Respiratory Disorders (19 Questions)

Pneumonia Objectives:
1) Describe the pathophysiology of pneumonia
2) Differentiate cues associated with this disorder
3) Explain methods of treatment for this disorder
4) Discuss pharmacological interventions
Objective 1: Pathophysiology of Pneumonia
Pneumonia is inflammation of the lungs caused by various microorganisms, which can include
bacteria, fungi, viruses

TYPES OF PNEUMONIA:
Community-Acquired: Community setting or if disease develops within the first 48 hours post-
hospitalization. Strep pneumonia is the most common walking pneumonia
Hospital Acquired: Develops 48 or more hours after hospitalization. A type of healthcare
associated pneumonia. HIGH MORTALITY RATE. Common with debilitated, dehydrated
patients with minimal sputum production
Health Care Associated: Often caused by multidrug-resistant organisms. Early diagnosis and
treatment are critical
Ventilator Associated: Prevention is key; however, it is considered ventilator associated if patient
received mechanical ventilation for at least 48 hours
Immunocompromised Host: Patients who are immunocompromised (cancer, transplant, HIV,
steroids, diabetics) who do not have the immune system to fight off infection, even when the
hospital does everything it can to prevent transmission of infection

Bundles are your friends!

What are bundles? A list of tasks that should be completed; “order sets” that every patient with
these criteria should receive in order to reduce rate of infection

Objective 2: Differentiate cues associated with this disorder

o Streptococcal Pneumonia: sudden onset of chills, fever, pleuritic chest pain,
tachypnea, and respiratory distress
o Headache
o Low-grade fever
o Myalgia (muscle pain), rash
o Orthopnea
o Crackles heard in lungs

Assessment & Diagnosis:

o History
o Physical exam
o Chest X-ray
o Blood culture
o Sputum examination: Right drug for the Right bug!
o Bronchoscopy may be used for acute severe infection

PREVENTION:
o Pneumococcal Vaccination: reduces incidence of pneumonia and deaths in the older adult
population
o Recommended for all adults over 65+ and 19+ for individuals with conditions that
weaken the immune system
Objective 3: Explain methods of treatment for this disorder
Methods of treatment are mainly pharmacological for pneumonia, but I’ll use this objective to
discuss nursing interventions:
Nursing plan of care should include:
o Assess the airway patency early & often
o Increased activity if able
o Maintenance of proper fluid volume & adequate nutrition
o Understanding of the treatment protocol and preventive measures
o Absence of complications

Nursing Interventions for Patient w/ Bacterial Pneumonia:

o Oxygen with humidification to loosen secretions
o Face mask or nasal cannula
o Coughing techniques
o Chest physiotherapy
o Position changes
o Incentive spirometry: ESPECIALLY important post-op
o Nutrition
o Hydration
o Rest
o Activity as tolerated
o Patient education
o Self-care

Objective 4: Discuss pharmacological interventions

1) Antibiotics: pending results of a culture and sensitivity
a. Obtain specimen as soon as possible
b. May give broad spectrum in the meantime to at least be fighting SOMETHING,
until we know what specific germ is causing this pneumonia
c. Allergies & accurate medical history is essential
2) Supportive Treatment
a. Fluids
b. Oxygen for hypoxia: Keep SpO2 over 94%
c. Antipyretics
d. Antitussives, decongestants, and antihistamines
3) Gerontologic Considerations: older adults need to be treated immediately

Asthma Objectives:
1) Describe the pathophysiology of asthma
2) Differentiate cues associated with this disorder
3) Explain methods of treatment for this disorder
4) Discuss pharmacological interventions
Objective 1: Describe the pathophysiology of asthma
Asthma: chronic inflammatory disorder, intermittent or persistent with airway obstruction from
bronchial hyperresponsiveness, inflammation, bronchoconstriction, and excess mucus production
o Largely reversible if we educate patients to manage exacerbations
o Most common chronic disease of childhood
o Inflamed Airway = Less O2 getting thru = Less O2 going to cells
o Hyperresponsiveness: swelling & mucus production, all of which is going to limit airway
production
Predisposing Factors: Atopy & assigned female at birth
Causal Factors: Exposure to allergens and occupational sensitizers
Contributing Factors: Infections, pollution, active/passive smoking

