Obesity

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?

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.

A severely obese patient has undergone Roux-en-Y gastric bypass (RYGB) surgery. The nurse will monitor for dumping syndrome, which is characterized by which of these symptoms? Select all that apply.

A complication of RYGB is dumping syndrome, in which gastric contents empty too rapidly into the small intestine, overwhelming its ability to digest nutrients. Symptoms can include vomiting, nausea, weakness, sweating, faintness, and, on occasion, diarrhea. Patients are discouraged from eating sugary foods after surgery to avoid dumping syndrome. Constipation is not a symptom of dumping syndrome.

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?

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.

Which type of bariatric surgery decreases the amount of small intestine available for nutrient absorption and also removes part of the patient's stomach?

Biliopancreatic diversion is a malabsorptive surgery that involves removing 70% of the stomach. This surgery decreases the amount of small intestine available for nutrient absorption. Adjustable gastric banding is a restrictive surgery in which the band encircles the stomach, creating a stoma and a gastric pouch with about 30 mL capacity.Vertical sleeve gastrectomy is a restrictive surgery in which 85% of the stomach is removed, leaving a sleeve-shaped stomach with 60 to 150 mL capacity. Roux-en-Y gastric bypass surgery is a combination of restrictive and malabsorptive surgery in which a small pouch is created on the stomach by restrictive surgery. The small gastric pouch is connected to the jejunum and the remaining stomach and first segment of the small intestine are bypassed in this type of surgery.

The nurse is reviewing the assessment findings and body mass index (BMI) of four patients. Which patient is an appropriate candidate for bariatric surgery?

Criteria for patients to undergo bariatric surgery include: BMI 40 kg/m2, or BMI 35 kg/m2, complicated by one or more of the following: hypertension, diabetes mellitus type 2, heart failure, or sleep apnea. Patient A with a respiratory rate of 10 breaths/min during sleep and a BMI of 35 is eligible for bariatric surgery. Patients B and D are not eligible, because the findings are within normal parameters. Although obese, Patient C does not have accompanying hyperglycemia.

The nurse is caring for an obese patient who is being considered for bariatric surgery. What category of body mass index (BMI) would the patient fall within to be considered for bariatric surgery?

Criteria guidelines for bariatric surgery include having a BMI of 40 or a BMI of 35 with one or more severe obesity-related medical complications such as hypertension, type 2 diabetes mellitus, heart failure, or sleep apnea. A BMI greater than 25 is considered overweight, and a BMI greater than 30 is considered obese.

The nurse is evaluating the suitability of a patient for liposuction. Which characteristics indicate that the patient is suitable for liposuction?

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.

A patient is taking lorcaserin (Belviq). The nurse should monitor for what adverse effects associated with the medication? Select all that apply.

Lorcaserin (Belviq) is a selective serotonin (5-HT) agonist that acts on the brain to suppress the appetite and create a sense of satiety. Adverse effects of this drug include dizziness, dry mouth, and constipation related to the drug's action.Diarrhea and abdominal bloating are not common adverse effects of this drug.

The nurse is caring for a patient with an energy utilization and storage disorder called metabolic syndrome. Which treatment strategies will be helpful for this patient? Select all that apply.

Metabolic syndrome is an energy utilization and storage disorder associated with an increase in fasting plasma glucose levels. Administering metformin enhances the patient's insulin sensitivity and decreases blood glucose levels. A healthy diet promotes weight loss and prevents obesity. A diet rich in unsaturated fatty acids decreases the patient's risk of weight gain. Therefore, the nurse should provide information about a nutritious diet to the patient. Sedentary lifestyles lead to metabolic syndrome. The nurse should provide the patient with information on positive lifestyle changes. Administering tranexamic acid increases blood clotting. A diet rich in saturated fat develops abnormal levels of blood cholesterol in the patient. Palm kernel oil is a rich source of saturated fat, so a patient with metabolic syndrome should avoid it.

Why does the primary health care provider instruct the nurse to administer adenosine to an obese patient?

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.

A 50-year-old African-American woman has a body mass index (BMI) of 35 kg/m2, type 2 diabetes mellitus, hypercholesterolemia, and irritable bowel syndrome (IBS). She is seeking assistance in losing weight, because, "I have trouble stopping eating when I should, but I do not want to have bariatric surgery." Which drug therapy should the nurse question if it is prescribed for this patient?

