Utilize patient centered communication with obesity

-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, dexamethasone
suppression test, ACTH stimulation test, CT/MRI of pituitary and adrenals, plasma ACTH levels
may 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 electrolyte
imbalances.
-Nurse management of adrenalectomy: High protein diet, address HTN hyperglycemia and
hypokalemia, risk for bleeding, monitor vitals I/O and electrolytes, risk for infection, critical
circulatory instability for 48 hours after surgery, daily monitoring of urine cortisol for effectiveness
of surgery, monitor for adrenal insufficiency, bedrest until BP stabilized
-May take several months to adjust to hormone dose, avoid exposure to extreme temperatures
Addison’s disease -Usually advanced at diagnosis, autoimmune, degenerative
-Clinical manifestations: progressive weakness /fatigue, anorexia, weight loss, bronze colored skin
hyperpigmentation , 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, and
coma)
-Nurse management: Instruct patients to wear medic alert bracelet at home and carry wallet card ,
monitor for infections, administer meds (hydrocortisone), teach to take BP, increase sodium intake,
-do not stop meds abruptly
Obesity definition and etiology -Primary: Somebody takes in more calories than what their body is utilizing
-Secondary: Chromosomal/congenital abnormalities, metabolic problems, CNS lesions
and disorders
-Etiology: The process leading to and sustaining the obese state are complex. Increase in
number (hyperplasia) and size (hypertrophy) of adipocytes. Strong evidence of
significant genetic/biological susceptibility factors that are influenced by environmental
and 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 loss
Body weight classification -Body mass index (BMI)
-Waist circumference
-Waist-to-hip ratio

-Determination of body shape
Obese:
Men >40” waist
Women >35” waist
BMI Weight (kg)/Height (m
2)
-Underweight = BMI <18.5 kg/m 2
-Normal = BMI 18.5-24.9 kg/m 2
-Overweight = BMI 25-29.9 kg/m 2
-Obese = BMI >30 kg/m 2
-Extreme obesity = BMI > 40 kg/m
2
-Used with at least one other classification
Body shape