Malnutrition Obesity Keith Rischer RN MA CEN 1

Malnutrition & Obesity Keith Rischer RN, MA, CEN 1

Today’s Objectives… Ø Ø Ø 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 Ø Ø Dietary recommendations q 1800 calories/day… 0. 8 gm protein per kg q Risk of malnutrition if <70% Nutritional assessment includes: q Diet history q Exam and health history ü GI disease/malabsorption ü COPD q Measurement of height and weight ü Assessment of body mass index-BMI – Weight (lbs)/height (inches) x 703= – 190/72 x 703=26. 6 BMI – Ideal 20 -25 3

Malnutrition in Acute Care Ø Who is at risk? q Poverty q Drug & ETOH abuse q N/V/D Lab Values Ø Complications Ø q Poor wound healing q Increased risk of infection q Lethargy ü Activity intolerance 4

Nursing Considerations: Malnourished Ø Low protein stores q q q loss of muscle and lean body mass decreased drug binding increase in levels of free circulating drugs ü Ø Drugs given subcutaneous or IM closely monitored q adipose tissue has decreased blood supply ü q Ø 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 Ø Enteral Feedings q Ø Types Nursing Considerations q q q Confirm placement Check residuals Change bag qd 4 hours of formula at time Monitor labs ü Ø Lytes, albumin, hgb Complications q q Aspiration Diarrhea 6

Imbalanced Nutrition: Less Than Body Requirements Ø IV Total Parenteral Nutrition (TPN) q q q Ø Nursing Considerations q q Ø Central access Lipids Protein-dextrose-vitamins Monitor daily wt. / I&O Carefully check contents Complications q q Fluid imbalance Lyte imbalances ü ü Check labs Liver function 7

Obesity Ø Ø Ø 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 Ø Ø Ø 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 Ø Ø Ø 17% children overweight Between 8% - 45% of newly diagnosed cases of childhood diabetes are type II, associated with obesity. q 4% of Childhood diabetes was type II in 1990 q Now 20% Of Children diagnosed with Type II diabetes, 85% are obese q 25% of all white children overweight 2001 q 33% African American and Hispanic children overweight 2001 10

Complications of Obesity Diabetes mellitus Ø Hypertension Ø Hyperlipidemia Ø CAD Ø Obstructive sleep apnea Ø Obesity hypoventilation syndrome Ø Depression and other mental health/behavioral health problems Ø 11

Contributing Factors to Obesity Diet Ø Physical inactivity Ø Drugs Ø q Corticosteroids q Estrogens q NSAIDS q Antihypertensives q Antidepressants Ø and psychoactive drugs Genetics 12

Weight Loss Strategies/Education Ø Goal reduce body weight by 10% of baseline within 6 months q loss of 1 to 2 lbs/week q Decrease caloric intake 300 -500 day q Ø Ø 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 Ø Ø Ø Skin care q high risk for breakdown and delayed wound healing q Folds become moist and harbor yeast and bacteria q Use of powders discouraged ü daily inspection, frequent turning, watch for shearing Risk for DVT q Early mobility Inability to obtain definitive diagnosis with scans and radiological tests 14

Nonsurgical Management of Obesity Ø Ø Fasting Novelty diets q Ø Diet therapy q Ø Ø Atkins Weight watchers etc. Exercise program Behavior modification Food diary q Emotional/situational influences q Ø Drug therapy q Xenical ü Inhibits lipase…fats are partially digested 15

Bariatric Surgery Ø BMI 40 or higher q Ø Ø or 35 – 39. 9 with related health problem Must agree to strict lifestyle/diet regimen Post op care priorities 16

Complications: Bariatric Surgery Ø Ø Ø DVT-PE Narrowing of the opening between the stomach and small intestine – strictures can form Gallstones Bleeding ulcers q 1 in 100 may develop Altered digestion, long-term nutritional deficiencies Dumping syndrome q Ø tachycardia, nausea, diarrhea, abdominal cramping Infections 17

Dietary Concerns: Bariatric Surgery Ø Nutritional supplements q Iron deficiency q B-12 deficiency ü B 12 injections Ø Dietary modifications q Avoid foods high in sugar q Avoid alcoholic beverages q Avoid high protein foods 18