Objective 2: Differentiate cues associated with this disorder

o More common in early morning and night
o Generalized chest tightness 3 Most Common Clinical
o Expiration requires more effort Manifestations:
o Expiration is prolonged 1) Cough
Cues of an Exacerbation: 2) Dyspnea
o Diaphoresis 3) Wheezing
o Tachycardia
o Widened pulse pressure
o Alteration in respiratory rate
o Hypoxemia (v/q mismatch)
o Central Cyanosis
Diagnostics:
o Sputum
o Blood testing: serum levels of IgE and Serum levels of Eosinophilia
o ABGs: Initially hypocapnia and respiratory alkalosis
o Pulse Oximetry
o Pulmonary Function Test
Objective 3: Explain methods of treatment for this disorder
There is no known treatment for asthma, but there are ways to manage asthma:
➢ Avoiding known triggers
➢ Peak Flow Meter Monitoring
o What is peak flow? Measurement of the highest airflow during a forced
expiration.
o Daily monitoring is recommended for patients
who have one or more of the following:
▪ Moderate or severe persistent asthma
▪ Poor perception of changes in airflow or
worsening symptoms
▪ Unexplained response to environmental
or occupational exposures
▪ Discretion of provider and patient
▪ Steps:
1) Move the indicator to the bottom of
the number scale
2) Stand up
3) Take a deep breath, and fill the lungs
completely
4) Place mouthpiece in mouth and
close lips around mouthpiece
5) Blow out hard and fast with a single
blow
6) Record the number achieved on the
indicator. If patient coughs or makes
a mistaken, do it again
7) Repeat steps 1-5 two more times,
and write the highest number down
in the asthma diary
➢ Knowing the purposes & how/when to use medications
o Follow your asthma action plan
▪ The asthma action plan is based upon results from the peak flow meter. If
you’re within the green zone, you’re good to go. If you’re in the yellow,
it’s a sign that asthma is getting worse and you may need quick relief
medicine. If red zone, it’s a medical alert
▪ Green = Good (80% or more of best peak flow)
▪ Yellow = Worsening (50%-79% of best peak flow)
▪ Red = Medical Alert (Less than 50% of best peak flow)
➢ Nursing Care
o EDUCATION: Educate patients on how to avoid their triggers, how to perform
peak flow monitoring, proper inhalation technique, how to implement an asthma
action plan, and when to seek help
Exercise-Induced Asthma
Prevention: Use a QUICK RELIEF medication PRIOR to exercise!
 Short-Acting beta2 adrenergic agonists (SABA)
Objective 4: Discuss pharmacological interventions
QUICK RELIEF:
1) Short-Acting Beta2 Adrenergic Agonists (SABA)
a) Most common you’ll see is albuterol
i) The rescue drug for acute asthma attacks
b) How does it work?
i) Promotes bronchodilation
ii) Will provide relief for acute symptoms and
prevention of exercise-induced asthma
2) Anticholinergics
a) Ipratropium Bromide
i) Taken as an inhaler or nebulizer treatment
b) How does it work?
i) Inhibits muscarinic cholinergic receptors and reduces intrinsic vagal tone of the
airway
ii) May be used for patients who do not tolerate SABA
iii) Can also be used WITH SABA in an acute asthma attack
3) Inhaled Corticosteroids
a) Budesonide
i) Anti-inflammatory
b) Used for long-term prevention of symptoms, suppression & control of inflammation
c) Oral thrush can develop: you MUST educate patient to rinse mouth after use
d) Taking steroids may raise blood sugar and decrease the immune system
4) Systemic Corticosteroids
a) Prednisone
i) Anti-inflammatory
b) Used for short-term control of. Inadequately controlled & persistent asthma
i) Or long-term prevention of symptoms in severe, persistent asthma
c) Must monitor glucose levels because these can cause hyperglycemia
5) Long-Acting Beta2 Adrenergic Agonists
a) Formoterol & Salmeterol
b) How do they work?
i) Bronchodilation of smooth muscles
c) Used for long-term prevention of symptoms and prevention of exercise-induced
bronchospasms
i) NOT used for acute symptoms or exacerbations
6) Leukotriene Receptor Antagonist
a) Montelukast
i) Next step up for asthma control; going down to cellular level
b) How does it work?
i) Suppresses the effects of leukotrienes, which reduce inflammation,
bronchoconstriction, airway edema, and mucus production
ii) Long-term control and prevention of symptoms in mild persistent asthma
Important to Know for Nebulizer Treatments:
o Listen to lung sounds BEFORE and AFTER
treatment
o Check pulse ox BEFORE and AFTER treatment
o Clean equipment
o Check heart rate prior to treatment

