Download NUR 307 Exam 4 Guide OBESITY 2025/2026 Latest and more Exams Pharmacology in PDF only on Docsity!
NUR 307 Exam 4 Guide OBESITY 2025/2026 Latest
❖ Assessment and diagnosis ➢ Understand classifications based on BMI ▪ Underweight = <18. ▪ Normal = 18.5-24. ▪ Overweight = 25-29. ▪ Obese 1 = 30-34. ▪ Obese 2 = 35-39. ▪ Obese 3 = >40+ ➢ Waist circumference ▪ Women = > ▪ Men = > ➢ Waist to hip ratio ▪ Women = .80+ ▪ Men = .90+ ▪ Android obesity = apple shape (men) ▪ Gynoid obesity = pear shape (women) ➢ Labs ▪ Cholesterol ▪ Triglyceride ▪ Fasting glucose ▪ Glycosylated hgb ▪ Hx – secondary to a disease ❖ Describe the causes, classifications, and diseases and disorders associated with obesity. ➢ Causes ▪ Less educated ▪ Earn less income ▪ Behavioral = diet, sedentary lifestyle ▪ Environmental = exposure to healthy foods, transportation to healthy foods, lack of healthy options ▪ Physiologic/Genetic = imbalances in hormones (cortisol) ▪ Women>men ▪ African, Hispanics ➢ Classification ➢ Diseases & disorders ▪ Type 2 diabetes ▪ Inc risk for cancer ▪ Inc cholesterol ▪ HTN ▪ Asthma ▪ Alzheimer’s
❖ Identify strategies aimed at preventing and treating obesity, including lifestyle modification, pharmacologic therapy, and nonsurgical interventions. ➢ Lifestyle ▪ Realistic, short term goals
- 1lb/week or 5lbs/mo ▪ Weight loss and maintenance ▪ Improve diet habits
- 24hr recall
- Calorie deficit of 500-1000cal → 5 - 10% w/in 6mo
- Less calories, fat, cholesterol
- More fruits, veggies, fiber
- Read labels ▪ Diets
- DASH
- Mediterranean
- Therapeutic lifestyle changes diet ▪ Inc physical activity
- 150min moderate aerobic OR 75min vigorous aerobic
- 2x weekly muscle training ▪ Address barriers
- Transportation
- Income
- Culture ▪ Self-monitor ▪ Behavioral intervention sessions ▪ Sleep habits (7hrs w/o interruptions
- Avoid mental stimulation before bed or caffeine ➢ Pharmacologic ▪ Goals of medication = supplement to diet + exercise ▪ Antiobesity meds = inhibit GI absorption of fat or alter brain receps to enhance satiety or reduce cravings
- 30+ BMI
- 27+ comorbidities ▪ GI lipase inhibitor
- Diminishes intestinal absorption and metabolism of fats (triglycerides) ▪ Selective serotonergic 5-HT2C recep agonist
- Stimulates central 5-HT2C receps causing appetite suppression ▪ GLP-1 recep agonist
- Mimics effects of incretins → delayed emptying → curbs appetite ▪ Sympathomimetic amines
- Stimulate central noradrenergic receps → appetite suppression ▪ Dual agents
- Combines 2 meds w/known anti-obesity effects → taken together create synergistic effect
▪ Pharmacokinetics and dynamics
- Less IV norepinephrine
- More opioid for pain relief
- If have inc adipose tissue = Metabolites are unbound and elicit greater effects
- Weight based calculations may need to change (bc high dose has AE) ▪ Skin integrity
- Pressure ulcer – move around 2hrs
- Clean skin folds
- Approp. Specialty equipment in room or near Air mattress to prevent pressure ulcers + circulation ▪ Body mechanics and mobility ➢ Interventions ▪ Ensure dietary restrictions ▪ Reduce anxiety ▪ Relieve pain ▪ Ensure fluid volume balance ▪ Prevent infection/anatomic leak ▪ Ensure adequate nutritional status ▪ Supporting body image changes ▪ Ensure maintenance of bowel habits ❖ Compare and contrast surgical modalities indicated to treat patients with obesity in terms of preoperative, postoperative, and long-term management and complications. ➢ Preoperative ▪ Edu
