Obesity Nursing Care Plans

Description

Obesity is a complex disorder involving an excess accumulation of body fat at least 20% over average desired weight for age, sex, and height or a body mass index of greater than 27.8 for men and greater than 27.3 for women. Obesity isn’t just a cosmetic concern. It increases your risk of diseases and health problems such as heart disease, diabetes and high blood pressure. That’s why using a product such as pink lady kush is becoming more and more popular, as these have been shown to be an efficient way of losing weight, and can be used as a supplement for many other health implications. However, there are many other reliable ways of losing weight it just depends on your preference.

It is different from being overweight, which means weighing too much. The weight may come from muscle, bone, fat, and/or body water. Both terms mean that a person’s weight is greater than what’s considered healthy for his or her height.

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Obesity occurs over time when you eat more calories than you use. The balance between calories-in and calories-out differs for each person. Factors that might affect your weight include your genetic makeup, overeating, eating high-fat foods, and not being physically active. A balance of these four things are very important to maintain a healthy lifestyle. For more infomation check out these tips on losing weight.

Nursing Care Plans
Imbalanced Nutrition

Nursing Diagnosis

  • Imbalanced Nutrition: More Than Body Requirements

May be related to

  • Food intake that exceeds body needs
  • Psychosocial factors
  • Socioeconomic status

Possibly evidenced by

  • Weight of 20% or more over optimum body weight; excess body fat by skinfold/other measurements
  • Reported/observed dysfunctional eating patterns, intake more than body requirements

