1. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Chapter 63 Care of Patients with Malnutrition and Obesity

2. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Nutrition Standards for Health Promotion & Maintenance  Dietary Guidelines for Americans  USDA MyPlate  Cultural awareness  Geriatric considerations

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

4. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Nutritional Assessments  Malnourished  Well-nourished  Obese  Physical presentation  Laboratory studies  Influences for nutritional status  Age  Culture  Socioeconomic status

5. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Malnourished Patient  Three forms of PCM  Long-term nutritional disorders  Patients who need TPN  How to encourage patients to eat?

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

7. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Operative Procedures  Gastric restriction

8. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Operative Procedures (cont’d)  Malabsorption surgery  Gastric bypass

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

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

11. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. A 90-year-old woman has been admitted for dehydration. Upon assessment, it is noted that she has dry mucous membranes, generalized weakness, difficulty ambulating, and very little appetite. Her weight is down from 110 to 96 pounds. Her dentures are loose and poor fitting. 1.Which assessment findings support a risk for malnutrition? 2.Which findings support failure to thrive? (cont’d)

12. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. The patient is admitted to the acute medical patient care unit. The nurse reviews her admission laboratory results. Which result supports a diagnosis of malnutrition? A.Serum albumin 3.5 g/dL B.Hematocrit 37% C.Hemoglobin 12 g/dL D.Prealbumin 13 mg/dL (cont’d)

13. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. On assessment, the patient is noted to have conjunctival xerosis, dry skin, follicular hyperkeratosis, and a bright magenta (purple) tongue. Which vitamin deficiency does the nurse suspect? A.Vitamin A B.Vitamin C C.Vitamin D D.Vitamin K (cont’d)

14. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Which dietary item should be removed from the patient’s nutritional tray? A.Applesauce B.Scrambled eggs C.Toast with butter D.Granola cereal (cont’d)

15. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. The patient is ordered daily multiple vitamins with zinc and iron supplements. Which interventions would promote oral nutritional intake? (Select all that apply.) A.Providing mouth care before each meal B.Placing a small bore nasoduodenal tube C.Assisting the patient to sit up in a chair D.Ordering foods that the patient likes to eat E.Assessing the patient for symptoms of depression F.Having a UAP feed the patient (cont’d)

16. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Chapter 63 Audience Response System Questions 16

17. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Question 1 What is a potential outcome when administering total parenteral nutrition (TPN)? A.Infection B.Hyperglycemia C.Electrolyte imbalance D.Dehydration

18. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Question 2 An older adult with anemia requests help with his menu choices. What type of food should the patient be encouraged to eat? A.One-half cup of prunes B.Skim milk C.Wheat bread D.Oranges

19. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Question 3 What percentage of adults in the United States are obese (body mass index >30)? A.14% B.21% C.34% D.47%