MSN5050 Management of Chronic Diseases: Week 1A & 1B

key contributing factors for obesity

- genetic mutations (research identified "79 syndromes and 31 genes that cause obesity through monogenetic or polygenetic mutations") - types of food and beverages consumes (processed foods, high calorie foods, high fructose corn syrup, simple sugars, transfats) - hormone imbalances (leptin, grehlin, somatostatin, CCK, insulin, etc.) - human microbiome

the collective genome of the microbiota has more than ___ times more genes than in the human genome

100

What is "people-first" language?

A person is an individual that is not defined only by their disability; should be referred to as "a person with __", rather than a "__ person".

☆ Interface Model of Disability

Based on the life experiences of the person with a disability and views disability at the intersection of the medical diagnosis of a disability and environmental barriers; considers rather than ignores the diagnosis. The person with a disability, rather than others, defines the problems and seeks or directs solutions.

Social Model of Disability "Barriers Model of Disability" "Disability Model"

Disability as socially constructed and as a political issue that is a result of social and physical barrier in the environment; disability can be overcome with the removal of these barriers.

Functional Model of Disability

Disability is considered an umbrella term for impairments, activity limitations, participation restrictions, and their interaction with environmental factors; addresses the components of health rather than consequences of disease.

Functional Consequences Theory of Aging

Encourages nurses to consider the effects of normal age-related changes as well as the damaged incurred through disease or environmental and behavioral risk factors when planning care; suggesting that nurses can alter the outcome for patients through nursing interventions that address the consequences of these changes. ☆ Nurse must differentiate between normal, irreversible age-related changes and modifiable risk factors

Medical Model of Disability

Equates people who are disables with their disabilities and views the disability as a problem of the person, directly caused by disease, trauma, or other health condition, that requires medical care provided in the form of individual treatment by professionals. Management of the disability is aimed at a cure or the person's adjustment and behavior change.

vasomotor symptoms associated with "dumping syndrome"

HEAT & SPEED UP pallor perspirations palpitations headache feelings of warmth dizziness drowsiness

GI symptoms associated with "dumping syndrome"

HEAT & SPEED UP tachycardia, sweating, nausea, vomiting, bloating, abdominal cramping, diarrhea, increased blood glucose and insulin secretion (resulting in reactive hypoglycemia) ☆ usually occurs minutes to 2 hours after eating

Biopsychosocial Model of Disability

Integrates the medical and social models to address perspectives of health from a biologic, individual and social perspective.

Rehabilitation Model of Disability

Regards disability as a deficiency that requires a rehabilitation specialist or other helping professional to fix the problem; often being perceived as failing if they have failed to overcome the disability.

adverse effects of phentermine, benzphetamine, diethylpropion, phendimetrazine

SPEED UP palpitations tachycardia tremors hypertension dizziness diarrhea or constipation mouth dryness restlessness alterations in taste

adverse effects of orlistat

SPEEDING UP steatorrhea (oily stools, fats not metabolized and passed in stool) diarrhea fecal incontinence flatus

the nurse provides care to a menopausal client, who states, "I read a news article that says I am at risk for coronary vascular disease due to inflammation." which method should the nurse suggest to the client to aid in the prevention of inflammation that can lead to atherosclerosis? (prepu question)

addressing obesity

what may develop as a result of "dumping syndrome"?

anorexia, as patients can become hesitant to eat

the nurse is providing care for a client who had a biliopancreatic diversion with duodenal switch 2 days ago. how should the nurse best address the client's risk for postoperative venous thromboembolism? (prepu question)

assist the client with ambulating as early and often as possible

a nurse is providing discharge instruction for a client who is postoperative bariatric surgery. what statement will the nurse include when providing teaching aimed at decreasing the risk of gastric ulcers? (prepu question)

avoid taking NSAIDs

5 rules of wound care

categorization selection change evolution practice

caution and contraindications of orlistat

caution in pts with known history of renal insufficiency, liver disease or gallbladder disease (associated use may cause renal calculi, liver failure and cholelithiasis) do not administer with cyclosporine

potential complications of bariatric surgery

changes in bowel habits hemorrhage venous thromboembolism bile reflux dumping syndrome dysphagia bowel and gastric outlet obstruction