NOT AN OBJECTIVE, BUT N2K:

Complications of Asthma:
o Status asthmaticus
o Severe, life-threatening continuous
reaction
o Respiratory Failure
o Pneumonia
o Airway Obstruction
o Hypoxemia
o Treat with O2
o Monitor pulse ox
o Dehydration
o Why? Losing moisture as you breathe
o Monitor I’s & O’s, and dry lips
o Anxiety
o Why? Not being able to breathe is incredibly anxiety-provoking
o TALK to your patients: educate them, help them to breathe

COPD Objectives:
1) Discuss the pathophysiology of COPD
2) Differentiate cues with this disorder
3) Explain methods of treatment for this
disorder
4) Discuss pharmacological interventions

Objective 1: Pathophysiology of COPD

COPD is characterized by 3 primary symptoms:
1. Cough
2. Sputum Production
3. Dyspnea
COPD is defined as: a progressive respiratory
disease of airflow obstruction involving the
airways
Risk Factors: Smoking, exposure to secondhand smoke, increased age, occupational exposure,
air pollution, genetic abnormalities
Objective 2: Differentiate cues with this disorder
Emphysema Chronic Bronchitis
▪ Air-trapping; CO2 cannot get out of the ▪ Chronic Productive cough and sputum
alveoli production for greater than 3 months for 2
▪ Barrel Chest consecutive years
▪ Tachypnea ▪ Mucus secretion
▪ Dyspnea ▪ Inflamed airway → Obstructed airway
▪ Hypercapnia ▪ You will see cyanosis from hypoxemia
▪ Tripod Positioning ▪ Rhonchi
▪ Digital Clubbing
Emphysema = Entrapped Air
Bronchitis = Blue appearance
Barr El Chest from Air Trapping

Objective 3: Explain methods of treatment for this disorder

No treatment, but there are therapeutic procedures & medical managements:

Pursed Lip Breathing:

o Helpful for conditions that need a longer expiratory phase
o Patients with COPD often default to this pattern of breathing due to airway obstruction
o You want to add time to that expiratory phase to get rid of all of their CO2 so there is no
residual CO2
o Breathe in through nose for 2 seconds. Purse lips. Slowly breathe out for 4 seconds
Diagnostics:
o History of smoking, vaping, exposure
o Dyspnea → specific scales to grade the degree
o Pulse oximetry
o Pulmonary Function Tests: FEV1
 o Chest X-ray
o CT Scan: can help with differential diagnoses & screen for cancer
o ABGs
Education:
o Remove the irritant as best as you can to reduce risks and symptoms
o Smoking cessation
o Managing exacerbations
o Medication education
o Adequate nutrition and hydration
o Immunizations
o Mobilization: increase lung capacity

Objective 4: Discuss pharmacological interventions

1) Bronchodilators
a. Relieve bronchospasm by improving expiratory flow through widening of airways
and promoting lung emptying with each breath
2) Corticosteroids
a. Anti-inflammatory agents
i. Watch for decreased immunity and elevated blood glucose
3) Mucolytics
a. Break up mucus to thin the secretions for easier coughing up
4) Oxygen Treatment
a. Needs an order
b. Observe for signs of improvement or decompensation
c. Ways to measure levels: pulse ox or ABGs
d. Administer O2 at greater than 21% to provide adequate transport of O2
i. Take Away: Hypoxia to tissues causes pain and cyanosis, as well as puts
strain on the heart

Pulmonary Rehab:
o Goal: reduce symptoms, improve quality of life, increase physical activity & exercise
capacity
o Patients are taught methods to allow them to integrate back into society & reduce the
rate of hospitalizations
Fluid & Electrolytes (15 Questions)
Electrolyte Objectives:
1) Review the risk factors and clinical manifestations of electrolyte imbalances
2) Describe nursing strategies for sodium, potassium, calcium, and magnesium imbalances
(I’m combining these objectives for each electrolyte)

