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Utilize patient centered communication with obesity

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-Utilize patient-centered communication with obesity individuals.-Summarize the nutritional therapy and exercise plans for obese individuals.-Describe the collaborative care and nursing management for obese individuals.-Compare and contrast the different bariatric surgical procedures.-Describe the clinical manifestations, nursing and collaborative management-ACTH-secreting pituitary adenoma, adrenal tumors, lungs/pancreas tumors-Hypokalemia and hypertension(d/t potassium loss and sodium retention)-Risk for infection because of the inhibition of immune response-Diagnostic studies: plasma cortisol, 24 hr urine cortisol, salivary cortisol, dexamethasonesuppression test, ACTH stimulation test, CT/MRI of pituitary and adrenals, plasma ACTH levelsmay be low, elevated, or normal-Treatment:Normalize hormone secretion.Suppress synthesis and production of cortisol.Surgical removal of tumors or adrenalectomy. Address fluid volume excess and electrolyteimbalances.-Nurse management of adrenalectomy: High protein diet, address HTN hyperglycemia andhypokalemia, risk for bleeding, monitor vitals I/O and electrolytes, risk for infection, criticalcirculatory instability for 48 hours after surgery, daily monitoring of urine cortisol for effectivenessof surgery, monitor for adrenal insufficiency, bedrest until BP stabilized-May take several months to adjust to hormone dose, avoid exposure to extreme temperaturesAddison’s disease-Usually advanced at diagnosis, autoimmune, degenerative-Clinical manifestations: progressiveweakness/fatigue, anorexia, weight loss,bronze colored skinhyperpigmentation, orthostatic hypotension, hyponatremia (salt cravings),hyperkalemia, n/v,diarrhea, hypercalcemia-Addisonian crisis: Emergency caused by sharp drop in adrenocortical hormones (high fever,weakness, severe abdominal/lower back/leg pains, vomiting, diarrhea, hypotension, shock, andcoma)-Nurse management: Instruct patients to wearmedic alert braceletat home and carrywallet card,monitor for infections, administer meds (hydrocortisone), teach to take BP, increase sodium intake,-do not stop meds abruptlyObesity definition and etiology-Primary: Somebody takes in more calories than what their body is utilizing-Secondary: Chromosomal/congenital abnormalities, metabolic problems, CNS lesionsand disorders-Etiology: The process leading to and sustaining the obese state are complex. Increase innumber (hyperplasia) and size (hypertrophy) of adipocytes. Strong evidence ofsignificant genetic/biological susceptibility factors that are influenced by environmentaland psychosocial factors. Research has identified several genes linked to obesity.-50-100% increased mortality-Spend 42% more on healthcare and costs-Most conditions can improve with weight lossBody weight classification-Body mass index (BMI)-Waist circumference-Waist-to-hip ratio
-Determination of body shapeObese:Men >40” waistWomen >35” waistBMIWeight (kg)/Height (m2)-Underweight = BMI <18.5 kg/m2-Normal = BMI 18.5-24.9 kg/m2-Overweight = BMI 25-29.9 kg/m2-Obese = BMI >30 kg/m2-Extreme obesity = BMI > 40 kg/m2-Used with at least one other classificationBody shape

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Term
Fall
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Tags
Blood sugar, contrast dye

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