- Risks and benefits
- Complications: Hemorrhage VTE (blood clot) Bile reflux Dumping syndrome = gastric emptying sped up + dumps into intestines → ab pain/N/V Dysphagia Bowel and gastric outlet obstruction = due to adhesions from surgery
- Postsurgical outcomes
- Diet changes Start = liquids Can’t hold more than 10 - 20mL if not it will rupture
- Lifelong follow-up
- Lab testing Complete metabolic panel (electrolytes, albumin, protein) Assess for malnourishment
- Dec anxiety about surgery ➢ Postoperative ▪ General assessment (head to toe)
- Emphasis on GI system ▪ Assess to ensure goals for recovery are met ▪ Absence of complications
- DM resolve / HTN resolve
- General assessment + Need for supplement
➢ Nursing diagnosis ▪ Deficient knowledge about the dietary limitations during the immediate preoperative and postoperative phases ▪ Anxiety related to impending surgery ▪ Acute pain related to surgical procedure ▪ Risk for deficient fluid volume related to nausea, gastric irritation, and pain ▪ Risk for infection related to anastomotic leak ▪ Imbalanced nutrition: less than body requirements related to dietary restrictions ▪ Disturbed body image related to body changes from bariatric surgery ▪ Risk for constipation and/or diarrhea related to gastric irritation and surgical changes in anatomic structures from bariatric surgery ➢ Planning and goals for pt doing bariatric surgery ▪ Relief of pain ▪ Maintenance of homeostatic fluid balance ▪ Prevention of infection ▪ Adherence to diet ▪ Knowledge about vitamin supplements ▪ Need for lifelong follow-up ▪ Achievement of positive body image ▪ Maintain normal bowel habits PAIN ❖ Understanding tolerance, dependence, addition, breakthrough pain ➢ Physical dependence ▪ Normal response w/opioid use of 2weeks or more ▪ Manifested by withdrawal symptoms ▪ Chances of dependency is unlikely ➢ Tolerance ▪ Normal response w/regular use of opioid ▪ Dec in 1 or more of the effects ▪ Inc usage needed to effect pain relief ➢ Addiction ▪ Chronic, relapsing, treatable ▪ Influenced by genetic, psychosocial and environmental factors ▪ Compulsive use/craving for effects other than pain ▪ Taking opioids for pain relief IS NOT ADDICTION ❖ Care of a patient with PCA ❖ Define the fundamental concepts of pain ➢ Unpleasant sensory, emotional experience w/actual or potential tissue damage ➢ Personal and subjective experience ➢ Patient most reliable source ➢ Most common reason for getting help
➢ Components ▪ Self-report ▪ Location ▪ Intensity
- Scales Numeric rating scale = 0- 10 ➢ Older children + adults Wong-baker faces ➢ Younger children ➢ Developmental delayed Faces pain scale revised ➢ Faces + numbers Verbal descriptor scale ➢ Mild, mod, severe Visual analog scale ➢ Identify characteristics of pain ➢ Mild to severe ▪ Quality
- Sharp, dull, burning ▪ Onset and duration
- When did it start?
- New, or prior to hospitalization
- Intermittent pain or constant ▪ Aggravating and relieving factors
- What makes it better/worse?
