Nursing Care Plan - Eating Disorders : Obesity

Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems. Body mass index (BMI), a measurement which compares weight and height, defines people as overweight (pre-obese) if their BMI is between 25 kg/m² and 30 kg/m², and obese when it is greater than 30 kg/m². Obesity increases the likelihood of various diseases, particularly heart disease, type 2 diabetes, breathing difficulties during sleep, certain types of cancer, and osteoarthritis. Obesity is most commonly caused by a combination of excessive dietary calories, lack of physical activity, and genetic susceptibility, although a few cases are caused primarily by genes, endocrine disorders, medications or psychiatric illness. Evidence to support the view that some obese people eat little yet gain weight due to a slow metabolism is limited; on average obese people have a greater energy expenditure than their thin counterparts due to the energy required to maintain an increased body mass.
Dieting and physical exercise are the mainstays of treatment for obesity. Moreover, it is important to improve diet quality by reducing the consumption of energy-dense foods such as those high in fat and sugars, and by increasing the intake of dietary fiber. To supplement this, or in case of failure, anti-obesity drugs may be taken to reduce appetite or inhibit fat absorption. In severe cases, surgery is performed or an intragastric balloon is placed to reduce stomach volume and/or bowel length, leading to earlier satiation and reduced ability to absorb nutrients from food.
Obesity is a leading preventable cause of death worldwide, with increasing prevalence in adults and children, and authorities view it as one of the most serious public health problems of the 21st century.Obesity is stigmatized in much of the modern world (particularly in the Western world), though it was widely perceived as a symbol of wealth and fertility at other times in history, and still is in some parts of the world

CARE SETTING

Community level unless morbid obesity requires brief inpatient stay

RELATED CONCERNS

1. Cerebrovascular accident (CVA)/stroke
2. Cholecystitis with cholelithiasis
3. Cirrhosis of the liver
4. Diabetes mellitus/Diabetic ketoacidosis
5. Heart failure: chronic
6. Hypertension: severe
7. Myocardial infarction
8. Obesity: surgical interventions (gastric partitioning/gastroplasty, gastric bypass)
9. Psychosocial aspects of care
10. Thrombophlebitis: deep vein thrombosis
11. Patient Assessment Database

ACTIVITY/REST

May report: 

1. Fatigue, constant drowsiness
2. Inability/lack of desire to be active or engage in regular exercise; sedentary lifestyle
3. Dyspnea with exertion

May exhibit: 
Increased heart rate/respirations with activity

CIRCULATION

May exhibit: 
Hypertension, edema

EGO INTEGRITY

May report: 

1. History of cultural/lifestyle factors affecting food choices
2. Weight may/may not be perceived as a problem
3. Eating relieves unpleasant feelings, e.g., loneliness, frustration, boredom
4. Perception of body image as undesirable
5. SOs resistant to weight loss (may sabotage patient’s efforts)

FOOD/FLUID

May report:

1. Normal/excessive ingestion of food
2. Experimentation with numerous types of diets (“yo-yo” dieting) with varied/short-lived results
3. History of recurrent weight loss and gain

May exhibit: 

1. Weight disproportionate to height
2. Endomorphic body type (soft/round)
3. Failure to adjust food intake to diminishing requirements (e.g., change in lifestyle from active to sedentary, aging)

PAIN/DISCOMFORT

May report: 
Pain/discomfort on weight-bearing joints or spine

RESPIRATION

May report: 
Dyspnea

May exhibit: 
Cyanosis, respiratory distress (Pickwickian syndrome)

SEXUALITY

May report: 
Menstrual disturbances, amenorrhea

TEACHING/LEARNING

May report: 

1. Problem may be lifelong or related to life event
2. Family history of obesity
3. Concomitant health problems may include hypertension, diabetes, gallbladder and cardiovascular disease, hypothyroidism
4. Discharge plan
5. DRG projected mean length of inpatient stay: 5.1 days
6. May require support with therapeutic regimen; home modifications, assistive
7. devices/equipment.
8. Refer to section at end of plan for postdischarge considerations.

DIAGNOSTIC STUDIES

1. Metabolic/endocrine studies: May reveal abnormalities, e.g., hypothyroidism, hypopituitarism, hypogonadism, Cushing’s syndrome (increased insulin levels), hyperglycemia, hyperlipidemia, hyperuricemia, hyperbilirubinemia. It is also suggested that the cause of these disorders may arise from neuroendocrine abnormalities within the hypothalamus, which result in various chemical disturbances.
2. Anthropometric measurements: Measures fat-to-muscle ratio.

NURSING PRIORITIES

1. Assist patient to identify a workable method of weight control incorporating healthful foods.
2. Promote improved self-concept, including body image, self esteem.
3. Encourage health practices to provide for weight control throughout life.

DISCHARGE GOALS

1. Healthy patterns for eating and weight control identified.
2. Weight loss toward desired goal established.
3. Positive perception of self verbalized.
4. Plans developed for future weight control.
5. Plan in place to meet needs after discharge.