"geriatric triad"

changes in cognitive status, falls, incontinence

"geriatric syndromes"

common problems experienced by older adults that cannot be specifically categorized as a disease, requiring further assessment to determine the underlying causes

anti-obesity medications QSEN ALERT

considered teratogenic; women of childbearing are should be screened for pregnancy carefully

isometric exercises

contracting and retracting the muscle in a fixed position to maintain strength with an immobilized joint

caution and contraindications of phentermine, benzphetamine, diethylpropion, phendimetrazine

contraindicated in patients with heart disease, uncontrolled hypertension, hyperthyroidism and glaucoma do not drink alcohol while taking these medications

a nurse cares for a client who has secondary obesity. which condition is the most likely to result in secondary obesity? (prepu question)

cushing's disease

interactive dressings

dressings that can absorb wound exudate, while maintaining a moist environment for healing e.g. hydrocolloids, alginates, hydrogels ☆ most commonly used

active dressings

dressings that improve the healing process and decrease healing time e.g. skin grafts, biologic skin substitutes

clinical manifestations of Alzheimer's Disease

early stages: forgetfulness, subtle memory loss, small difficulties in otherwise routine activities but compensated for progressing stages: daily forgetfulness, ability to recognize otherwise familiar people, places, environments and objects, repetition in communication, loss of ability to perform ADLs terminal stages: immobile, complete dependency personality changes: depression, combativeness, suspicion, paranoia, hostility

how often moisture-retentive dressings should be changed

every 1-3 days

how often should lotion be reapplied to retain effectiveness

every 3-4 hours

passive exercises

exercises performed by the nurse without patient assistance to retain range of motion to retain circulation

active exercises

exercises performed by the patient to increase muscle strength

resistive exercises

exercises performed by the patient against manual or mechanical resistance to increase muscle strength

active-assistive exercises

exercises performed by the patient with nursing assistance to encourage normal muscle function

stage 4 pressure ulcer

full thickness skin and tissue loss

stage 3 pressure ulcer

full thickness skin loss

likely cause of hemorrhage after 72 hours - 30 days

gastric or duodenal ulcer

orlistat

gastrointestinal lipase inhibitor, diminishes intestinal absorption and metabolism of fats (particularly triglycerides) ☆ daily multivitamin advised

a client who is postoperative open RYGB bariatric surgery is scheduled for discharge and will have a Jackson-Pratt drain to care for while at home. which teaching will the nurse include specific to this? (prepu question)

how to empty the drain how to measure drainage amount recording drainage amount when to contact the healthcare provider

top risk factors for the most common chronic diseases

hypertension tobacco, ENDS or secondhand smoke overweight or obesity lack of physical activity excessive alcohol consumption diets low in fruits or vegetables consumption of foods high in sodium and saturated fats

benefits of moisture-retentive dressings

improved fibrinolysis accelerated epidermal resurfacing reduced pain fewer infections reduced scar tissue gentle, selective autolytic debridement decreased frequency of dressing changes

when is obesity most likely to resolve with medication?

in patients who are implementing lifestyle modifications as well as anti-obesity medications

a client who is post op from bariatric surgery reports constipation, what is the most likely cause? (prepu question)

insufficient water intake

the healthcare provider prescribes orlistat in an effort to help the client lose weight, along with diet and exercise. when teaching the client about this medication, what will the nurse include? (prepu question)

it binds with enzymes to prevent digestion of fat

patients with obesity tend to have __ diverse microbiota than patients who are of normal weight

less

best position for a post-op bariatric surgery patient to promote comfort (prepu question)

low fowler's position

stage 1 pressure ulcer

non-blanchable erythema of skin intact

responsibility of a nurse in MA of reporting elder abuse/neglect

nurses who suspect elder abuse, neglect or misappropriation must immediately report it to their supervisor (verbally)

who is at an increased risk of infection after bariatric surgery? (prepu question)

older adults adults with a greater body mass males

anti-obesity medications

orlistat

a client with obesity reports pain in the joints. which musculoskeletal condition related to obesity does the nurse suspect the client has? (prepu question)

