Med Surg chap 41 Nursing Management: Obesity

While caring for a patient after bariatric surgery, the nurse identifies that the patient is at risk for deep vein thrombosis (DVT). Which treatment strategy should be included in the patient's care plan to prevent this complication? Select all that apply. 1 Antifibrinolytic drugs 2 Antiembolic stockings 3 Vitamin K supplements 4 Low-dose heparin 5 Active and passive range-of-motion exercises

DVT is characterized by the presence of a blood clot in a vein deep in the body. Venous stasis and venous distension in the patient stimulates the formation of blood clots in the body. Antiembolic stockings prevent venous stasis, thereby reducing the signs of DVT. Low-dose heparin prevents the formation of new blood clots and preventsthe enlargement of blood clots in the body. Therefore, low-dose heparin is prescribed to the patient. Active and passive range-of-motion exercises increase venous return, thereby reducing blood clots in the veins. Antifibrinolytic drugs and vitamin K supplements have blood clotting ability and further increase the risk in the patient. 2,4,5

In developing an effective weight reduction plan for an overweight patient who states a willingness to try to lose weight, it is most important for the nurse first to assess which factor? 1 The length of time the patient has been obese 2 The patient's current level of physical activity 3 The patient's social, emotional, and behavioral influences on obesity 4 Anthropometric measurements such as body mass index and skinfold thickness

Eating patterns are established early in life and eating has many meanings for people. To establish a weight reduction plan that will be successful for the patient, the nurse should first explore the social, emotional, and behavioral influences on the patient's eating patterns. The duration of obesity , current physical activity level, and current anthropometric measurements are not as important for the weight reduction plan. Text Reference - p. 913 3

Why does the primary health care provider instruct the nurse to administer adenosine to an obese patient? 1 To reduce swelling 2 To promote vasodilatation 3 To reduce circulating blood levels 4 To decrease the risk of sleep apnea

Obesity results in an imbalance between endothelium-derived vasoactive factors and causes vasoconstriction in the patient. Adenosine is a vasodilator and prevents the progression of vasoconstriction-related diseases. Obesity results in an inflammatory state in metabolic tissues and promotes insulin resistance. Therefore, dietary changes are advised to reduce inflammation associated with obesity. Obesity increases the patient's circulating blood volume and cardiac output. Diuretics reduce the circulating blood volume in an obese patient. During sleep, the throat and tongue muscles relax, which may cause airway blockage in an obese patient. Administering sleep-inducing agents decreases the risk of sleep apnea in an obese patient. 2

Following a Roux-en-Y gastric bypass, the patient experiences vomiting, nausea, sweating, faintness, and occasional episodes of diarrhea. The nurse takes a history of the patient's oral consumption after the surgery. The nurse informs the patient that the consumption of which item triggered the patient's symptoms? 1 Fish 2 Meat 3 Candy 4 Spinach

Signs and symptoms such as vomiting, nausea, sweating, faintness, and occasional diarrhea following a Roux-en-Y Gastric Bypass procedure indicate dumping syndrome in the patient. Sugar-rich foods, such as candies, pass through the stomach quickly and further increase the risk of dumping syndrome in the patient. Protein-rich foods, such as fish and meat, do not pass through the stomach quickly and usually do not result in dumping syndrome. Spinach, which is a high-fiber soluble food, prevents the quick transfer of sugars to the stomach and does not worsen dumping syndrome. 3

The nurse calculates a patient's body mass index (BMI) to be 27 kg/m2. This BMI would fall under which classification? 1 Underweight 2 Normal body weight 3 Overweight 4 Obese

The most common measure of obesity is the body mass index (BMI). BMI is calculated by dividing a person's weight (in kilograms) by the square of the height in meters. Individuals with a BMI less than 18.5 kg/m2 are considered underweight, whereas those with a BMI between 18.5 and 24.9 kg/m2 reflect a normal body weight. A BMI of 25 to 29.9 kg/m2 is classified as being overweight, and those with values at 30 kg/m2 or above are considered obese. The term severely (morbidly, extremely) obese is used for those with a BMI greater than 40 kg/m2. 3

