Nursing A ConceptBased Approach to Learning VOLUME ONE
Nursing: A Concept-Based Approach to Learning VOLUME ONE EDITION VOLUME ONE|| SECOND EDITION MODULE 12 Metabolism Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Exemplar 12. 4 Obesity Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Exemplar Learning Outcomes After reading about this exemplar, you will be able to: 1. Describe the pathophysiology, etiology, clinical manifestations, and direct and indirect causes of obesity. 2. Identify risk factors and prevention methods associated with obesity. 3. Illustrate the nursing process in providing culturally competent care across the life span for individuals with obesity. Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Exemplar Learning Outcomes, continued After reading about this exemplar, you will be able to: 4. Formulate priority nursing diagnoses appropriate for an individual with obesity. 5. Summarize therapies used by interdisciplinary teams in the collaborative care of an individual with obesity. Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Exemplar Learning Outcomes, continued After reading about this exemplar, you will be able to: 6. Plan evidence-based care for an individual with obesity and his or her family in collaboration with other members of the healthcare team. 7. Evaluate expected outcomes for an individual with obesity. Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Overview • Obesity excess of adipose tissue § Most prevalent preventable health problem in U. S. § Has serious physiology and psychological consequences § Associated with increased morbidity and mortality § 35% adults in U. S. are obese § 17% of children in U. S. are obese Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Pathophysiology and Etiology • Energy is required for all body activities § ADLs § Cell and tissue function • Nutrients in food provide energy • Body stores excess nutrients and energy to meet the body’s needs when nutrients are unavailable • Ability to store and release energy is important Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Pathophysiology and Etiology, continued • Basal metabolic rate (BMR) § 70% of energy goes to maintain BMR • Physical activity § 5 – 10% of energy • Excess calories stored as fat, triglycerides Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Etiology • Obesity occurs when excess calories are stored as fat • Complex systems regulate § Food intake § Energy storage § Energy expenditure • Appetite regulated by CNS, emotions • Hormones involved in regulating obesity: thyroid hormone, insulin, leptin Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Risk Factors • Genetics: hereditary contributes 25 – 40% of risk for obesity • Physical inactivity: most important contributor • Environmental factors: contribute to increased food intake • Psychological factors: low self-esteem Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Clinical Manifestations • Defined by body mass index (BMI) § BMI 25– 29. 9 kg/m 2 overweight § BMI ≥ 30 kg/m 2 obese • Upper body obesity § Waist-to-hip ratio • > 1 in men • > 0. 8 in women • Lower body obesity § Waist-to-hip ratio < 0. 8 Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Clinical Manifestations, continued • Many contributing factors § Treatment is complex § Ongoing process § Individualized program needed • Morbid obesity § BMI > 40 kg/m 2 or >200% of ideal body weight Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Complications of Obesity • Significant risk factor for cardiovascular disease • 60% have metabolic syndrome • Increases risk of insulin resistance and type 2 DM • Affects reproductive function Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Complications of Obesity, continued • Increased weight increases risk for § § § § Gallstones Several types of cancer Osteoarthritis Depression Sleep disorders Stress incontinence Low back pain Postoperative complications Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Collaboration • Treatment interdisciplinary § Focuses on reducing health risks § Changing eating, exercise habits Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Diagnostic Tests • BMI divide weight (in kg) by height (in m 2) • Anthropometry • Underwater weighing • Bioelectrical impedance • Waist circumference Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Diagnostic Tests, continued • Other tests § § § Thyroid profile Serum glucose Serum cholesterol Lipid profile ECG Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Pharmacologic Therapy • Prescription and OTC § Amphetamine, nonamphetamine appetite suppressants • Phentermine • Sibutramine (Meridia) • Orlistat (Xenical) § OTC • Bulk-forming agents Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Exercise • Critical element • Under care of physician • Aerobic exercise 30– 40 minutes 5 days each week Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Nutrition • Collaborate with nutritionist • Create diet plan to create 500– 1, 000 kcal deficit • Low kcal, low fat, high in fiber • Very-low-calorie diet for client BMI > 30 Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Behavior Modification Critical component Food records Eliminating cues that precipitate eating Examine factors that affect eating behaviors • Social support, group programs successful • • Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Surgery • Bariatric surgery BMI > 40 kg/m 2 • Restrictive/malabsorptive procedures § Bypass portion of small intestine § Rapid weight loss • Restrictive procedures § Safer § Generally less effective in long term • Complications of surgery § High risk of complications Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Nursing Process • Promote healthy eating § Diet rich in whole grains, fruits, vegetables; low in fat • Encourage children, adults to maintain an active lifestyle Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Assessment • Health history § § Risk factors, family history Recent weight gain or loss Perceptions of weight, health Diet, food intake • Physical examination § Vital signs, height, weight § Skinfold measurements Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Diagnosis • Nursing diagnoses may include: § Imbalanced Nutrition: More Than Body Requirements § Chronic Low Self-Esteem § Noncompliance § Activity Intolerance (NANDA-I © 2012) Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Planning • Goals may include that client will § § § Make sensible dietary choices Follow exercise routine Relate strategies to deal with hunger Attend support group meetings Demonstrate appropriate weight loss Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Implementation • Caring interventions § Encourage client to identify contributing factors § Establish realistic goals, objectives § Assess knowledge of balanced diet plans § Discuss behavior modification strategies § Monitor weight loss, BP, lab data Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Implementation, continued • Encourage exercise § Assess current activity level, tolerance § With medical clearance, plan program • Promote weight loss § Discuss ability, willingness to incorporate changes § Help identify behavior modification strategies § Have client establish strategies for "stress" eating Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Implementation, continued • Promote self-esteem § § Encourage client to verbalize experience Set small goals Offer positive feedback, encouragement Refer for counseling as appropriate Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Evaluation • Expected outcomes may include that client: § Identifies and understands factors contributing to weight loss § Understands and applies behavioral modification techniques to lose weight § Accomplishes desired weight loss § Incorporates physical activity into routines Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
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