Altered Nutrition & Obesity

• ABCD
• Anthropometric
• biochemical
• Clinical
• Dietary data

measurement of height and weight

albumin-tells us about protein status of pt.

signs and symptoms of malnutrition observed in the client

Asking pt. do you avoid any particular foods? do you watch what you eat in any way?

Rather than asking if they are on a diet

• made after assessment data is interpreted....
• Imbalanced nutrition
• Risk for imbalanced nutrition
• Adult failure to thrive
• Deficient knowledge of nutrition or food..

NANDAS

PT. must be a part of this and bite to the plan.  If they arent it wont work....

Short term goals are good and tailor it around what works for them.  Small meals, 3 meals, skip desserts, leave 1/3 of food on plate....whatever works for them

nutrition therapy- rather than "diet", use terms like eating pattern, food intake, eating style

client teaching-spend time with a dietician or nutritionist

Monitoring is before evaluation and helps you to stay on top of progress or difficulties the client is experiencing

Evaluating is seeing if interventions have worked

• Consume adequate nutrients based on calorie and needs
• Weight Management
• Physical Activity
• Encourage a variety of foods
• Limit fats
• Choose carbs wisely
• Watch sodium and K
• Watch alcohol consumption
• Practice food safety

Dietary Approaches to Stop Hypertension

• Diet rich in
• Potassium, calcium, magnesium, fiber and protein
• with reduced sodium intake

60 min a day min of cardio, weight and flexibility

• 2 c of fruit
• 2.5 c of veggies....dark green
• 3 + oz of whole grains
• 3 c of fat free milk

Less than 10% of calories from saturated fats

<300 mg/day in cholesterol, trans fats

TOTAL fat intake btwn 20-35% of total daily calories

• Polyunsaturated and monounsaturated fatty acids
• Nuts, fish and veggie oils

fiber rich fruits, vegetables and whole grains

NOT much high sugar or starch containing products

Sodium less than 2300 mg (1 tsp) daily

Potassium-eat lots of fruits and veggies

Men 2 drinks a day and women 1

an imbalance between energy expenditure and energy intake from a long term sedentary lifestyle and/or excessive calorie intake

an increase in body weight for height of approximately 50% and may not always reflect a problem if it is due to muscle mass

• -Looking at what changes in our society have lead to this obesity epedimic (sit behind desk, convenience cuz 2 income family, pace of life)
• -Looking at what healthcare providers can do to combat this issue(education, PSA)
• -Looking at patients individually and consider what issues must be considered with the patient (NPO, disease, labs, pre hospital nutrition,

• plasma protein levels
• albumin
• transferrin total iron binding capacity
• Hgb

Mild-20-30% over ideal body weight or a BMI >30

Severe-40-100% over ideal body weight or a BMI> 35

Massive-greater than 100% over ideal body weight or a BMI >40

weight in lbs/height in inches x 703

Healthy is 18.5-24.9

It's in %

Current weight/IBW X 100

• To figure out IBW...
• Allow 100 lbs for first 5 ft then add 5lbs for each additional inch.

Men-allow 106 lbs for first 5 ft, and add 6 lbs for each additional inch.

Then plug in to above equation

When you have abdominal fat out of proportion to total body fat....this is a predictor of disease morbidity

• Women >35 in
• Men>40 in

WHR of >0.8 places the person at risk for health problems

Visceral is fat in the abdomen which makes you look like an apple

Subcutaneous fat is in the hips and abdomen and makes you look like a pair, but is better to have than visceral

• Hypertension
• cardiac disease
• PVD
• sleep apnea
• chronic back pain
• DJD
• certain cancers

results from the intake of calories in amounts exceeding metabolic needs.  This excess is stored as fat in subcutaneous and viscera layers of the body

hypertrophy, enlargement of existing fat cells in adipose tissues

In teens when they are growing....if have this at any other time it will condition you to be overweight throughout life

Patient buying in to plan

by the release of triglycerides

cholesterol and bile salts

• from congenital anomalies
• chromosomal abnormalities
• metabolic problems
• CNS disorders

most often causes are polygenetic....related to interaction of both biologic and environmental factors

hypothalamus

• hypothyroid
• polycistic ovaries
• cushings

• corticosteroids
• estrogens
• NSAIDS
• anti hypertensives
• antidepressants-retains fluids
• insulin-increase appetite

Imbalanced Nutrition more than body requirements R/T inappropriate eating patterns, lack of exercise, stress AEB weight at 200% of desirable weight for heigh and body build

• modify eating patterns
• begin and continue a regular exercise program

• achieve desired weight loss to a healthy level
• maintain weight loss at a healthy level
• prevent or minimize health problems R/T obesity

lost 1-2 lbs of adipose tissue per week

requires a calorie deficit of 500-1000 calories per day to do this cuz  1 lbs of fat =3500 calories

complex carbs and proteins

require close medical supervision cuz need use high protein liquids....