The nurse has completed initial instruction with a patient regarding a weight loss program. The nurse determines that the teaching has been effective when the patient makes which statement? 1 "I plan to lose 4 lb a week until I have lost the 60-pound goal." 2 "I will keep a diary of weekly weights to illustrate my weight loss." 3 "I will restrict my carbohydrate intake to less than 30 g/day to maximize weight loss." 4 "I should not exercise more than my program requires because increased activity increases the appetite."

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The nurse assesses a patient with Alzheimer's disease and determines that the patient's body mass index (BMI) is 28.8 kg/m2. What does the nurse interpret from these findings? 1 The patient has gynoid obesity. 2 The patient has primary obesity. 3 The patient has android obesity. 4 The patient has secondary obesity.

A BMI of 28.8 kg/m2 indicates that the patient is overweight. Alzheimer's disease is one of the types of central nervous system lesions. Patients with this disease may become obese due to cognitive loss and functional inabilities. Secondary obesity may result from central nervous system lesions or congenital anomalies. Therefore, the nurse infers that the patient has secondary obesity. If an obese patient has a greater amount of fat in the upper body, it indicates that the patient has gynoid obesity. If the calorie intake is more than the calorie expenditure for the body's metabolic demands, it is called primary obesity. If an obese patient has a greater proportion of fat deposited in the abdominal area, it indicates that the patient has android obesity. 4

The nurse is caring for a 45-year-old woman with a herniated lumbar disc. The patient realizes that weight loss is necessary to lessen back strain. The patient is 5'6" tall and weighs 186 lb (84.5 kg) with a body mass index (BMI) of 28 kg/m2. The nurse explains to the patient that this measurement places her in which of the following weight categories? 1 Normal weight 2 Overweight 3 Obese 4 Severely obese

A normal BMI is 18.5 to 24.9 kg/m2 , whereas a BMI of 25 to 29.9 kg/m2 is considered overweight. A BMI of 30.0 to 39.9 is considered obese and a BMI of 40 or greater is severely obese. Text Reference - p. 906 2

A 58-year-old man with chronic low back pain realizes he needs to reduce his weight to lessen the back pain and strain. He is 6 feet tall and weighs 218 pounds. The nurse interprets that the patient currently is classified as overweight, which correlates to which body mass index (BMI) range? 1 18 to 24 2 25 to 29 3 30 to 34 4 > 35

A normal BMI is 18.5 to 24.9 kg/m2, and a BMI of 25 to 29.9 is considered overweight. A BMI of 30 to 34 indicates obesity , and more than 35 indicates morbid obesity. 2

The nurse is reviewing cultural and ethnic factors related to obesity. Which statement does the nurse identify as being true? 1 Among men, Mexican Americans have the lowest prevalence of being overweight or obese. 2 Native Americans have a lower prevalence of being overweight than the general population. 3 Among women, African Americans have the highest prevalence of being overweight or obese. 4 Asian Americans have the same prevalence of being overweight and obese compared with the general population.

African Americans and Hispanics have a higher prevalence of obesity than whites. Among women, African Americans have the highest prevalence of being overweight or obese, and 15% are severely obese. Among men, Mexican Americans have the highest prevalence of being overweight or obese. Native Americans have a higher prevalence of being overweight than the general population. Asian Americans have the lowest prevalence of being overweight and obese compared with the general population. Text Reference - p. 908 3

What should the nurse include in a postoperative plan of care for a patient who has undergone bariatric surgery? 1 Avoid ambulating the patient. 2 Give 30 mL of water every 2 hours. 3 Give solid foods along with liquids. 4 Avoid sugar-free liquids in the patient's diet.

