Malnutrition and Obesity

Caused by a lack of adequate nutrients or an imbalanced intake of nutrients and can be identified in clients who are underweight, overweight, or obese

malnutrition

Major causes of malnutrition are:
M____ and M____
Decreased q_____ of l____
Increased h____ c____ c___

morbidity and mortality
decreased quality of life
increased healthcare costs

Healthy people 2030 Goal: Increase proportion of primary care practitioners who regularly measure ____ of adult clients

BMI

Healthy people 2030 goal:  Increase proportion of physician office visits made by ____ clients who are ____ that include counseling for education related ____ reduction, ____ & ____ activity

adult
obese
weight
nutrition
physical

Healthy People 2030 Goal: Increase the proportion of adults who are at a ____ ____

healthy weight

Healthy People 2030 Goal: Reduce household food ____, and in doing so, reduce _____

insecurity
hunger

Clients with at least two of the following meet criteria for malnutrition:
Inadequate intake of c_____
Loss of M___ M____
Loss of s____ f____
Unintentional w____ l____
Decreased h_____ strength, indicating decreased f_____ status
w_____ loss masked by localized or generalized e____

calories
muscle mass
subcutaneous fat
weight loss
handgrip
functional
weight
edema

what are the three types of malnutrition?

protein-energy malnutrition
chronic disease related malnutrition
acute disease related or injury related malnutrition

malnutrition caused by Chronic alcohol use disorder, COPD, HIV/AIDS, Cystic Fibrosis, and Chronic Kidney disease

chronic disease related malnutrition

malnutrition caused by sepsis, burns, or multi-trauma (acute tissue injury and/or head injury)

acute disease or injury related malnutrition

How long does the nurse have to perform a malnutrition risk screening from the time a person is admitted to the hospital?

24 hours

• Treatment for malnutrition includes
  • B___ O____ diet
  • Liquid s_____
  • M_____ supplements
  • Correction of f____ & e_____ imbalances
  • E_____ feedings
  • p_____ nutrition

balanced oral
supplements
multivitamin
fluid
electrolyte
enteral
parenteral

nutrition given to the patient when they are unable to consume adequate nutrients with oral intake

enteral feedings

nutrition given to the patient when they have GI tract impairments that interfere with absorption of nutrients

parenteral nutrition

What things should we be continuously assessing when a malnourished patient is hospitalized?
D____ A___
D____ W____
I___ & O____
M_____ L____

document appetite
daily weights
intake & output
monitor labs

what labs should we be monitoring when a patient is malnourished?
E____ & M____
B___
C____
C____
L___ F___ T___
A___ & P___ A___

electrolytes & minerals
BUN
Creatinine
CBC
liver function tests
albumin & pre-albumin

Who should you consult if the patient has malnutrition or is suspected to have malnutrition?

dietician

If malnutrition is related to inadequate resources, what two people should you consult?

social worker or case manager

who should you consult if the patient is having functional issues?

PT/OT

As a nurse we should ___ the patient and counsel the patient about d___-N___ interactions and assists them with n___ d___ foods and ways to increase c____ i___

educate
drug-nutrient
nutrient dense
calorie intake

Environmental Actions to promote optimal intake:
____ management before ____
decrease ____ ___
eliminate ____/clear area of ____, ____, etc.

pain
meals
strong odors
distractions
urinals
bedpans

Comfort: Actions to promote optimal intake:
H____ activities before ____
H____ A___
E____ G___
S____ U___ I____ C____

hygiene
meals
hearing aids
eye glasses
sitting up in chair

Function Actions to promote optimal intake:
Eliminate n___-u___ care activities
Ensure appropriate t____ of f____/f_____
Encourage to f____ s_____ as much as possible but assist if needed
Assists to o____ p_____ or c____ f____ if needed
Allow time to c____ and s_____

non-urgent
temperature
foods/fluids
feed self
open packages
cut food
chew
swallow

Chronic condition caused by calorie intake in excess of energy expenditure that can be affected by many factors: cultural, metabolism, environment, socioeconomics, individual behaviors

obesity

What are te risk factors of obesity?

genetic predisposition
hormones

what behavioral factors can cause obesity?

sedentary lifestyle
diet choices

what hormones can affect obesity?

Leptin and Ghrelin

satiety (produced by adipose tissue)

Leptin

hunger (produced by stomach)

Ghrelin

BMI of 25-29.9

overweight

BMI of >30

obesity

what is considered an obese waist circumference in females?

88.9 cm (35 inches)

what is considered an obese waist circumference in males?

101.6 cm (40 inches)

Indicates excess weight in waist and abdomen and is used as a predictor of CAD

waist-to-hip ratio

what is a waist-to-hip ratio that is considered obesity for females?

0.8 or greater

what is a waist-to-hip ratio that is considered obesity for males?

0.95 or greater

The nurse can help obese patients adopt a h____ e____ p____ and decrease ___-___ kcal/day

healthy eating plan
500-750

behavior modification strategies for obesity:
G___ S___
a___ of t____
In person or remote s___ g___ m___
b__ c___ c___
s___ m___ a___
m____ i____

goal setting
avoidance of triggers
support group meetings
behavior change contract
stress management activities
motivational interviewing

when can medications be used for obesity?

BMI >30 and no complications
BMI >27 and 1 complication

meds that suppress and reduce food intake that should be combine with exercise program

anorectic meds

Most effective treatment for managing obesity & related conditions

bariatric surgery

Candidates for Bariatric Surgery:
BMI > ___ and ___ complication(s) from obesity
BMI > ____ and ___ or ____ obesity related complications
BMI __-__ with T___ not well controlled with d___, p___ a___, and m_____

40
no
35
one
more
30-34.9
T2DM
diet
physical activity
medications

What are other surgical interventions for obesity?

adjustable gastric banding
Roux-en-Y gastric bypass
sleeve gastrectomy