So must watch K!!!

200-800 calories a day....must be under medical supervision and can only be for short periods of time

• complex carbs
• fiber
• proteins
• unsaturated fats

• women-1200 calories/day
• mens-1500 calories/day

Total fat 30% or less or total calories

Count calories NOT FAT!!

• Fried foods
• Ramen Noodles
• Cup of Soups
• Cake mixes
• Bisquick
• Margarine/butter

3-4 glasses 4 x's a day within a 1/2 period and drink water before and with meals

Dudek list...

• 30 min a day most days
• BUT
• 60 min to prevent weight gain
• 60-90 min to sustain weight loss

brisk walking

• Appetite suppressant
• increases metabolic rate

Side effect increase in BP, HR, insomnia and constipation

blocks 1/3 of fat absorption

Side effect:  abdominal cramps, loos stools, anal leakage, decrease in absorption of fat soluble vitamins

• Been obese for over 5 years 
• MORBIDLY OBESE
• BMI of >35
• NO endocrine problems
• Psychiatric and social stability

Restrictive-stomach stapling or vertical banded gastroplasty

stomach is partitioned and stomach volume is reduced by placement of sutures horizontally or vertically creating a small pouch.

Limits intake by increaseing feeling of fullness

• 15-30mLs or less
• No fluids with meals
• Typical gastric volume afterwards is 2-6 oz

facilitates weight loss through a reduction in calorie absorption, usually in conjunction with a restrictive procedure

Gastric Bypass

Stomach is stapled completely horizontally with a small opening for food to sit in.

jejunum is resected from the duodenum and connected to the stomach entrance and the distal duodenal stump is connected to the jejunum

food passes from the stomach pouch directly to the jejunum BYPASSING most of the stomach and duodenum.

Advantage is higher weight loss and more successful keeping weight off than Gastric banding

• Uncontrolled vomitting and pain if too much intake
• leaks from gut to abdomonal cavity...causing peritinitis
• GERD and heartburn
• Nutritional deficits
• Anemia

Only with Gastric Bypass or RNY

occurs a few weeks after surgery

When during a meal or 5-30 min after the meal person becomes weak, syncope, pallor, vertigo, palpitations, diaphoresis, tachy

cuz food enters directly in to the jejunum without undergoing usual changes and dilution in the stomach.

CHYME is HYPEROSMOLAR

Increase in BP and immediate decrease in BP

pt. feels full, discomfort, distention, diarrhea, abdominal cramping, nausea, hyperactive bowel sounds

Caused by intense gastrocolic reflex and excessive amounts of insulin

• Besides usual post op care
• HOB 30-45
• Medicate for pain...very painful procedure
• N/G tube on low continuous suction (LCS)
• Avoid blockage by eating slow and chewing well
• Watch for perforation of stomach staples

• Day 1-4 clear liquid
• Day 5 Pureed
• Then blenderized for 8 weeks, introducing soft bland foods

NO MORE THAN 1oz of total food and fluids at first

Take vitamin and mineral supplements

high protein shakes

• upper abdominal pain
• should and back as well

• high protein for healing
• low carb to prevent dumping
• low roughage cuz cant digest
• low fat for gas
• 6 small meals

FLUID between meals, not with meals so dont stretch the pouch

60-70% of excess weight....quickly gone!!

• INFECTION
• anemia
• vitamin deficienty
• diarrhea
• psychiatric problems

Hard to heal fat....so it is common for dehisence.  Need to get pt. lots of proteins and make sure they dont stretch the abdomen

seen after gastric surgery and is a dense layer of fatty tissue growth consisting of subcutaneous skin-"apron of fat" that hangs down/over

Found in lower abdominal area

• psychiatric evaluation
• counseling
• lifestyle modifications