Obesity Flashcards Preview

Advanced Health Assessment > Obesity > Flashcards

Flashcards in Obesity Deck (35)
Loading flashcards...
0

How can you calculate ideal body weight?

males: 105 + 6lb/in >5 feet

females: 100 + 5lb/in >5 feet

1

How is BMI calculated?

weight (kg) / height (m)

2

How is obesity defined?

BMI >30 kg/m2

3

How is overweight defined?

25-29 BMI, or more than 20% greater than IBW

4

What are some conditions associated with obesity?

OSA, respiratory derangements, systemic HTN, diabetes, ischemic heart disease, CHF, delayed gastric emptying, hepatobiliary disease, thromboembolic disease, musculoskeletal disease

5

What are the specific risk factors for PE?

truncal obesity
pre-existing vascular disease
obesity hypoventilation syndrome or OSA
BMI >60

6

How do lung volumes change in obesity?

FRC is reduced
ERV is reduced
Tidal volumes drop to the range of closing capacity (atelectasis)

7

What are the implications of a decreased FRC in an obese patient?

you have less time for safe apnea

8

What are some respiratory changes in obesity?

increased O2 consumption and CO2 production
high MV
reduced chest wall compliance
restrictive lung patterns
pulmonary HTN and lung disease

9

How do PFTs change with obesity?

PFTs will actually remain normal until the patient hits severe lung disease or pulmonary HTN

10

Deviations in lung volume during position changes in the obese patient can lead to...

V/Q mismatch
hypoxemia
increased R to L shunt

11

How does increased soft tissue around the airway in an obese patient affect the anesthesia provider?

harder to put them in sniffing position
obstruction of the airway
can impair the mandible and cervical mobility
difficulty maintaining mask ventilation

may consider fiberoptic intubation

12

If a patient needs to be supine but can't tolerate laying flat because of their obesity, what can you do??

use a wedge that elevates their chest and shoulders to about 25 degrees. this allows for better expansion of the lungs while the abdominal contents are pushed down further

13

Cardiac output is increased by 0.1L/min per kilogram of extra adipose tissue. How does this effect circulating blood volume?

circulating blood volume will increase to perfuse the extra fat and that will place an extra strain on the myocardium, creating large LVs

14

In terms of cardiac effects, obese patients have decreased reserves for...

hypotension
hypertension
fluid overload
tachycardia

15

What are the risk factors for atherosclerosis?

high LDL and low HDL

16

Hyperlipidemia can lead to....?

premature CAD
pancreatitis
premature vascular disease

17

How is the severity of OSA measured?

number of hypopneic episodes in one hour OR
apnea hypoxic number in one hour

18

What are some symptoms of OSA?

daytime sleepiness
snoring
oxygen desaturation
impaired concentration
morning headache

19

What are the risk factors for OSA?

male
obese
middle age
ETOH use
drug sleep aids
abdominal fat distribution
neck girth of >17 for men or >16 for women

20

What are the effects of OSA?

hypoxemia
R sided heart failure
hypercapnia
pulmonary and systemic vasoconstriction
polycythemia
respiratory acidosis during sleep

21

What pre-op questions should you ask a patient who is at risk for OSA?

sleeping patterns
snoring
daytime somnolence

22

If your patient has obesity hypoventilation syndrome, what are some alternatives you can use to prevent associated symptoms?

observe them overnight if they were intubated
try an epidural or regional block instead of GA

23

How is OHS different from OSA?

nocturnal central apneic events occur which means that there is apnea without a respiratory effort -- patient won't even try to take deep breaths anymore because of densitization of hypercarbia sensors in the brain

24

What are the characteristics of Pickwickian syndrome/OHS?

obesity
hypercapnia
daytime hypersomnolence
arterial hypoxemia
pulmonary hypertension
respiratory acidosis
R sided heart failure

25

What are some GI specific complications associated with obesity?

hiatal hernia
GERD
delayed gastric emptying
increased gastric volume and pressure
increased gastric acidity

26

What are some thromboembolic complications associated with obesity?

polycythemia
doubled risk of DVT
increased intra-abdominal pressure
immobility

27

What are the risk factors for development of aspiration pneumonitis?

gastric volume >25 mL
gastric pH <2.5 associated with increased parietal cell secretion

28

What are some preventive measures you can take for a patient at high risk of GI related complications?

order reglan and an anti-reflux drug

29

What is the best predictor of difficult airway?

neck circumference
(>40 in = 35% chance of difficult airway)