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Malnutrition & Obesity Keith Rischer RN, MA, CEN 1 Today’s Objectives… Explain the potential consequences and complications associated with malnutrition. Analyze assessment data to determine common nursing diagnoses for the client with malnutrition. Explain the potential consequences, contributing factors and complications associated with obesity. Contrast non-surgical vs. surgical management of obesity. Describe post-op complications of bariatric surgery and lifelong dietary modifications required. 2 Nutritional Standards Dietary recommendations 1800 calories/day…0.8 gm protein per kg Risk of malnutrition if <70% Nutritional assessment includes: Diet history Exam and health history GI disease/malabsorption COPD Measurement of height and weight Assessment of body mass index-BMI – Weight (lbs)/height (inches) x703= – 190/72 x703=26.6 BMI – Ideal 20-25 3 Malnutrition in Acute Care Who is at risk? Poverty Drug & ETOH abuse N/V/D Lab Values Complications Poor wound healing Increased risk of infection Lethargy Activity intolerance 4 Nursing Considerations: Malnourished Low protein stores loss of muscle and lean body mass decreased drug binding increase in levels of free circulating drugs Drugs given subcutaneous or IM closely monitored adipose tissue has decreased blood supply increasing drug toxicity delayed action and unpredictable duration IM can inadvertently be given subcutaneous Cutaneous patches may deliver drugs with erratic action 5 Imbalanced Nutrition: Less Than Body Requirements Enteral Feedings Types Nursing Considerations Confirm placement Check residuals Change bag qd 4 hours of formula at time Monitor labs Lytes, albumin, hgb Complications Aspiration Diarrhea 6 Imbalanced Nutrition: Less Than Body Requirements IV Total Parenteral Nutrition (TPN) Nursing Considerations Central access Lipids Protein-dextrose-vitamins Monitor daily wt./ I&O Carefully check contents Complications Fluid imbalance Lyte imbalances Check labs Liver function 7 Obesity USA Obesity Rates Reach Epidemic Proportions Data (2003) suggests 6% of population is obese Eight out of 10 over 25's Overweight 78% of American's not meeting basic activity level recommendations 25% completely Sedentary 76% increase in Type II diabetes in adults 30-40 yrs old since 1990 8 Obesity related diseases 80% of type II diabetes related to obesity 70% of Cardiovascular disease related to obesity 42% breast and colon cancer diagnosed among obese individuals 30% of gall bladder surgery related to obesity 26% of obese people having high blood pressure 9 Childhood Obesity 17% children overweight Between 8% - 45% of newly diagnosed cases of childhood diabetes are type II, associated with obesity. 4% of Childhood diabetes was type II in 1990 Now 20% Of Children diagnosed with Type II diabetes, 85% are obese 25% of all white children overweight 2001 33% African American and Hispanic children overweight 2001 10 Complications of Obesity Diabetes mellitus Hypertension Hyperlipidemia CAD Obstructive sleep apnea Obesity hypoventilation syndrome Depression and other mental health/behavioral health problems 11 Contributing Factors to Obesity Diet Physical inactivity Drugs Corticosteroids Estrogens NSAIDS Antihypertensives Antidepressants and psychoactive drugs Genetics 12 Weight Loss Strategies/Education Goal reduce body weight by 10% of baseline within 6 months loss of 1 to 2 lbs/week Decrease caloric intake 300-500 day Eat slowly so that the brain gets the message that the stomach is full Take seconds of vegetables and salads instead of higher calorie foods Try to eat 3 balanced meals at regular times Record all food eaten 13 Nursing Considerations: Obesity Skin care high risk for breakdown and delayed wound healing Folds become moist and harbor yeast and bacteria Use of powders discouraged daily inspection, frequent turning, watch for shearing Risk for DVT Early mobility Inability to obtain definitive diagnosis with scans and radiological tests 14 Nonsurgical Management of Obesity Fasting Novelty diets Diet therapy Atkins Weight watchers etc. Exercise program Behavior modification Food diary Emotional/situational influences Drug therapy Xenical Inhibits lipase…fats are partially digested 15 Bariatric Surgery BMI 40 or higher or 35 – 39.9 with related health problem Must agree to strict lifestyle/diet regimen Post op care priorities 16 Complications: Bariatric Surgery DVT-PE Narrowing of the opening between the stomach and small intestine – strictures can form Gallstones Bleeding ulcers 1 in 100 may develop Altered digestion, long-term nutritional deficiencies Dumping syndrome tachycardia, nausea, diarrhea, abdominal cramping Infections 17 Dietary Concerns: Bariatric Surgery Nutritional supplements Iron deficiency B-12 deficiency B12 injections Dietary modifications Avoid foods high in sugar Avoid alcoholic beverages Avoid high protein foods 18