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

3. 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?

4. 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

5. 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

6. 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)

7. MyPlate
The U.S. Department of Agriculture MyPlate.

8. 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!

9. 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)

10. 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

11. Obesity Many conditions with varying causes Assessment of BMI
Norms: Men: 15-20% Women:
Overweight defined
Increase for height to weight up to 10% greater than Ideal body weight BMI:
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 >

12. 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

13. 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

15. Operative Procedures Gastric restriction
Adjustable banded gastroplasty.

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

17. 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

18. 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

19. NCLEX Review

20. 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.

21. 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.

22. 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

23. 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.