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Malnutrition
&
Obesity
Keith Rischer RN, MA, CEN
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Today’s Objectives…
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Explain the potential consequences and complications
associated with malnutrition.
Analyze assessment data to determine common
nursing diagnoses for the client with malnutrition.
Explain the potential consequences, contributing
factors and complications associated with obesity.
Contrast non-surgical vs. surgical management of
obesity.
Describe post-op complications of bariatric surgery
and lifelong dietary modifications required.
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Nutritional Standards
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Dietary recommendations
 1800 calories/day…0.8 gm protein per kg
 Risk of malnutrition if <70%
Nutritional assessment includes:
 Diet history
 Exam and health history
 GI disease/malabsorption
 COPD
 Measurement of height and weight
 Assessment of body mass index-BMI
– Weight (lbs)/height (inches) x703=
– 190/72 x703=26.6 BMI
– Ideal 20-25
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Malnutrition in Acute Care
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Who is at risk?
 Poverty
 Drug
& ETOH abuse
 N/V/D
Lab Values
 Complications
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 Poor
wound healing
 Increased risk of infection
 Lethargy
 Activity
intolerance
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Nursing Considerations: Malnourished
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Low protein stores
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loss of muscle and lean body mass
decreased drug binding
increase in levels of free circulating drugs
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Drugs given subcutaneous or IM closely monitored
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adipose tissue has decreased blood supply
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increasing drug toxicity
delayed action and unpredictable duration
IM can inadvertently be given subcutaneous
Cutaneous patches may deliver drugs with erratic action
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Imbalanced Nutrition: Less Than Body
Requirements
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Enteral Feedings
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Types
Nursing Considerations
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Confirm placement
Check residuals
Change bag qd
4 hours of formula at time
Monitor labs
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Lytes, albumin, hgb
Complications
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Aspiration
Diarrhea
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Imbalanced Nutrition: Less Than
Body Requirements
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IV Total Parenteral Nutrition (TPN)
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Nursing Considerations
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Central access
Lipids
Protein-dextrose-vitamins
Monitor daily wt./ I&O
Carefully check contents
Complications
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Fluid imbalance
Lyte imbalances
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Check labs
Liver function
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Obesity
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USA Obesity Rates Reach Epidemic Proportions
Data (2003) suggests 6% of population is obese
Eight out of 10 over 25's Overweight
78% of American's not meeting basic activity level
recommendations
25% completely Sedentary
76% increase in Type II diabetes in adults 30-40 yrs old since
1990
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Obesity related diseases
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80% of type II diabetes related
to obesity
70% of Cardiovascular disease
related to obesity
42% breast and colon cancer
diagnosed among obese
individuals
30% of gall bladder surgery
related to obesity
26% of obese people having
high blood pressure
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Childhood Obesity
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17% children overweight
Between 8% - 45% of newly diagnosed cases of
childhood diabetes are type II, associated with obesity.
 4% of Childhood diabetes was type II in 1990
 Now 20%
Of Children diagnosed with Type II diabetes, 85% are
obese
 25% of all white children overweight 2001
 33% African American and Hispanic children
overweight 2001
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Complications of Obesity
Diabetes mellitus
 Hypertension
 Hyperlipidemia
 CAD
 Obstructive sleep apnea
 Obesity hypoventilation syndrome
 Depression and other mental
health/behavioral health problems
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Contributing Factors to Obesity
Diet
 Physical inactivity
 Drugs
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 Corticosteroids
 Estrogens
 NSAIDS
 Antihypertensives
 Antidepressants
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and psychoactive drugs
Genetics
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Weight Loss Strategies/Education
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Goal
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reduce body weight by 10% of baseline within 6 months
loss of 1 to 2 lbs/week
Decrease caloric intake 300-500 day
Eat slowly so that the brain gets the message that
the stomach is full
Take seconds of vegetables and salads instead of
higher calorie foods
Try to eat 3 balanced meals
at regular times
Record all food eaten
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Nursing Considerations: Obesity
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Skin care
 high risk for breakdown and delayed wound healing
 Folds become moist and harbor yeast and bacteria
 Use of powders discouraged
 daily inspection, frequent turning, watch for
shearing
Risk for DVT
 Early mobility
Inability to obtain definitive diagnosis with scans and
radiological tests
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Nonsurgical Management of
Obesity
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Fasting
Novelty diets
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Diet therapy
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Atkins
Weight watchers etc.
Exercise program
Behavior modification
Food diary
 Emotional/situational influences
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Drug therapy
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Xenical
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Inhibits lipase…fats are partially digested
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Bariatric Surgery
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BMI 40 or higher
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or 35 – 39.9 with related health problem
Must agree to strict lifestyle/diet regimen
Post op care priorities
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Complications: Bariatric Surgery
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DVT-PE
Narrowing of the opening between the stomach and small
intestine – strictures can form
Gallstones
Bleeding ulcers
 1 in 100 may develop Altered digestion, long-term
nutritional deficiencies
Dumping syndrome
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tachycardia, nausea, diarrhea, abdominal cramping
Infections
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Dietary Concerns: Bariatric Surgery
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Nutritional supplements
 Iron
deficiency
 B-12 deficiency
 B12 injections
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Dietary modifications
 Avoid
foods high in sugar
 Avoid alcoholic beverages
 Avoid high protein foods
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