While performing postoperative care for a patient who has undergone bariatric surgery, the nurse should give 30 mL of water every 2 hours to maintain the patient's fluid and electrolyte balance. Limiting ambulation can result in deep vein thrombosis (DVT). Therefore, the nurse should encourage the patient to perform early ambulation. The combination of solids and liquids in the patient's diet should be avoided, as it puts stress on the gastrointestinal system, causing the patient discomfort. Sugar-rich liquids can result in dumping syndrome, so the nurse should give sugar-free liquids to the patient. 2

An overweight patient admitted to the hospital for heart failure weighs 192 pounds. The nurse instructs the patient that an acceptable portion size of animal protein is approximately how many ounces? 1 1 ounce 2 3 ounces 3 5 ounces 4 7 ounces

An appropriate serving size of animal protein is 3 ounces, about the size of one's fist. 1 ounce is one third of the normal serving size; 5 and 7 ounces are greater than one serving size. Text Reference - p. 914

When assessing a patient with obesity, what questions are appropriate for the nurse to ask the patient? Select all that apply. 1 What kind of food do you prefer? 2 Where do you go for a vacation? 3 Are other family members overweight? 4 What is your motivation to lose weight? 5 What is your educational background?

Asking about food preferences helps to evaluate the patient's food habits, inquiring about the weight of family members will reveal any family history of weight issues, and asking about motivation to lose weight will clarify the patient's reasons for trying to lose weight. These all help in detailing the history and planning the required lifestyle modifications. Information about where the patient goes for vacation and about educational background are not relevant. Text Reference - p. 913 1,3,4,

A patient has a body mass index (BMI) of 27. The nurse has discussed weight-loss goals with the patient. Which statement made by the patient indicates proper understanding of the teaching? 1 "I will exercise for 15 minutes every day of the week." 2 "I will limit intake to 500 calories per day." 3 "I will increase my intake of sugar-free foods and beverages." 4 "I will begin to steam and broil my foods for most meals."

Broiling and steaming foods is a healthier way to prepare meals. Limiting intake to 500 calories per day is not indicated for this patient, and the severe calorie -energy restriction would place the patient at risk for multiple nutrient deficiencies. Low-calorie diets are defined as those having 800 to 1200 calories per day. Exercise should be at least 30 minutes per day. 4

Two weeks after a subtotal gastrectomy, a patient reports the sudden onset of clammy skin, weakness, and diaphoresis after a meal. What diagnosis does the nurse suspect? 1 Acute pancreatitis 2 Dumping syndrome 3 Acute myocardial infarction 4 Mesenteric artery embolism

Dumping syndrome is the most likely cause of these symptoms about 2 weeks after surgery. Dumping syndrome is believed to be caused by food directly entering the jejunum without first being processed in the stomach. Acute pancreatitis would present with acute abdominal pain, nausea, vomiting, and tachycardia. In addition to complaints of feeling clammy, weak, and diaphoretic, an acute myocardial infarction would likely manifest with chest pain and pressure. Mesenteric artery embolism would also manifest as nausea, vomiting, and abdominal pain. The nurse should further question the patient to determine the cause of the episode, including other associated symptoms and what types and quantities of foods were eaten at the meal. 2

The nurse is teaching a patient about developing strategies to plan a weight loss program. What nursing actions are appropriate? Select all that apply. 1 Suggest lifestyle changes. 2 Advise diet therapy alone. 3 Advise focusing on reasons to lose weight. 4 Advise medication and surgery. 5 Modify diet, exercise, and behavior.

For successful weight loss, lifestyle changes such as healthy eating habits and adequate physical activity should be stressed. It is also important to focus on reasons to lose weight. A multifaceted approach needs to be used and will include nutritional therapy, exercise, and behavior modification. Advising diet therapy or medication and surgical intervention for all patients is not recommended. 1,3,5

The nurse is evaluating the suitability of a patient for liposuction. Which characteristics indicate that the patient is suitable for liposuction? 1 The patient is aged and obese. 2 The patient is aged and underweight. 3 The patient is obese and desires weight reduction. 4 The patient has reduced weight but more fat around the chin.