Desired Outcomes

  • Identify inappropriate behaviors and consequences associated with overeating or weight gain.
  • Demonstrate change in eating patterns and involvement in individual exercise program.
  • Display weight loss with optimal maintenance of health.
Nursing Interventions Rationale
Review individual cause for obesity (organic or nonorganic). Identifies and influences choice of some interventions.
Carry out and review daily food diary (caloric intake, types and amounts of food, eating habits). Provides the opportunity for the individual to focus on a realistic picture of the amount of food ingested and corresponding eating habits and feelings. Identifies patterns requiring change or a base on which to tailor the dietary program.
Explore and discuss emotions and events associated with eating. Helps identify when patient is eating to satisfy an emotional need, rather than physiological hunger.
Formulate an eating plan with the patient, using knowledge of individual’s height, body build, age, gender, and individual patterns of eating, energy, and nutrient requirements. Determine which diets and strategies have been used, results, individual frustrations and factors interfering with success. Although there is no basis for recommending one diet over another, a good reducing diet should contain foods from all basic food groups with a focus on low-fat intake and adequate protein intake to prevent loss of lean muscle mass. It is helpful to keep the plan as similar to patient’s usual eating pattern as possible. A plan developed with and agreed to by the patient is more likely to be successful.
Emphasize the importance of avoiding fad diets. Elimination of needed components can lead to metabolic imbalances like excessive reduction of carbohydrates can lead to fatigue, headache, instability and weakness, and metabolic acidosis (ketosis), interfering with effectiveness of weight loss program.
Discuss need to give self permission to include desired or craved food items in dietary plan. Denying self by excluding desired or favorite foods results in a sense of deprivation and feelings of guilt and failure when individual “succumbs to temptation.” These feelings can sabotage weight loss.
Be alert to binge eating and develop strategies for dealing with these episodes (substituting other actions for eating). The patient who binges experiences guilt about it, which is also counter productive because negative feelings may sabotage further weight loss efforts.
Identify realistic increment goals for weekly weight loss. Reasonable weight loss (1–2 lb per wk) results in more lasting effects. Excessive and rapid loss may result in fatigue and irritability and ultimately lead to failure in meeting goals for weight loss. Motivation is more easily sustained by meeting “stair-step” goals.
Weigh periodically as individually indicated, and obtain appropriate body measurements. Provides information about effectiveness of therapeutic regimen and visual evidence of success of patient’s efforts. (During hospitalization for controlled fasting, daily weighing may be required. Weekly weighing is more appropriate after discharge.)
Determine current activity levels and plan progressive exercise program (walking) tailored to the individual’s goals and choice. Exercise furthers weight loss by reducing appetite; increasing energy; toning muscles; and enhancing cardiac fitness, sense of well-being, and accomplishment. Commitment on the part of the patient enables the setting of more realistic goals and adherence to the plan.
Develop an appetite reeducation plan with patient. Signals of hunger and fullness often are not recognized, have become distorted, or are ignored.
Emphasize the importance of avoiding tension at mealtimes and not eating too quickly. Reducing tension provides a more relaxed eating atmosphere and encourages more leisurely eating patterns. This is important because a period of time is required for the appestat mechanism to know the stomach is full.
Encourage patient to eat only at a table or designated eating place and to avoid standing while eating. Techniques that modify behavior may be helpful in avoiding diet failure.
Discuss restriction of salt intake and diuretic drugs if used. Water retention may be a problem because of increased fluid intake and fat metabolism.
Reassess calorie requirements every 2–4 wk; provide additional support when plateaus occur. Changes in weight and exercise necessitate changes in plan. As weight is lost, changes in metabolism occur, resulting in plateaus when weight remains stable for periods of time. This can create distrust and lead to accusations of “cheating” on caloric intake, which are not helpful. Patient may need additional support at this time.
Consult with dietitian to determine caloric and nutrient requirements for individuals weight loss. Individual intake can be calculated by several different formulas, but weight reduction is based on the basal caloric requirement for 24 hr, depending on patient’s sex, age, current and desired weight, and length of time estimated to achieve desired weight. Note: Standard tables are subject to error when applied to individual situations, and circadian rhythms and lifestyle patterns need to be considered.
Provide medications as indicated:
Appetite-suppressant drugs like diethylpropion (Tenuate), mazindol (Sanorex), Sibutramine (Meridia); May be used with caution and supervision at the beginning of a weight loss program to support patient during stress of behavioral and lifestyle changes. They are only effective for a few weeks and may cause problems of addition in some people.
Hormonal therapy like thyroid (Euthroid), levothyroxine (Synthroid); May be necessary when hypothyroidism is present. When no deficiency is present, replacement therapy is not helpful and may actually be harmful. Note: Other hormonal treatments, such as human chorionic gonadotropin (HCG), although widely publicized, have no documented evidence of value.
Orlistat (Xenical); Lipase inhibitor blocks absorption of approximately 30% of dietary fat. Facilitates weight loss and maintenance when used in conjunction with a reduced-calorie diet. Also reduces risk of regain after weight loss.
Vitamin, mineral supplements. Obese individuals have large fuel reserves but are often deficient in vitamins and minerals. Note: Use of Xenical inhibits absorption of water-soluble vitamins and beta-carotene. Vitamin supplement should be given at least 2 hr before or after Xenical.
Hospitalize for fasting regimen and stabilization of medical problems, when indicated. Aggressive therapy and support may be necessary to initiate weight loss, although fasting is not generally a treatment of choice. Patient can be monitored more effectively in a controlled setting, to minimize complications such as postural hypotension, anemia, cardiac irregularities, and decreased uric acid excretion with hyperuricemia.
Prepare for surgical interventions (gastric partitioning or bypass) as indicated. These interventions may be necessary to help the patient lose weight when obesity is life-threatening.
Disturbed Body Image

Nursing Diagnosis

May be related to

  • Biophysical/psychosocial factors such as patient’s view of self (slimness is valued in this society, and mixed messages are received when thinness is stressed)
  • Family/subculture encouragement of overeating
  • Control, sex, and love issues

Possibly evidenced by

  • Verbalization of negative feelings about body (mental image often does not match physical reality)
  • Fear of rejection/reaction by others
  • Feelings of hopelessness/powerlessness
  • Preoccupation with change (attempts to lose weight)
  • Lack of follow-through with diet plan
  • Verbalization of powerlessness to change eating habits