Hyponatremia Hypernatremia
RISK FACTORS RISK FACTORS
▪ Imbalance of water ▪ Fluid deprivation
▪ Losses by vomiting, diarrhea, sweating ▪ Excess sodium consumption
▪ Adrenal Insufficiency ▪ Diabetes insipidus
▪ Certain medications ▪ Heat stroke
▪ Diuretics ▪ Hypertonic IV solutions
CLINICAL MANIFESTATIONS CLINICAL MANIFESTATIONS
▪ Poor skin turgor ▪ Thirst
▪ Dry mucosa ▪ Elevated temperature
▪ Headache
▪ Decreased salivation
▪ Decreased blood pressure
▪ Nausea
▪ Abdominal cramping
▪ Neurologic Changes

NURSING CARE NURSING CARE

▪ Treat underlying condition ▪ Infusion of hypotonic electrolyte infusion-
▪ Sodium replacement: SLOWLY LOW & SLOW to pull salt out of
▪ Temporary water restriction until balanced bloodstream
▪ Encourage dietary sodium ▪ Diuretics
▪ Assess cognition, elimination, gas ▪ Assess cognition, elimination, gas
exchange, perfusion, I’s & O’s, daily weight, exchange, perfusion, I’s & O’s, daily weight,
and lab values and lab values

Hypokalemia Hyperkalemia
Risk Factors Risk Factors
▪ GI Losses ▪ Impaired renal function
▪ Medications ▪ Rapid administration of K+
▪ Alterations of acid-base balance ▪ Hypoaldosteronism
▪ Poor dietary intake ▪ Medications
▪ Hyperaldosteronism ▪ Tissue trauma
▪ Acidosis
Clinical Manifestations Clinical Manifestations
▪ EKG U-waves: cardiac dysrhythmias ▪ EKG: Tall-peaked-T waves
▪ Dilute urine ▪ Muscle weakness
▪ Excessive thirst ▪ Paresthesia’s
▪ Fatigue ▪ Anxiety
▪ Anorexia ▪ GI Manifestations
▪ Muscle weakness
▪ Decreased bowel motility
 Nursing Care Nursing Care
▪ Monitor: Gas exchange, perfusion, ▪ Monitor: Perfusion, ABGs, nutrition,
cognition, elimination, ABGs elimination, pulse ox, blood pressure
▪ Nutritional Counseling ▪ Limitation of dietary potassium
▪ Monitor patients receiving digitalis for ▪ Administration of cation exchange resins
toxicity ▪ Emergent care for cardiac arrythmias
▪ Potassium replacement: LOW AND SLOW, include: Dialysis, IV calcium gluconate, IV
no more than 10 mEq/hr sodium bicarbonate, and IV regular insulin
▪ IV INFUSION- never IV push and IV dextrose