osteoarthritis

bmi indicators

overweight: 25-29.9 obesity: 30-39.9 severe or extreme obesity: 40+

stage 2 pressure ulcer

partial thickness skin loss with exposed dermis

relationship between obesity and pressure injuries

patients with obesity are at an increased risk for pressure injuries

pharmacological aspects of aging

polypharmacy (use of multiple medications) - increased drug-drug interactions - over or incorrect prescribing occurs commonly in older adults altered pharmacokinetics (alterations in metabolism, absorption, distribution and excretion) - absorption: may be affected by changes in gastric pH or decreased GI motility - distribution: may be altered as a result of decreased body water and increase in body fat - metabolism, distribution & excretion: normal age-related changes or diseases that alter blood flow, liver and renal function or cardiac output

autolytic debridement

process that uses the body's own digestive enzymes to break down necrotic tissue ☆ a foul odor may be produced as the result of necrotic tissue breakdown, but does not indicate infection

How can the nurse prevent musculoskeletal complications?

proper positioning of the patient use of pillows to support or align the body educate the patient about the use of splits or assistive equipment perform weight-bearing or range of motion exercises with the patient, if possible

passive dressings

protective dressing, help maintain a moist environment

a client who is recovering from bariatric surgery has not had a bowel movement for 48 hours and bowel sounds are absent on auscultation. the nurse has informed the on-call health care provider who has prescribed insertion of a nasogastric tube to low suction. what is the nurse's best action? (prepu question)

question the order!! ng tube is contraindicated due to the client's recent bariatric surgery, as it may disrupt the surgical suture line and cause anastomotic leak or hemorrhage

"dumping syndrome"

rapid transit of food bolus from the stomach into the small intestines, causing a quick release of metabolic peptides; resulting in undesirable vasomotor and GI symptoms

major risk factors that are part of the Braden Scale

sensory perception moisture activity mobility nutrition friction and shearing

what are biochemical assessments that are useful in determining nutritional status

serum or urine tests, which can determine the level of nutrients within the body - albumin or pre albumin levels - transferrin levels - retinol-binding protein - cbc - electrolytes counts urine: - creatinine

how long are sympathomimetic amines are intended to be prescribed for? (anti-obesity medication)

short-term, no longer than 12 weeks - has many side effects and patients do tend to regain weight after stopping medication

a nurse cares for a client who is post op from bariatric surgery. once able, the nurse encourages oral intake for what primary purpose? (prepu question)

stimulate gi peristalsis

key barriers to care for people with disabilities

structural barriers negative and stereotypical attitudes lack of access to information transportation difficulties financial limitations lack of resources that understand their particular disability dependency on caregivers

likely cause of hemorrhage before 72 hours

suture disruption

phentermine, benzphetamine, diethylpropion, phendimetrazine

sympathomimetic amines: stimulate central noradrenergic receptors, causing appetite suppression

"evolution" of wound care

the nurse changes the wound dressing and products used according to the healing progression, in order to optimize wound healing

"change" of wound care

the nurse changes the wound dressing based on their observations

"practice" of wound care

the nurse practices wound dressing in order to increase skill and optimize nursing performance

the nurse observes that a client's medical report indicates that the client has Cushing syndrome. during inspection, the nurse notes that the client's BMI is 31, waist circumference is 40 inches, and localized fat pads exist around the neck and upper part of the back. which of the following must the nurse keep in mind while planning the client's care? (prepu question)

the nurse recognizes that the client's obesity may be specifically related to the endocrine disorder, performs a thorough nutritional assessment.

"selection" of wound care

the nurse selects the most appropriate wound dressing for the patient based not he provider's prescription; and is prepared to offer feedback on the appropriateness of the dressing for the patient

"categorization" of wound care

the nurse understands the different options and indications for wound dressings, as well as the contraindications and any potential adverse reactions

"double-burden" of nutrition and metabolism for developing nations

undernutrition and obesity

a client who is postoperative from bariatric surgery is diagnosed with bile reflux after reports of severe epigastric pain and vomiting of bilious material. what statements are true regarding this condition? (prepu question)

usually occurs after the disruption of the pylorus symptoms are usually relieved after pharmacological treatment

when caring for a client with obesity and diabetes after abdominal surgery, what is the client at increased risk for? (prepu question)

wound dehiscence