces life expectancy by 3 to 7 years in persons with a body mass index (BMI) over 30 Increases medical costs (from the CDC) AAG/obesity.htm Obesity

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Drugs and Chemicals That Produce Weight Gain Many drugs can cause weight gain, but few cause obesity – The drugs that can cause obesity also heighten risk of type 2 diabetes – What types of drugs can cause problems? – full Cessation of smoking has been shown to cause weight gain because of nicotine withdrawal – 1 to 2 kg in first few weeks – 2 to 3 kg in 4 to 6 months

VirusToxins  Adenoviruses (AD-36) have been found in some obese humans in large amounts ◦ This has been replicated in nonhuman primates, which display mild obesity and low circulating cholesterol concentrations  Food additives ◦ Used as preservatives and sometimes flavors  Chlorinated chemicals  Monosodium glutamate

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Children often resemble parents: if parents are overweight, children are more likely to be overweight.  Leptin-deficient obese patients treated with leptin decreased their food intake; fat was mobilized until body weight was normal  Other genes are being identified, such as melanocortin-4

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Genetics  Certain medications  Very difficult to actually be in energy balance (energy balance is an ideal, but not a realistic goal )  Self esteem  Body image  Depression

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Dietary Guidelines for Americans  USDA MyPlate  Cultural awareness  Geriatric considerations

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Only four short-term and two long-term medications have been approved by the Food and Drug Administration (FDA) for weight loss – Most thought to modify neurotransmitters in the central nervous system – To be eligible, a person must have a BMI greater than 30 or have diabetes, heart disease, high blood pressure or other problems that could benefit from weight loss New drugs on their way to approval

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Genes have not changed in people in the last 20 years, but the environment has ◦ Cognitive approaches to weight loss may not resolve  Three preventive strategies: ◦ 1. Education ◦ 2. Regulation ◦ 3. Modification of the food supply

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

 Malnourished  Well-nourished  Obese  Physical presentation  Laboratory studies  Influences for nutritional status ◦ Age ◦ Culture ◦ Socioeconomic status

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Assessment of BMI  Teaching plans  Education of adolescents  Treatment ◦ Nonmedical approaches ◦ Drug therapy ◦ Surgical management Obesity

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  hoosing.htm hoosing.htm  What I found on this website is great!  Class activity  what if I my patient wants to know about a plan such as Adkins or Nutri-System.  My patient wants to know how to plan a diet for a diabetic!  What about Cardiovascular disease.  What about weigh loss and medications. Great websites from NIH

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  My patient is a diabetic with heart disease or a risk for.  My patient ask me if I loose weight does that mean I will not have heart disease any more or the risk of heart disease!  Let see what the NIH has to say!  ddk-19.htm

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Gastric restriction

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Malabsorption surgery  Gastric bypass

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Abdominal binder  Position  SaO 2 monitoring  Sequential compression hose and/or heparin  Skin assessment  Absorbent padding  Removal of urinary catheter within 24 hours

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.  Assist patient out of bed  Ambulate as soon as possible  Monitor abdominal girth  6 small feedings, prevent dehydration  Observe for signs of dumping syndrome

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Black, J. & Hawks, M. Medical Surgical Nursing Clinical Management for Positive Outcomes. St Louis: Saunders- Elsevier. Taylor, C, Lillis, C., LeMone, P., Lynn, P. Fundamentals of Nursing. The Art and Science of Nursing Care. Philadelphia: Lippincott Williams & Wilkins