CARE obese patients

Obesity is the pathological condition characterized by ideal body weight increased by over 15% -20% and increased fat mass.

Clinical forms:
A. Obesity android (type abdominal) fat distribution in the upper half of the body, predominantly in the abdominal region. May be present in both sexes and are at increased risk for the

occurrence of hypertension, diabetes, atherosclerosis, increased cortisol, low testosterone, lack of ovulation.
B. Obesity gynoid (type gluteo-femoral) fat distribution in the lower half of the body (thighs, hips). It is more common in women, this type of obesity is lower cardiovascular risk, can cause osteoarthritis, hernias, varicose veins.

Obesity classification is according to several criteria, the most used is the body mass index BMI = weight G/Î2 = kg, height = meters
1.Data collection:
Means of obtaining information are:
a) history, the interview with the patient:
– To obtain information about patient nutrition (quantity, frequency of meals, how to prepare the food);
– Assessing the patient’s knowledge about nutrition and the ability to select appropriate food;
– Adopting the role of nutrition in combating emotional states;
b) observation of the patient, direct referral sources difficulty;
c) consulting sources: cards and other documents.
Circumstances of occurrence:
– Persons of the female menopause;
– People with a family history of obesity;
– Increased incidence in urban areas;
– Unhealthy lifestyle: a) consumption of high calorie foods (fatty meat, sausages, fatty cheeses, pastries, increased consumption of concentrated sweets);
b) feed rate: rare and high calorie meals;
c) eating disorders triggered by stress, emotions, depression, anxiety, alcohol consumption (increase appetite, caloric intake);
d) physical inactivity – usual (convenience, movement by car computer, TV)
– Strength (physical, accidents, postoperative immobilization, age)
– Lack of practicing sports;
e) professional stress leads to eating disorders, most often abusive sense.
Manifestations of addiction:
– Weight gain;
– Fatigue;
– Asthenia;
– Shortness of breath, sweating;
– Constipation, bloating;
– Sexual disorders;
– Amenorrhea;
– Varicose veins;
– Hypertension.

February. Analysis and interpretation of data:
Nurse analyze data and identify health issues, features (causes, sources of difficulty) and formulates diagnosis care.

Issues
– Respiratory disorders;
– Difficulties in raising;
– Poor circulation
– Intolerance to physical activity;
– Alteration of bowel habits;
– Risk of impaired skin integrity;
– Risk of cardiac complications (hypertension, atherosclerosis);
– Risk of respiratory complications;
– Risk of arthritis (osteoarthritis, osteoarthritis, spondylosis);
– Risk of impairment of other metabolites (glucose – diabetes, lipid – dyslipidemia)
– Loss of self-esteem.
Needs disrupted

Need to have good circulation and breathing
Need to move and have a good posture
…………………………………………

Poor Circulation
Events: – Varicose vascular bundles in calves
– Pain
– Burning
– Fever
– Cyanosis
Exercise intolerance
events: fatigue, shortness of breath, tachycardia …

Three. Care planning:
Include goals of care.
Objectives:
– Short term: ex. reduce anxiety by providing a calm environment security and understanding;
– Medium: ex. – Planning with the patient analysis and exploration to be made (determination of glucose, lipid profile, determination of TSH, cortisol, performing EKG, etc.)
– Patient awareness of eating behavior;
– Limit consumption by establishing a diet;
– Lunches at fixed times;
– Obtaining adequate mobility and posts;
– Exercise;
– Meeting the needs independently.
– Long term: – obtaining patient compliance by reducing and maintaining the new weight, obesity prevention
– Prevention of complications.

April. Making interventions (care application):
Posts:
– Delegated: ex. – Harvesting analyzes prescription;
– The treatment prescribed by the doctor.
– Autonomy:
– Physical and mental preparation of the patient for investigation;
– Monitoring of vital functions;
– Establishment of the diet with the patient as desired;
– Establishes rules to comply with the patient in the diet such as cutlery and plates using small, prolonged chewing before swallowing, making small portions, placing fork on the table after each sip, planning food purchases (cash match) remains Food discard pause between courses.
– Measure the patient’s body weight daily;
– Replaces the patient in case of dependent events in meeting their needs.