Hypocalcemia Hypercalcemia
RISK FACTORS RISK FACTORS
▪ Hypoparathyroidism ▪ Malignancy
▪ Malabsorption ▪ Hyperthyroidism
▪ Pancreatitis ▪ Bone loss related to immobility
▪ Alkalosis ▪ Diuretics
▪ Transfusion of citrated blood
▪ Kidney injury
▪ Medications
Clinical Manifestations Clinical Manifestations
▪ TETANY ▪ Polyuria
▪ Trousseau Sign ▪ Thirst
▪ Chvostek Sign ▪ Muscle weakness
▪ Seizures ▪ Intractable nausea
▪ Hyperactive deep tendon reflexes ▪ Abdominal cramps
▪ Dyspnea & laryngospasm ▪ Diarrhea
▪ Abnormal clotting ▪ Peptic ulcer
▪ Bone pain
▪ EKG Changes
NURSING CARE NURSING CARE
▪ Monitor: perfusion, cognition, GI ▪ Monitor: perfusion, cognition,
elimination GI/elimination
▪ Calcium replacement can be in the form of ▪ Treat underlying cause
an IV piggyback (for emergent use) or oral ▪ Replace fluids via IV or orally
calcium with vitamin D supplements ▪ Ensure safety
▪ Seizure precaution ▪ Provide diuretics- watch K+ levels!
▪ Exercises to decrease bone calcium loss
▪ Education for diet & medications
 Hypomagnesemia Hypermagnesemia
RISK FACTORS RISK FACTORS
▪ Alcoholism ▪ Kidney Injury
▪ GI Losses ▪ Diabetic ketoacidosis
▪ Enteral/Parenteral feeding deficient in Mg+ ▪ Excessive administration of Mg+
▪ Medications ▪ Extensive soft tissue injury (muscle
▪ Rapid administration of citrated blood breakdown causes Mg+ to get into
bloodstream)
Clinical Manifestations Clinical Manifestations
▪ Chvostek & Trousseau signs ▪ Hypoactive reflexes
▪ Apathy ▪ Drowsiness
▪ Depressed mood ▪ Muscle weakness
▪ Psychosis ▪ Depressed respirations
▪ Neuromuscular irritability ▪ ECG Changes
▪ Tremors ▪ Dysrhythmias
▪ ECG Changes & dysrhythmias ▪ Cardiac arrest
NURSING CARE NURSING CARE
▪ Monitor: Perfusion, cognition, GI ▪ Monitor: perfusion, muscular skeletal,
elimination cognition
▪ Mg+ Replacement: Magnesium sulfate IV is ▪ IV Calcium gluconate
administered w/ an infusion pump, or oral ▪ Hemodialysis
replacement ▪ Loop diuretics, sodium chloride
▪ Seizure precautions ▪ Monitor for dysphagia
▪ Dietary Teaching

Fluid Balance Objectives

1) Review risk factors and clinical manifestations of fluid imbalances
2) Describe the nursing management strategies for fluid deficit and excess
3) Identify the effects of aging on fluid and electrolyte regulation

Objective 1: Review risk factors and clinical manifestations of fluid imbalances

Hypovolemia: Lack of water AND electrolytes, causing a decrease in circulating blood volume
o Causes:
o Altered oral intake
o Excessive GI Losses
o Excessive renal losses
o Blood loss, hemorrhage
Dehydration: Lack of FLUID in body, causing a. shift of water from the plasma into the
interstitial space
o Causes:
o Prolonged fever
o Diabetes ketoacidosis & Diabetes insipidus
o Excessive intake of salt/sodium
o Insufficient water intake

Consequence: BOTH deficits = a decrease in blood volume

Clinical Manifestations of a Fluid Volume Deficit:
➢ Vital Signs: tachycardia, hypotension, tachypnea, hypoxia
➢ Neuromuscular: dizziness, syncope, weakness, muscle cramps,
confusion, seizures
➢ GI: Thirst, furrowed tongue, dry mucous membranes, nausea,
vomiting
➢ Renal: Oliguria
➢ Other: decreased skin turgor, flattened neck veins, diminished
capillary refill, acute weight loss

FLUID VOLUME EXCESS Risk Factors:

o Heart failure
o Cirrhosis
o Kidney failure
o Excessive sodium intake
o Excessive water intake
o Syndrome of inappropriate antidiuretic hormone (SIADH)
o Excessive administration of IV fluids

FLUID VOLUME EXCESS Clinical Manifestations

➢ Vital Signs: Tachycardia, Hypertension, Tachypnea, Bounding pulse
➢ Respiratory: dyspnea, orthopnea, crackles
➢ Neuromuscular: Weakness, confusion, changes in LOC, seizures
➢ Other: Edema, distended neck veins (JVD), weight gain, ascites

Objective 2: Describe the nursing management strategies for fluid deficit and excess
Fluid Volume Deficit Management:
o Frequent monitoring
o Initiate IV access for fluid replacement
o Consider safety & fall prevention:
o Observe gait stability
o Change position slowly
o Encourage call light use and ask for assistance
o Monitor for fluid volume overload

Fluid Volume Excess Management:

o Positioning: sit them up a little higher
o Supplemental oxygen as needed
o Monitor edema
o Application of antiembolism stockings
o Patient teaching related to sodium and fluid restrictions
o Fluid restrictions (decrease IV flow rate)
o Diuretics
o Dialysis
Objective 3: Identify the effects of aging on fluid and electrolyte regulation
Older Adults may experience:
o Decrease in thirst sensation
o Decrease renal capacity
o Decrease in muscle mass = Decrease in body fluid
o Polypharmacy
They may be more susceptible to dehydration (due to the decreased thirst sensation)
Older adults need more frequent monitoring & assessment of functional status

