Care of Patients with Malnutrition and Obesity Chapter 63 Care of Patients with Malnutrition and Obesity

Question? “Patients who report their own measurements tend to overestimate height and underestimate weight.” What does this quote mean to a nurse in a health care provider’s office?

Student Question: Why Is Proper Nutrition So Important? Carbohydrates, protein, and fats are nutrients that supply the body with energy Food energy is used to maintain body temperature, respirations, cardiac output, muscle function, protein synthesis, and the storage and metabolism of food sources Imbalances in food intake and energy can create weight gain or weight loss Body proteins are used for energy when calorie intake is insufficient

Nutrition Standards for Health Promotion & Maintenance Current focus: Health promotion & disease prevention by healthy eating and exercise Dietary Guidelines for Americans Revised every 5 years by US Department of Health & Human Services (DHHS) and the US Department of Agriculture (USDA) Emphasize the need to include preferences of racial & ethnic groups, vegetarians, & other populations. (Table 63-1) Requires cultural awareness Geriatric population needs 8 glasses of water a day & increased fiber to prevent constipation; Daily calcium, Vit D & B12 supplements

Nutrition Standards cont… USDA MyPlate Reminder about good food choices Half of each meal incorporates fruits & vegetables Half of grains consumed should be whole (not refined)

MyPlate The U.S. Department of Agriculture MyPlate.

Nutritional Assessments Malnourished Well-nourished Obese Physical presentation Laboratory studies Influences for nutritional status Age Culture Socioeconomic status Activity: Students perform a nutritional assessment on each other!

Malnourished Patient Three forms of PCM (Protein-Calorie Malnutrition) Marasmus: calorie malnutrition in which body fat and protein are wasted Kwashiorkor: lack of protein quantity & quality, despite adequate calories Marasmic-Kwashiorkor: combined protein & energy malnutrition Eating disorders Anorexia & bulimia Video: (if time allows) http://www.youtube.com/watch?v=6DNGKCI-7Aw

Feeding Tubes Complications: Refeeding Syndrome Life-threatening complication when nutrition is started after a patient is in starvation mode Increased Osmolarity Electrolyte Imbalances Dehydration How can a nurse be proactive in assessing these situations prior to becoming problems? Best way to check placement? Xray See chart 63-4

Obesity Many conditions with varying causes Assessment of BMI Norms: Men: 15-20% Women: 18-32 Overweight defined Increase for height to weight up to 10% greater than Ideal body weight BMI: 25-29.9 Obesity defined Excess amount of body fat compared to lean body mass: the BMI 30 or > Morbid Obesity: weight that has a severely negative effect on health BMI 40 or >

Obesity cont… The second leading cause of preventable deaths in the US (secondary to smoking) Complications Effects on the cardiovascular & respiratory systems OA More susceptible to infections & infectious disease

Treatment for Obesity Education of adolescents Treatment Nonmedical approaches Diet programs Behavioral Management Complementary & alternative therapies Acupuncture, acupressure, Ayurvedic, Hypnosis Drug therapy Surgical management gastric restriction surgeries

Operative Procedures Gastric restriction Adjustable banded gastroplasty.

Operative Procedures (cont’d) Malabsorption surgery Gastric bypass Roux-en-Y gastric bypass (RNYGB).

Special Considerations After Bariatric Surgery Abdominal binder Position SaO2 monitoring Sequential compression hose and/or heparin Skin assessment Absorbent padding Removal of urinary catheter within 24 hours

Special Considerations after Bariatric Surgery (cont’d) Assist patient out of bed Ambulate as soon as possible Monitor abdominal girth 6 small feedings, prevent dehydration Observe for signs of dumping syndrome

NCLEX Review

Question 1 What is a potential outcome when administering total parenteral nutrition (TPN)? Infection Hyperglycemia Electrolyte imbalance Dehydration Answer: B Rationale: Monitor serum electrolytes and glucose daily or per facility protocol. (Some facilities require finger-stick blood sugars [FSBSs] every 4 hours.) If insulin is added to the TPN to manage hyperglycemia, FSBS should be checked frequently. Infection at the catheter site is a serious risk, as are fluid and electrolyte imbalances.

Answer Answer: B Rationale: Monitor serum electrolytes and glucose daily or per facility protocol. (Some facilities require finger-stick blood sugars [FSBSs] every 4 hours.) If insulin is added to the TPN to manage hyperglycemia, FSBS should be checked frequently. Infection at the catheter site is a serious risk, as are fluid and electrolyte imbalances.

Question 2 An older adult with anemia requests help with his menu choices. What type of food should the patient be encouraged to eat? One-half cup of prunes Skim milk Wheat bread Oranges Answer: B Rationale: Vitamin B12 deficiency in a patient’s diet can result in anemia. Older people are at risk for several nutritional concerns including anemia from vitamin B12 and iron deficiencies. Vitamin B12 can be found in meats, fish, dairy, and egg food products. Prunes and oranges can assist with adding fiber and vitamins to the diet. Encouraging complex carbohydrates such as wheat bread is also important for good nutrition. (Source: Accessed November 28, 2011, from www.nal.usda.gov/fnic/pubs/olderadults.pdf)

Answer Answer: B Rationale: Vitamin B12 deficiency in a patient’s diet can result in anemia. Older people are at risk for several nutritional concerns including anemia from vitamin B12 and iron deficiencies. Vitamin B12 can be found in meats, fish, dairy, and egg food products. Prunes and oranges can assist with adding fiber and vitamins to the diet. Encouraging complex carbohydrates such as wheat bread is also important for good nutrition.