- Pain med, walking, reposition ▪ Effects on function and QOL
- ADLs ▪ Comfort function goal
- Reference point to set goals to relieve pain
- Establish with or for ➢ Pain for specific populations ▪ Nonverbal = hierarchy of pain measures
- Self-report – writing pointing
- VS ▪ Young children = FLACC
- Face
- Legs & Extremities flexed or relaxed
- Activity
- Cry
- Consolability ▪ Pts w/advanced dementia = PAINAD
- Nonverbal and non; reluctant to report pain
- Breathing
- Vocalization
- Facial expression
- Body language
- Consolability
▪ Pts in critical care units = CPOT
- Intubated
- Facial expression
- Body movements
- Muscle tension
- Vocalization ❖ Pain management ➢ Effective and safe analgesia ➢ Optimal relief ➢ Comfort function goal ➢ Responsibility of all members of the healthcare team ➢ Pharmacologic: multimodal ➢ Routes and dosing ▪ PO = longer to take affect ▪ IV = quick effect ➢ Patient-controlled analgesia (PCA) ❖ List the first-line agents from the three groups of analgesic agents. ➢ Opioid analgesics = act on CNS, inhibits activity of ascending nociceptive pathways ▪ MU agonist = morphine, hydromorphone, fentanyl, oxycodone ▪ Agonist-antagonist = buprenorphine, nalbuphine, butorphanol
- Buprenorphine = treat Dependence and addiction Methadone help w/drug addiction ➢ Non-opioid ▪ Acetaminophen (Tylenol) ▪ NSAIDs = dec pain by inhibiting cyclo-oxygenase (involved in prostaglandin making)
- Ibuprofen, naproxen, celecoxib ➢ Adjunctive analgesics = used to enhance effects of other pain ▪ Local anesthetics = block nerve conduction of nerve fibers
- Lidocaine patch 5% ▪ Anticonvulsants
- Gabapentin, pregabalin ▪ Antidepressants
- TCA = desipramine, nortriptyline
- SNRI = duloxetine, venlafaxine ▪ Ketamine (anesthetic) = red loc to relieve pain ❖ Adverse effects of analgesics ➢ Resp depression ➢ Sedation ➢ N/V – eat before/after/with food ➢ Constipation – hydration, stool softener, fiber ➢ Pruritis ❖ Identify the unique effects of select analgesic agents on older adults. ➢ Sensitive to agents that produce sedation and CNS effects ▪ Dec renal/liver function (metabolism and excretion) ▪ More SE (CNS) + sedation ➢ Initiate with low dose and titrate slowly ➢ Inc risk for NSAID-induced GI toxicity ➢ Acetaminophen preferred for mild pain ➢ Opioid dose should be reduced 25% to 50%
➢ Chemo w/drugs ▪ Eliminate/reduce # of malignant cells ▪ TARGET EVERY CELL ▪ Strict guideline – cancer nurse certification ▪ Toxicity: GI, hemato, renal, liver, cardiopulm, reproductive, neuro, cognitive, fatigue ➢ Radiation ▪ Target specific part of body
- External
- Internal (brachytherapy) = inside or near tumor Visitor and distance to pt limitations
- Systemic = drugs PO or IV ▪ Used also as palliative care to control spread ▪ Chemo and radiation can cause long-term sequalae (consequences) after therapy is done
- Affects all systems
- Leukemia
- Angiosarcoma
- Skin cancer
- Chemo brain
- Also at risk of developing same/diff cancer ➢ Immunotherapy ➢ Target therapy ➢ Hormonal therapy ❖ Nursing considerations with preparing and administering chemotherapy ➢ BSA ➢ Weight ➢ Previous chemo/radiation ➢ Functioning of organ systems ➢ IV extravasation = leak of chemo from vein → tissue ▪ Stop drug infusion ▪ Vesicants = can cause necrosis of tendons/muscles/nerves/vessels/tissue
- Cosmegen
- Daunoxome
- Adriamycin
- Mustagen
- mutamycin ▪ Antidote order set ❖ Complications of cancer ➢ Large tumors press on organs → dec function of organ + pain ➢ Infection = primary cause of death (neutropenic) ➢ Malnutrition (absorption) ➢ Protein deficiency ➢ Electrolytes ➢ Dehydration ➢ Weight loss ▪ More than 10% of overall body weight in a timer period – come in/report ➢ Impaired wound healing