Nutrition Alterations (16 Questions)

Objectives:
1) Recall guidelines for healthy eating
2) Define the concepts of undernutrition and obesity, risk factors, and impact on health
3) List management strategies to assist with the treatment of undernutrition
4) Identify strategies aimed at preventing and treating obesity
5) Explain nursing management considerations for obesity
6) Recognize risks of surgical interventions to treat obesity and prevention strategies

Objective 1: Recall guidelines for healthy eating

Basic Metabolic Rate (BMR): The amount of energy needed to maintain the body at rest and the
metabolic activities of cells and tissues
Factors that increase BMR: Growth, infection, hormones, emotional tension
Factors that decrease BMR: aging, prolonged fasting, prolonged sleep

Guidelines for Healthy Eating:

MyPlate:
o Initiative to promote dietary guidelines for
consumers
o Promote better food choices
o Healthy eating across the lifespan
o Promote exercises
o Guidelines: Half the plate should be fruits &
veggies, ¼ grain, ¼ protein
o Make at least half the grains consumed
whole grains

Objective 2: Define the concepts of undernutrition and obesity, risk factors, and impact on
health
Undernutrition: Body is not getting enough nutrition
Overnutrition: Body is getting too many nutrients
For this class with testing, malnutrition & undernutrition are the same thing. And
overnutrition is considered obesity
Causes of Malnutrition: Expected Findings of Malnutrition:
o Alcohol abuse o Losing weight or having a low body
o Medications weight
o Economic factors o Loss of muscle or fat
o Socioeconomical status o Lack of appetite
o Physiologic (meds, health problems) o Feeling tired or weak
o Physical o Changes to skin and hair
o Disease o Mood changes
o Issues with chewing & swallowing o Swelling
o Surgery o Dizziness
o Eating disorders o Poor concentration
o Increased risk of infection

Obesity Risk Factors: Impact on Health & Complications of Obesity:

o Sedentary Lifestyle o Respiratory difficulties
o Parental Obesity o Hypertension
o Labile emotions o Diabetes mellitus
o Traumatic life event o Fatty liver disease
o Low SES o Gout
o Family Lifestyle o Premature death
o Certain medications o Increased cholesterol levels
o Smoking cessation o Infertility
o Pregnancy o Cardiovascular disease
o Aging o Thromboembolism
o Poor sleeping habits o Chronic kidney disease

N2K What labs to expect to see upon assessment of an individual with malnutrition:
o Hemoglobin- decreased in patient due to anemia
o Hematocrit
o Serum albumin- decrease because protein deficiencies
o Pre-albumin
o BUN: increases with starvation and dehydration, or decreases with protein depletion
o Creatinine
N2K BMI VALUES:

Underweight: < 18.5

Normal: 18.5-24.9
Overweight: 25-29.9
Obesity Class I: 30-34.9
Obesity Class II: 35-39.9
Extreme Obesity: 40+
Objective 3: List management strategies to assist with the treatment of undernutrition
 Dietary Education: most important
 Support
 Stimulating appetite
 Assist with eating
 Appropriate diet and modified consistencies
 Enteral/parenteral feeding: long-term supplemental nutrition

