Problems occur at higher rates for obese patients

Mortality rate rises as obesity increases

Especially with increased visceral fat

Obese patients have a decreased quality
of life

Most conditions improve with weight loss

Impact of obesity on body systems:

o       BMI > 30 and waist circumference > 102cm men and > 88cm women

o       Consider environmental, genetic, socioeconomic, and emotional  factors

o       Patient may withhold information out of embarrassment or shyness

o       Provide acceptable reasons for personally intrusive questions

o       Health history of obesity:

o       Time of obesity onset

o       Diseases related to metabolism and obesity

o       Medications

o       Height, weight, BMI, waist circumference

o       Interested in losing weight

o       Contributors to weight gain

o       What impedes weight loss

o       How patient uses food (e.g., to relieve stress, provide comfort)

o       Other overweight family members

o       Environmental or genetic factors influencing weight gain

o       Diet teaching

o       Identify social support/support groups

o       Post gastric bypass surgery care

o       Medication education (appetite suppressant, fat blocking)

o       Behavior modification

o       Modify eating patterns

o       Participate in a regular physical activity program

o       Achieve weight loss to a specified level

o       Maintain weight loss at a specified level

o       Minimize or prevent health problems related to obesity

o       Life long change

• NPO

·        Clear liquid diet

·        Full liquid diet

·        Regular

• Diet as tolerated

·        Sodium restricted diets

·        Soft/Low residue diet

·        Low cholesterol diet

·        Carb controlled (diabetic)

Assessing Hydration

Distribution of body fluids 

o       ICF

o       ECF

§         Intravascular and Interstitial

o       ICF-potassium and magnesium

o       ECF-sodium and chloride

o       Average adult needs approx 2500ml/day

o       Thirst is primary regulator

o       Fluid loss counterbalances fluid intake

o       Urine, insensible loss (skin/lungs), sensible loss thru skin, feces

o       24H period-provides information about fluid/electrolyte balance

o       Intake: oral fluids, ice chips, foods that are liquid at room temp, tube feedings, parenteral fluids, IV medications, catheter/tube irrigants

o       Output: urine, vomitus, liquid feces, tube drainage, wound drainage

o       Urinary output = intake (1500-2000ml 24H)

o       Lab tests: serum electrolytes, serum osmolality, hematocrit

Fluid imbalances:

·        Body loses both water and electrolytes from ECF (isotonic)

·        Causes:

o       Increased losses: vomiting, diarrhea, excessive seating, polyuria, fever, nasogastric suction, excess drainage or wound losses; insufficient intake: anorexia, nausea, inability to access fluids, impaired swallowing, confusion and depression

o       Third space syndrome-shift of fluid to area where it is not accessible for use by the body

·        Clinical manifestations:

o       Complaints of weakness and thirst, weight loss, fluid intake less than output, decreased tissue turgor, dry mucous membranes, sunken eyeballs, subnormal temperature, weak, rapid pulse, decreased blood pressure, orthostatic hypotension, increased hematocrit, decreased urine volume, increased specific gravity of urine

o       Monitor weight and vital signs, including temperature, assess tissue turgor, monitor fluid intake and output, monitor laboratory findings, administer oral and IV fluids, frequent mouth care, measures to prevent skin breakdown, provide for safety

compromises cardio-respiratory function

·        Increase in both sodium and water (isotonic)

o       Excessive intake of sodium chloride (alka-seltzer, rapid IV infusion), congestive heart failure, renal failure, liver failure

o       Weight gain, fluid intake > output, full bounding pulse, tachycardia, increased blood pressure and central venous pressure, moist crackles, dyspnea, mental confusion

o       Edema: ECF increase in water and sodium content

§         Most apparent in eyes, and dependent limbs

§         Low levels of plasma proteins

§         Pitting edema-edema that leaves a small depression or pit caused when pressure is applied caused by movement of fluid to adjacent tissue (graded from 1+-4+)

o       weight, vital signs, assess for edema, breath sounds, fluid intake and output, lab findings, place in Fowler’s position, administer diuretics as ordered, restrict fluid intake, restrict dietary sodium, implement measures to prevent skin breakdown

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      • Older adults are at risk for dehydration because of decrease thirst sensation
      • Older adults may have mobility and cognitions problems that prevents them from getting enough to drink
      • Many older adults have decreased renal function
      • Decreased sensible and insensible water loss related to a decrease in the number of functioning sweat glands