Liposuction is a surgical procedure used for cosmetic purposes, and a patient with reduced weight but more fat around the chin is the most suitable for liposuction. Liposuction is not recommended for the aged because the skin is less elastic and will not accommodate the new underlying shape. The patient who is obese and aims at weight reduction is not suitable, as liposuction is not for weight reduction. 4

An overweight patient tells the nurse, "I had a friend who lost lots of weight on a low-carb diet. I want to try that!" The nurse will answer the patient with what factor in mind? 1 Low-carbohydrate diets are safe and easy to follow. 2 Low-carbohydrate diets produce long-lasting weight loss. 3 Low-fat diets provide more chance of success than low-carbohydrate diets. 4 People on low-carbohydrate diets may not get adequate amounts of fiber, vitamins, and minerals.

Low-carbohydrate diets do produce a rapid weight loss, but reduce the opportunity to get adequate amounts of fiber, vitamins, and minerals. These restrictive diets are difficult to maintain for long-term weight loss. It is best to recommend a dietary approach in which calorie restriction includes all food groups. Low carbohydrate diets are generally not safe nor are they easy to follow. They produce short-term weight loss, not long-term. Low-fat diets are not necessarily more successful than low-carbohydrate diets. 4

A nurse is teaching an elderly patient that aging problems can be exacerbated by obesity. Which condition should the nurse include as being affected by obesity? 1 Arthritis 2 Sinusitis 3 Vision problems 4 Chewing difficulty

Obesity can place more demands on arthritic joints, and the mechanical strain on weight-bearing joints can lead to premature immobility, thereby exacerbating arthritis. Sinusitis, vision problems, and chewing difficulty are not related to obesity. 1

A patient presents with a body mass index (BMI) of 20. What should the nurse document about the patient's weight classification? 1 Obese 2 Overweight 3 Underweight 4 Normal weight

Patients with a BMI between 18.5 and 24.9 are considered to have a normal body weight. Patients with a BMI less than 18.5 are considered underweight, those with a BMI of 25 to 29.9 are overweight, and those with a BMI of 30 or above are considered obese. 4

The nurse is reviewing the surgical notes of a patient who underwent bariatric surgery and notes that the first segment of the small intestine is bypassed with a small gastric pouch connected to the jejunum. Which surgical technique was performed? 1 Adjustable gastric banding 2 Vertical sleeve gastrectomy 3 Vertical banded gastroplasty 4 Roux-en-Y gastric bypass surgery

Roux-en-Y gastric bypass surgery is a combination of restrictive and malabsorptive surgical techniques. During Roux-en-Y, a small gastric pouch is connected to the jejunum. The remaining stomach and first segment of the small intestine is bypassed. Adjustable gastric banding involves placing a band around the stomach, reducing its capacity to approximately 30 mL. The vertical sleeve gastrectomy involves the removal of 85% of the stomach, reducing its capacity to approximately 60 to 150 mL. Vertical banding involves placing a band around the stomach and using a stapling technique above the band to create a small gastric pouch. 4

This irreversible bariatric surgical procedure involves creating a small gastric pouch and attaching it directly to the small intestine, using a piece of the small bowel. The nurse recognizes that this is which surgical procedure? 1 Biliopancreatic diversion 2 Roux-en-Y gastric bypass (RYGB) 3 Adjustable gastric banding 4 Vertical sleeve gastrectomy

The RYGB procedure is a combination of restrictive and malabsorptive surgery. This surgical procedure is the most common bariatric procedure performed in the United States. This procedure, which is irreversible, involves creating a small gastric pouch and attaching it directly to the small intestine using a Y-shaped limb of the small bowel. After the procedure, food bypasses 90% of the stomach, the duodenum, and a small segment of jejunum. A biliopancreatic diversion removes 70% of the stomach horizontally and anastomosis between the stomach and intestine. Adjustable gastric banding is reversible (the band can be adjusted to be tighter or looser). Vertical sleeve gastrectomy removes 85% of the stomach, leaving a sleeve-shaped stomach with 60 to 150 mL capacity. Text Reference - p. 917