Objective 4: Identify strategies aimed at preventing and treating obesity

Treatment of Obesity Includes:
1) Lifestyle Modifications
a. Improve diet habits
i. Set weight loss goals
b. Improve physical activity
i. 150 minutes of moderate aerobic exercise weekly
ii. To include muscle strength exercises
2) Pharmacologic Therapy
a. Anti-obesity medication ALONG WITH diet modification and exercise
b. Indications for anti-obesity medication:
i. BMI greater than 30
ii. BMI greater than 27 with related comorbidities
iii. What do these medications do?
1. Inhibit gastrointestinal absorption of fats
2. Alter central brain receptors to enhance satiety or reduce cravings
c. Pharmacological Medications: N2K Names of Drugs
i. Orlistat
1. Prevents digestion of fats
2. Adverse effects: oily discharge, reduced food and vitamin
absorption, decreased bile flow
ii. Lorcaserin
1. Stimulates receptors in your brain to curb appetite
2. Adverse effects: headache, dry mouth, fatigue, nausea
iii. Phentermine-topiramate
1. Suppresses appetite, feeling of satiety
2. Adverse effects: dry mouth, constipation, dizziness, insomnia,
numbness, tingling extremities
3) Non-surgical Interventions
a. Vagul Blocking Therapy
i. AKA Gastric Stimulation
ii. Blocking of vagus nerve with implanted
device
iii. Blocks communication between stomach
& brain
 b. Intragastric balloon
i. Endoscopic placement of saline filled
balloon into stomach
1. Will remain in place with 6 months
2. Thought to increase feelings of
fullness
c. Bariatric Embolization
i. Still in clinical trials
ii. Gastric fundus is embolized with beads
through the left gastric artery
1. Supposed to suppress ghrelin
secretion
4) Surgical Intervention
a. Criteria:
i. Bariatric surgery only after nonsurgical
attempts have failed
ii. Restrictive Procedures: restrict a patient’s
ability to eat
iii. Malabsorptive Procedures: Interferes with
ingested nutrient absorption
iv. Typical weight loss 10-35% of total body
weight within 2 years post-op
v. BMI as low as 30 with comorbid conditions
b. Roux-en-Y Bypass (RYGB)
i. Restrictive AND malabsorptive
ii. Horizontal staples across fundus
iii. Makes stomach capacity smaller
iv. 2nd most common surgical procedure
c. Gastric Banding
i. Restrictive procedure
ii. Device used to restrict quantity of food
passing through
d. Sleeve Gastrectomy
i. Restrictive procedure
ii. MOST common procedure
iii. Up to 85% of the stomach is removed
e. Biliopancreatic Diversion with Duodenal Switch
i. Combines gastric restriction with
intestinal malabsorption
ii. Results in the most post-op weight loss
iii. Half of the stomach is removed,
duodenum is sealed off, jejunum is
essentially now connected to bottom of
the stomach
Objective 5: Explain nursing management considerations for obesity
N2K: We want to watch for leaks at the anastomosis. Signs and symptoms of a leak would
include: increased back & shoulder pain, tachycardia, oliguria, and abdominal pain

Other postoperative Management Considerations:

o Education!!!
o Initially clear liquids
o Slow diet progression
o Reduce anxiety
o Manage pain
o Ensure fluid balance
o Ensure adequate nutrition
o Support body image changes

Caring for Patients with Obesity:

➢ Do not judge
➢ Hospitalized patients need support for optimal ventilation
➢ Monitor and address circulation
➢ Skin examination]
➢ Mobility support
➢ Education
➢ Encourage adherence to exercise and diet recommendations

Objective 6: Recognize risks of surgical interventions to treat obesity and prevention

strategies
N2K: Dumping Syndrome
What is it? A common occurrence among bariatric surgery patients, aka gastric emptying
 Thought to be caused by the rapid transit of the food bolus from the stomach into the
small intestine
EARLY Dumping Syndrome:
 15-30 minutes after a meal
o Upset stomach & throwing up
o Nausea
o Full feeling in stomach
o Belly cramps
o Loose stools
o Fast heartbeat
o Stomach growling
o Sweating
LATE Dumping Syndrome:
 1 to 3 hours after a meal
o Weakness
o Sweating
o Dizziness
 o Feeling tired
o Feeling light-headed or fainting
o Feeling shaky or jittery
o Trouble concentrating
Management of Dumping Syndrome:
 Medication
o Slows food digestion, prevents loose stools, provides extra vitamins & minerals
 Lifestyle & diet changes
o Eat small meals more often (5-6 meals daily)
o Chew food properly & slowly
o Avoid drinking fluids while eating
o Avoid drinking alcohol
o Avoid simple sugars, acid rich foods, and fried foods
o Eat high fiber & complex carbs
How to Diagnose Dumping Syndrome:
 Blood sugar test
o Low blood sugar = dumping syndrome
 Gastric emptying test: uses a radioactive matter and scanner machine to take a picture
of how fast the food moves inside the stomach and into the bowel
 Upper Gastrointestinal Endoscopy: examines the esophagus, stomach, and small
intestine to check for signs of other health problems