Alterations in Metabolism
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Transcript of Alterations in Metabolism
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Care of Patients with Malnutrition and Obesity
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Dietary Guidelines for AmericansFood Guide PyramidVegetarian Food Guide PyramidCultural awarenessGeriatric considerations
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Initial nutritional screeningAnthropometric measurementsBody mass indexSkin-fold measurements
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Protein-calorie malnutritionMarasmus calorie malnutrition, in
which body fat and protein are wasted, serum proteins are often preserved
KwashiorkorMarasmic-kwashiorkor
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Anorexia nervosaBulimia nervosa
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Patient historyClinical manifestationsPsychosocial assessment
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HemoglobinHematocritSerum albumin, thyroxine-binding
prealbumin and transferrinCholesterolTotal lymphocyte count
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Drugs to stimulate appetite—Periactin, Megace
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Those patients who can eat but cannot maintain adequate nutrition by oral intake of food alone
Those patients who have permanent neuromuscular impairment and cannot swallow
Those patients who do not have permanent neuromuscular impairment but are critically ill and cannot eat because of their condition
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Nasoenteric tube (NET)Nasogastric tube (NG)Nasoduodenal tube (NDT)
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GastrostomyPercutaneous endoscopic
gastrostomy (PEG)Low-profile gastrostomy device
(LPGD) Jejunostomy
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Bolus feedingContinuous feedingCyclic feeding
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Refeeding syndromeTube misplacement and
dislodgementAbdominal distention and nausea
and vomitingFluid and electrolyte imbalances
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Partial parenteral nutritionTotal parenteral nutrition
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Fluid imbalancesElectrolyte imbalances
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Home care managementHealth teachingHealth care resources
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Overweight—increase in body weight for height compared with standard, or up to 10% greater than ideal body weight
Obesity—excess amount of body fat when compared with lean body mass, at least 20% above upper limit of normal range for ideal body weight
Morbid obesity—severe negative effect on health, usually more than 100% above ideal body weight
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More than half of adults in the United States are estimated to be overweight or obese.
The proportion of adolescents from poor households who are overweight or obese is twice that of adolescents from middle- and high-income households.
Obesity is especially prevalent among women with lower incomes and is more common among African American and Mexican American women than among white women.
Among African Americans, the proportion of women who are obese is 80 percent higher than the proportion of men who are obese.
This gender difference also is seen among Mexican American women and men, but the percentage of white, non-Hispanic women and men who are obese is about the same.
Accessed www.healthypeople.gov 14june10
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HypertensionHyperlipidemiaCADStrokePeripheral arterial diseaseMetabolic syndromeObstructive sleep apneaObesity hypoventilation syndrome
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Depression and other mental health problems
Urinary incontinenceCholelithiasisGoutChronic back painEarly osteoarthritisDecreased wound healing
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DietPhysical inactivityDrug treatmentFamiliar and genetic factors
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Patient historyClinical manifestationsPsychosocial assessment
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Diet programs Nutrition therapy Exercise program Drug therapy—Meridia, Tenuate,
Bontril, Xenical Behavioral management Complementary and alternative
therapies—acupuncture, acupressure, ayurvedic therapy hypnosis
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LiposuctionBariatrics—branch of medicine that
manages obesity and its related diseases: Gastric restrictive Malabsorption Both
Preoperative care
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Gastric restriction
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Malabsorption surgeryGastric bypass
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Airway managementPain managementPatient and staff safetyCare of NG tubeAssess for anastomotic leaks
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Abdominal binderPosition Monitor SaO2
Sequential compression hose and/or heparin
Assess skinAbsorbent paddingRemove urinary catheter within 24
hours
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Assist patient out of bedAmbulation as soon as possibleMonitor abdominal girth6 small feedings and prevent
dehydrationObserve for signs of dumping
syndrome