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Malnutrition &

Obesity

Keith Rischer RN, MA, CEN

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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.

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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/malabsorptionCOPD

Measurement of height and weightAssessment of body mass index-BMI

– Weight (lbs)/height (inches) x703=– 190/72 x703=26.6 BMI– Ideal 20-25

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Malnutrition in Acute Care

Who is at risk?PovertyDrug & ETOH abuseN/V/D

Lab Values Complications

Poor wound healing Increased risk of infectionLethargy

Activity intolerance

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Nursing Considerations: Malnourished

Low protein stores loss of muscle and lean body mass decreased drug binding increase in levels of free circulating drugs

increasing drug toxicity

Drugs given subcutaneous or IM closely monitored adipose tissue has decreased blood supply

delayed action and unpredictable duration IM can inadvertently be given subcutaneous

Cutaneous patches may deliver drugs with erratic action

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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

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Imbalanced Nutrition: Less Than Body Requirements

IV Total Parenteral Nutrition (TPN) Central access Lipids Protein-dextrose-vitamins

Nursing Considerations Monitor daily wt./ I&O Carefully check contents

Complications Fluid imbalance Lyte imbalances

Check labs Liver function

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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

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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

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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

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Complications of Obesity

Diabetes mellitus Hypertension Hyperlipidemia CAD Obstructive sleep apnea Obesity hypoventilation syndrome Depression and other mental

health/behavioral health problems

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Contributing Factors to Obesity

Diet Physical inactivity Drugs

CorticosteroidsEstrogensNSAIDSAntihypertensivesAntidepressants and psychoactive drugs

Genetics

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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

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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

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Nonsurgical Management of Obesity

Fasting Novelty diets

Atkins

Diet therapy Weight watchers etc.

Exercise program Behavior modification

Food diary Emotional/situational influences

Drug therapy Xenical

Inhibits lipase…fats are partially digested

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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

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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

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Dietary Concerns: Bariatric Surgery

Nutritional supplements Iron deficiency B-12 deficiency

B12 injections Dietary modifications

Avoid foods high in sugarAvoid alcoholic beveragesAvoid high protein foods