➢ Oncologic emergencies due to obstruction, metabolic, or metastasis: on test ▪ SVC syndrome – heart ▪ Cardiac tamponade – heart ▪ Spin compression ▪ Syndrome of inapprop antidiuretic hormone secretion ▪ Hypercalcemia – electrolyte imbalance ▪ Tumor lysis syndrome ▪ Disseminated intravascular coagulopathy (DIC) - RBCs ❖ Management ➢ Skin ➢ Fluid, electrolyte, nutrition ➢ Cognitive ➢ Infection, bleeding ➢ Prevent N/V and fatigue ➢ Review lab data ➢ Protect caregivers ➢ Symptoms ▪ Myelosuppression = dec in bone marrow activity → dec blood cells (wipe out all cells)
- Interventions: Assess for fatigue and infection Neutropenic precaution Aseptic technique VS ▪ Thrombocytopenia = dec RBC and platelets ▪ Anemia ▪ N/V ▪ Anorexia ▪ Stomatitis = sores in the mouth → won’t eat → can’t heal
- Magic mouthwash = numbs area so pt can eat ▪ D/C ▪ Mucositis = inflammation of mucosa ▪ Skin Rx due to chemo and radiation and IV (could lose limb) ➢ Irreversible and progressive pulmonary/cardiac toxicities the longer the treatment → chronic diseases ➢ Help pt/family cope
DEATH/END OF LIFE
- Death = when all vital organs and body systems cease to function o EX: ▪ Dec RR + HR ▪ Kusmol breathing ▪ Cool to touch ▪ Modeled skin (cyanosis lips ▪ Dec LOC ▪ Dec urine and BM ▪ Incontinent ▪ Restless ▪ Congestion; Fluid in lungs - Death rattle/terminal secretions = noisy, wet sounding respirations ▪ Lack of speech - Nonverbal signs of pain: guarding, crying, moaning - Cheyne-stokes respiration = alt periods of apnea & deep rapid breathing o Brain death = irreversible loss of all brain functions (brainstem too) ▪ Clinical diagnosis
- End of life care o EOL care = issues r/t death and dying + services o Goals of care ▪ Provide comfort and supportive care ▪ Improve the QOL ▪ Help ensure a dignified death ▪ Give emotional support to family o Prevalent symptoms ▪ Resp distress ▪ SOB (dyspnea) ▪ Results in anxiety for pt and family
- Legal issues o Full or partial code (DNR = do not resuscitate/AND allow natural death) o Advanced directives o Power of attorney
- Nursing management o Assess for S/S of death o Oxygen o Nutritional status o Pain management o Elimination (bowel/bladder) o Mobility o Skin integrity ▪ Clean, dry ▪ Reposition ▪ Friction and sheet rubs o Airway clearance ▪ Elevate head of bed o Psychosocial (fear, anxiety, anger) o Monitor labs
- Special needs of nurses o Hobbies/interests o Schedule time for yourself o Ensure time for sleep o Maintain peer support system o Develop a support system beyond the workplace HIV = the virus that leads to AIDS over many years ❖ Cycle, stages ➢ Cycle ▪ Attachment = GP120 and GO41 glycoproteins bind w/CD4 recep using CCR5 (fusion) ▪ Uncoating = HIV contents released inside (2 RNA and 3 enzymes: reverse transcriptase, integrase and protease) ▪ DNA synthesis = HIV changed from RNA → DNA via reverse transcriptase ▪ Integration = uses integrase to implant in host cell DNA ▪ Transcription = forms single stranded mRNA to build new viruses ▪ Translation = mRNA makes chains of new proteins and enzymes for baby viruses ▪ Cleavage = protease cuts polyprotein chain into individual proteins that make up new virus ▪ Budding = proteins and viral RNA migrate to membrane and exit cell (kills cells in process) ➢ Stages ▪ 0 = early HIV infection, acute infection stage
- Can test neg + infect others ▪ 1 = primary/acute
- Development of HIV Abs
- CD4 drop ▪ 2 = T-lymphocytes 200- 499
- Early-stage AIDS ▪ 3 = confirmed to have AIDS – below 200 ❖ Describe the modes of transmission of human immune deficiency virus (HIV) infection and prevention strategies. ➢ Transmission = bodily fluids ▪ Blood ▪ Semen/precum ▪ Vaginal secretions ▪ Breast milk ➢ Prevention ▪ Use of condoms and damns ▪ Must be motivate and free to choose to use method ▪ Discordant couple (1 has HIV the other doesn’t) ▪ PrEP = to prevent getting HIV ▪ PEP = immediate exposure ➢ Education ▪ Behavioral interventions by ensuring people have information, motivation and skills to reduce risk ▪ HIV testing ▪ Linkage to treatment and care – enables to live longer ▪ Abstinence ▪ Correct use of condoms
- Polyurethan female condom ▪ Medical circumcision reduces risk by 60% ▪ Microbicides (vaginal and rectal)