Hypocaloric diet part of the therapeutic program aimed at optimizing complex lifestyle. Principles:
– Controlling the intake of certain foods, maintaining nutritional balance;
– Avoid foods with high caloric density;
– Prohibition of alcohol;
– Split meals (5-6/zi);
– Reducing caloric intake.
Steps: Weight loss takes 3 months and get the low-calorie diet, exercise, moderate, medication, cognitive behavioral therapy.
Maintaining weight takes 3-6 months, after which it may tempt a further decrease weight.
It is assessed at 3-6 months.
Types of diets:
a) deficient diet intake of 500 kcal to previous results in a loss of weight of 0.5-1 kg per week, or 3 months 5-10 kg 5-10% of the initial weight.
Indications – patients with overweight and other cardiovascular risk factors, abdominal fat distribution.
b) diet deficient intake of 1000 kcal to previous results in a weight loss of 1-2 kg / wk. Or 20% of the original weight after 3 months.
Indications: – weight loss in patients with very high cardiovascular risk and.
c). Diets indicated in special situations:
– 1200-1400 kcal standard hypocaloric diet: indicate the very high cardiovascular risk patients with grade III obesity and caloric intake prior of 4000 kcal / day.
– Halving the previous caloric port in those with low educational level, without however eliminating unhealthy habits which still has negative effects on hypertension, dyslipidemia, diabetes mellitus.
– Very low calorie diet: 800 kcal produce marked decrease in weight with significant side effects, so that is done under medical supervision for a short time.
Remember:
– A reduction of 5-10% weight have important effects on health;
– Must set realistic goals;
– Reducing food intake and thus reduce basal metabolism is reduced and the rate of weight loss, which will be notified of the patient;
– In the maintenance diet supplemented with 200-300 kcal provided intensified exercise.
Foods allowed in low-calorie diets:
– Skimmed milk, yogurt, cottage cheese diet, curd;
– Lean beef, veal, lamb, chicken;
– Low river fish (perch, pike, tench);
– Hard-boiled eggs;
– Vegetables: mushrooms, tomatoes, radishes, endive, green peppers, cucumbers, spinach, cauliflower, Loboda, zucchini, cabbage, green beans. They will be prepared in salads or braised or sauteed vegetables;
– Fats are consumed in small quantity and will come from the plant;
– Drink vegetable juices, fruit Skim milk.
– Salt on average 5 grams / day.
Prohibited foods:
– Cheese, whole milk fat yogurt, cottage cheese greasy;
– Fatty meats, oily fish, canned meat and fish, smoked sausage fat;
– Bread and pasta in large quantities;
– Fried eggs;
– Pulses: beans, peas, lentils and beans, potatoes in large quantities;
– Fruits: raisins, dates, figs, grapes, plums, nuts, peanuts;
– Fat: cream, sour cream, bacon, lard;
– Roux sauces, mayonnaise, soups and broths fat;
– Concentrated sweets, creams, doughs with fat;
– Drink alcohol provides 7 calories / gram, juices, tea, Russian;
– Seasoning: vinegar, herbs;
– Salt in quantities allowed.
May. Evaluation:
Assess: – the result or change observed;
– Patient satisfaction.

The expected:
– The patient aware of the importance of diet and exercise;
– The patient complies with diet and exercise performed;
– The patient does not accept food offered by others;
– Obtaining support from the encouragement of family and friends, compliments, positive attitude;
– Reduction and weight maintenance
– Autonomy in providing patient needs
– Normalize blood pressure and analyzes
– Getting a good physical and mental condition
– Regaining self-esteem.

Health Education:

Primary Prevention:
– Educating the entire population to avoid overeating and lack of exercise;
– Dispensary constitutional risk individuals;
– Ensuring a balanced diet without excess calories;
Secondary Prevention:
– Obese patients will be educated to respect calorie diets, perform physical exercises, walking, walking;
– Dispensary patients;

Tertiary Prevention:
– Addressing obese cardiac complications, respiratory, prevent worsening of these conditions.

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