obesity

• underweight BMI: less than 18.5
• normal weight BMI: 18.5-24.9
• overweight BMI: 25-29.9
• obesity (class 1) BMI: 30-34.9
• obesity (class 2) BMI: 35-39.9
• extreme obesity (class 3): greater than 40
• leptin: excreted by fat cells communicates satiety (full signals)
• ghrelin: excreted by stomach fundus/pancreas cells to signal hunger ("Growling")
• interventions typically begin in obesity (class 1) stage (30-34.9 BMI)
• bariatric surgery typically occurs in obesity (class 2) stage (35-39.9 BMI)
• treatment for obesity: weight loss therapy, diet therapy (FIRST intervention), physical activity, behavioral therapy, and medications
• bariatric surgery: recommended for 40 BMI or 35 BMI with comorbidities
• restrictive bariatric surgery: placement of a silicone band around the fundus of the stomach causing a restriction in the amount of food intake BUT band can erode or food can get stuck in the band
• malabsorptive bariatric surgery: rarely done now
• combination bariatric surgery: induce weight loss primarily through restriction but also create a component of malabsorption
• combination surgery = Roux-en-Y (RYBG)

  complications: paralic ileus, rupture, decreased blood supply, adhesion, abdominal pain, decreased bowel movements, and throwing up
• complications of surgery: pulmonary embolism, infection, anastomosis leak (EMERGENCY), and dumping syndrome
• anastomosis leak: emergency, patient is getting septic

  • rapid heart rate, fever, stomach pain, drainage from surgical wound
  • nausea, vomiting, pain in left shoulder area, low blood pressure, decreased urine output
• dumping syndrome: when high osmotic food enters the small intestines

  • results of stomach contents being rapidly dumped into the small intestines and occurs because of this rapid delivery of large amounts of active solids and liquids in the duodenum
• manifestations of dumping syndrome: nausea, vomiting, abdominal pain and cramps, diarrhea, bloating, fatigue, heart palpitations, and rapid heart rate
• interventions for dumping syndrome: diet modification *** (increase protein to increase amount of time the food takes to digest and avoid breads and fluids before a meal)
• bariatric surgery: 1-2 day hospitalization and observe for complications and educate on S&S of blood glucose going to low since the removal of ghrelin they cant tell
• nursing goal for surgery: healing without signs and symptoms of infection or complicatioins
• when checking vital signs for obese patients use appropriately sized equipment
• monitor potassium and sodium in these patients
• nursing interventions: obtain appropriately sized equipment for care, apply SCDs as ordered, encourage self care and mobility, turn patients frequently, use slide and transfer assistive devices, assist patient with skin care, and administer pain medication
• do NOT reposition NG tube and the surgeon is the only one to reposition, replace, or remove the NG tube post surgery
• educate patient on dietary needs: Vit B12, thiamine, Vit D, iron, calcium, copper, fat, soluble vitamins, fiber, and small frequent meals
• REPORT shortness of breath, tachycardia, severe abdominal pain, fever, purulent discharge or redness at wounds, and hypotension to the PROVIDER