Which patient has the highest morbidity risk? 1 Male 6 ft. 1 in. tall, body mass index (BMI) 29 kg/m2 2 Female 5 ft. 6 in. tall, weight 150 lb. 3 Male with waist circumference 46 in. 4 Female 5 ft. 10 in. tall, obesity Class III

The patient in Class III obesity has the highest risk for disease because Class III denotes severe obesity or a BMI greater than 40 kg/m2 . The female who is 5 ft. 6 in. tall has a normal weight for her height. The male patient who is over 6 feet tall is overweight, which increases his risk of disease, but a more precise determination cannot be made without the waist circumference. The patient with a waist circumference of 46 inches has a high risk for disease, but without the BMI or obesity class, a more precise determination cannot be made. 4

While reviewing the physical assessment reports of a female patient, the nurse identifies that the patient is at increased risk for cardiovascular disease and metabolic syndrome. The nurse determined that the patient is at risk based on which assessment finding? 1 Waist to hip ratio of 0.6 2 Body mass index (BMI) of 24 kg/m2 3 Waist circumference of 48 inches 4 Waist circumference of 32 inches

Waist circumference is used to assess and classify a patient's weight. A female with a waist circumference of 48 inches is at risk for cardiovascular disease and metabolic syndrome. The waist to hip ratio of 0.6, body mass index (BMI) of 24, and waist circumference of 32 are normal findings and are not indicative of increased health risks. 3

When taking the health history of a female patient presenting with obesity, the nurse makes note of the existing genetic and endocrine factors. What conditions should the nurse include in the assessment? Select all that apply. 1 Hyperacidity 2 Hypothyroidism 3 Cushing's syndrome 4 Chronic sinusitis 5 Polycystic ovarian disease

When obtaining the history, exploring genetic and endocrine factors such as hypothyroidism, Cushing's syndrome, and polycystic ovary syndrome in women is important. Chronic sinusitis and hyperacidity are not related to genetic and endocrine factors. 2,3,5

At the first visit to the clinic, the female patient with a body mass index (BMI) of 29 kg/m2 tells the nurse that she does not want to become obese. Which question used for assessing weight issues is the most important question for the nurse to ask? 1."What factors contributed to your current body weight?" 2 "How is your overall health affected by your body weight?" 3 "What is your history of gaining weight and losing weight?" 4 "In what ways are you interested in managing your weight differently?"

Asking the patient about her desire to manage her weight in a different manner helps the nurse determine the patient's readiness for learning, degree of motivation, and willingness to change lifestyle habits. The nurse can help the patient set realistic goals. This question also will lead to discussing the patient's history of gaining and losing weight and factors that have contributed to the patient's current weight. The patient may be unaware of the overall health effects of her body weight, so this question is not helpful at this time. 4

During the initial postoperative period following bariatric surgery, the nurse recognizes the importance of monitoring obese patients for respiratory insufficiency based on what knowledge? 1 The body stores anesthetics in adipose tissue. 2 Postoperative pain may cause a decreased respiratory rate. 3 Intubation may be difficult because of extra chin skin folds. 4 The patient's head must remain flat for a minimum of two hours postprocedure.

The body stores anesthetics in adipose tissue, placing patients with excess adipose tissue at risk for resedation. As adipose cells release anesthetics back into the bloodstream, the patient may become sedated after surgery, increasing the risk of hypoventilation and resultant respiratory insufficiency. Pain usually increases respiratory rate. Difficult intubation does not cause respiratory insufficiency. The patient's head should be elevated after bariatric surgery to decrease abdominal pressure and facilitate respirations. 1