Orlistat, which blocks fat breakdown and absorption in the intestine, produces some unpleasant gastrointestinal side effects. This drug would not be appropriate for someone with IBS. Locaserin suppresses the appetite and creates a sense of satiety that may be helpful for this patient. Phentermine (Adipex-P) needs to be used for a limited period of time (three months or less). Qsymia is a combination of two drugs, phentermine and topiramate. Phentermine is a sympathomimetic agent that suppresses appetite and topiramate induces a sense of satiety.

A patient presents with a body mass index (BMI) of 20. What should the nurse document about the patient's weight classification?

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.

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?

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.

The nurse is caring for a patient who has undergone Roux-en-Y gastric bypass surgery. Which nursing interventions will be beneficial to this patient? Select all that apply.

Roux-en-Y gastric bypass surgery results in the rapid emptying of stomach contents and causes dumping syndrome, decreasing the patient's absorption of calcium and iron. Therefore, the nurse recommends that the patient take calcium supplements. Foods rich in soluble fiber slow gastric emptying and prevent reabsorption of sugar at a faster rate. Therefore, the patient is encouraged to eat fiber-rich food. A patient who has undergone Roux-en-Y gastric bypass surgery does not tolerate milk or milk products. Simple carbohydrates can pass quickly through the patient's stomach and cause diarrhea and cramping. Carbonated beverages can lead to bloating and pain.

The nurse is caring for a patient who has undergone bariatric surgery. Which nursing interventions will be beneficial to this patient? Select all that apply.

The patient may experience electrolyte imbalances after bariatric surgery. Therefore, administering intravenous (IV) fluids will be beneficial. The nurse should place the patient's head at a 35- to 40-degree angle while assisting the patient into the semi-Fowler's position. This intervention promotes maximum chest expansion and prevents breathlessness by relaxing the patient's abdominal muscles and stabilizing the patient's airways. Anesthetics administered during surgery are stored in adipose tissues. The adipocytes release anesthetics into the bloodstream after surgery, increasing the risk of resedation. Therefore, the nurse should be prepared to perform a head-tilt maneuver to prevent respiratory depression that may be caused by resedation. Foods rich in carbohydrates increase the risk of diarrhea. Excess liquid intake promotes anastomosis leaks and increases the patient's pain.

An obese patient consults a nurse for weight loss advice. The patient reports frequent hunger as a barrier to weight loss. Which medications may be helpful in suppressing the patient's appetite? Select all that apply.

The sympathomimetic action of diethylpropion (Tenuate), phendimetrazine (Bontril), and phentermine and topiramate (Qsymia) are used to suppress the appetite in obese patients. Orlistat (Xenical) blocks fat breakdown and absorption in the intestine by inhibiting the action of intestinal lipases. Metformin (Glucophage) is an oral antidiabetic drug used to prevent diabetes by lowering glucose levels.

The nurse is reviewing the assessment of a 45-year-old female patient who may have metabolic syndrome. Which of these assessment findings from this patient are criteria for metabolic syndrome? Refer to chart. Select all that apply.

Three of the five criteria must be met for a diagnosis of metabolic syndrome . Waist circumference (≥40 inches in men, ≥35 inches in women); triglycerides (>150 mg/dL or drug treatment for elevated triglyceride levels); high-density lipoprotein (HDL) cholesterol.

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?

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

A patient with a body mass index (BMI) of 22 kg/m2 asks the nurse for weight-reducing medications. How should the nurse respond?

Weight reducing drugs are reserved for adults with a BMI of 30 kg/m2 or greater, or adults with a BMI of 27 kg/m2 with at least one weight-related condition, such as hypertension, type 2 diabetes, or dyslipidemia. The BMI of 22 kg/m2 in an adult patient indicates normal levels, so the nurse should suggest that the patient maintain a healthy diet. The nurse may suggest over-the-counter medications to an obese patient but not to a patient with a BMI of 22 kg/m2. Because the patient has a normal BMI, there is no need to report the information to the primary health care provider or tell the patient to avoid a carbohydrate-rich diet, unless the patient has any co-morbid condition.

What should the nurse include in a postoperative plan of care for a patient who has undergone bariatric surgery?

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.

The nurse is reviewing cultural and ethnic factors related to obesity. Which statement does the nurse identify as being true?

frican 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.