ch 40 Obesity

bariatric surgery: post-op care (6)

-DVT (increased risk) -airway patency (obesity can cause pt's breathing to become shallow and rapid, extra tissue can compress airway) -wound infection -wound dehiscence -ambulate pt ASAP -coughing, deep breathing, turning

obese BMI

-class I: 30-34.9 -class II: 35-39.9 -class III (extreme obesity): >40

causes of primary obesity (4)

-increased portion sizes -lack of physical exercise -socioeconomic status (less expensive foods with poor nutritional value) -eating your feelings (using food for comfort or reward)

what is a realistic weight loss goal for an obese pt?

1-2 lb/week 3-5%

The nurse is providing discharge instructions for a client following a Roux-en-Y gastric bypass surgery 3 days ago. What will the nurse include in the instructions? Select all that apply. 1. Do not drink fluids with meals. 2. Avoid foods high in carbohydrates. 3. Take an extended-release multivitamin daily. 4. Maintain a clear liquid diet for about 6 weeks. 5. Eat 6 small meals a day that are high in protein.

1. Do not drink fluids with meals. 2. Avoid foods high in carbohydrates. 5. Eat 6 small meals a day that are high in protein. (Because the stomach is so small, pts are instructed to not drink fluids with meals because providers do not want them to fill up on less nutritional liquids before having food) NCLEX

The nurse cares for a client following a Roux-en-Y gastric bypass surgery. Which nursing intervention is appropriate? 1. Encourage the client to ambulate. 2. Position the client on the left side. 3. Frequently irrigate the nasogastric tube (NG) with 30 mL saline. 4. Discourage the use of the patient-controlled analgesia (PCA) machine.

1. Encourage the client to ambulate. (Bariatric clients are at risk for developing deep vein thrombosis and atelectasis. It is important to encourage ambulation to promote both venous return in the legs and lung expansion.) NCLEX

normal BMI

18.5-24.9 kg/m²

overweight BMI

25-29.9 kg/m²

This bariatric surgical procedure involves creating a stoma and gastric pouch that is reversible and no malabsorption occurs. What surgical procedure is this? a. vertical gastric banding b. biliopacreatic diversion c. roux-en-y gastric bypass d. adjustable gastric banding

d. adjustable gastric banding MS

What information should be included in the dietary teaching for the patient following a Roux-en-Y gastric bypass? a. Avoid sugary foods and limit fluids to prevent dumping syndrome. b. Gradually increase the amount of food ingested to preoperative levels. c. Maintain a long-term liquid diet to prevent damage to the surgical site. d. Consume foods high in complex carbohydrates, protein, and fiber to add bulk to contents.

a. Avoid sugary foods and limit fluids to prevent dumping syndrome. MS workbook

Health risks associated with obesity include (select all that apply) a. colorectal cancer b. rheumatoid arthritis c. polycystic ovary disease d. nonalcoholic steatohepatitis e. systemic lupus erythematosus

a. colorectal cancer c. polycystic ovary disease d. nonalcoholic steatohepatitis MS

The best nutritional therapy plan for a person who is obese is: a. the Zone diet b. the Atkins diet c. Sugar busters d. foods from the basic food groups

d. foods from the basic food groups MS

A patient has been on a 1000-calorie diet with a daily exercise routine. In 2 months, the patient has lost 20 lb (9kg) toward a goal of 50 lb (23 kg) but is now discouraged that no weight has been lost in the last 2 weeks. What should the nurse tell the patient about this? a. A steady weight may be due to water gain from eating foods high in sodium. b. Plateaus where no weight is lost normally occur during a weight-loss program. b. A weight considered by the body to most efficient for functioning has been reached. c. A return to former eating habits is the most common cause of not continuing to lose weight.

b. Plateaus where no weight is lost normally occur during a weight-loss program. MS workbook

A 40-year-old severely obese female patient with type 2 diabetes wants to lose weight. After learning about the surgical procedures, she thinks a combination of restrictive and malabsorptive surgery would be best. Which procedure should the nurse teach her about? a. Lipectomy b. Roux-en-Y gastric bypass c. Adjustable gastric banding d. Vertical sleeve gastrectomy

b. Roux-en-Y gastric bypass MS workbook

Which explanation about weight reduction should be included when teaching the obese patient and her obese husband? a. Weight gain is caused by psychologic factors. b. Daily weighing is recommended to monitor weight loss. c. Progressively increasing physical activity helps decrease weight, cholesterol, and blood pressure levels. d. Men lose weight less quickly than women because they have a higher percentage of metabolically less-active fat.

c. Progressively increasing physical activity helps decrease weight, cholesterol, and blood pressure levels. MS workbook

A morbidly obese patient has undergone Roux-en-Y gastric bypass surgery. In planning postoperative care, the nurse anticipates that the patient a. may have severe diarrhea early in the postoperative period b. will not be allowed to ambulate for 1 or 2 days postoperatively c. will require nasogastric suction until healing of the incision occurs d. may have only liquids orally, and in very limited amounts, during the early postoperative period

d. may have only liquids orally, and in very limited amounts, during the early postoperative period MS

What is a postoperative nursing intervention for the obese patient following a Roux-en-Y gastric bypass? a. irrigating and repositioning the NG tube as needed b. delaying ambulation until the pt has enough strength to support self c. keeping the pt positioned on the side to facilitate respiratory function d. providing adequate support to the incision during coughing, deep breathing, and turning

d. providing adequate support to the incision during coughing, deep breathing, and turning (turning, coughing and deep breathing are essential to prevent post-op complications; protecting the incision from strain is important since wound dehiscence is a problem for obese pts; ambulation is usually started the evening of surgery) MS workbook

Before selecting a weight reduction plan with an obese pt, what is most important for the nurse to first assess?

the pt's motivation to lose weight MS workbook