Desired Outcomes

  • Verbalize a more realistic self-image.
  • Demonstrate some acceptance of self as is, rather than an idealized image.
  • Seek information and actively pursue appropriate weight loss.
  • Acknowledge self as an individual who has responsibility for self.
Nursing Interventions Rationale
Determine patient’s view of being fat and what is does for the individual. Mental image includes our ideal and is usually not up-to-date. Fat and compulsive eating behaviors may have deep-rooted psychological implications (compensation for lack of love and nurturing or a defense against intimacy).
Provide privacy during care activities. Individual usually is sensitive and self-conscious about body.
Promote open communication avoiding criticism and judgment about patient’s behavior. Supports patient’s own responsibility for weight loss; enhances sense of control, and promotes willingness to discuss difficulties and setbacks and problem-solve. Note: Distrust and accusations of “cheating” on caloric intake are not helpful.
Outline and clearly state responsibilities of patient and nurse. It is helpful for each individual to understand area of own responsibility in the program so that misinformation do not arise.
Graph weight on a weekly basis. Provides ongoing visual evidence of weight changes (reality orientation).
Encourage patient to use imagery to visualize self at desired weight and to practice handling of new behaviors. Mental rehearsal is very useful in helping the patient plan for and deal with anticipated change in self-image or occasions that may arise (family gatherings, special dinners) where constant decisions about eating many foods will occur.
Provide information about the use of makeup, hairstyles, and ways of dressing to maximize figure assets. Enhances feelings of self-esteem; promotes improved body image.
Encourage buying clothes instead of food treats as a reward for weight loss. Properly fitting clothes enhance the body image as small losses are made and the individual feels more positive. Waiting until the desired weight loss is reached can become discouraging.
Suggest the patient dispose of “fat clothes” as weight loss occurs. Removes the “safety valve” of having clothes available “in case” the weight is regained. Retaining fat clothes can convey the message that the weight loss will not occur and be maintained.
Have patient recall coping patterns related to food in family of origin and explore how these may affect current situation. Parents act as role models for the child. Maladaptive coping patterns (overeating) are learned within the family system and are supported through positive reinforcement. Food may be substituted by the parent for affection and love, and eating is associated with a feeling of satisfaction, becoming the primary defense.
Determine relationship history and possibility of sexual abuse. May contribute to current issues of self-esteem and patterns of coping.
Identify patient’s motivation for weight loss and assist with goal setting. The individual may harbor repressed feeling of hostility, which may be expressed inward on the self. Because of a poor self-concept the person often has difficulty with relationships. Note: When losing weight for someone else, the patient is less likely to be successful and maintain weight loss.
Be alert to myths the patient and SO may have about weight and weight loss. Beliefs about what an ideal body looks like or unconscious motivations can sabotage efforts to lose weight. Some of these include the feminine thought of “If I become thin, men will pursue me or rape me”; the masculine counterpart, “I don’t trust myself to stay in control of my sexual feelings”; as well as issues of strength, power, or the “good cook” image.
Assist patient to identify feelings that lead to compulsive eating. Encourage journaling. Awareness of emotions that lead to overeating can be the first step in behavior change (people often eat because of depression, anger, and guilt).
Develop strategies for doing something besides eating for dealing with these feelings such as talking with a friend. Replacing eating with other activities helps retrain old patterns and establish new ways to deal with feelings.
Help staff be aware of and deal with own feelings when caring for patient. Judgmental attitudes, feelings of disgust, anger, and weariness can interfere with care and be transmitted to patient, reinforcing negative self-concept and image.
Refer to community support and therapy group. Support groups can provide companionship, enhance motivation, decrease loneliness and social ostracism, and give practical solutions to common problems. Group therapy can be helpful in dealing with underlying psychological concerns.
Impaired Social Interaction

May be related to

  • Verbalized or observed discomfort in social situations
  • Self-concept disturbance

Possibly evidenced by

  • Reluctance to participate in social gatherings
  • Verbalization of a sense of discomfort with others

Desired Outcomes

  • Verbalize awareness of feelings that lead to poor social interactions.
  • Become involved in achieving positive changes in social behaviors and interpersonal relationships.
Nursing Interventions Rationale
Review family patterns of relating and social behaviors. Social interaction is primarily learned within the family of origin. When inadequate patterns are identified, actions for change can be instituted.
Encourage patient to express feelings and perceptions of problems. Helps identify and clarify reasons for difficulties in interacting with others (may feel unloved and unlovable or insecure about sexuality).
Assess patient’s use of coping skills and defense mechanisms. May have coping skills that will be useful in the process of weight loss. Defense mechanisms used to protect the individual may contribute to feelings of aloneness and isolation.
Have patient list behaviors that cause discomfort. Identifies specific concerns and suggests actions that can be taken to effect change.
Involve in role-playing new ways to deal with identified behaviors and situations. Practicing these new behaviors enables the individual to become comfortable with them in a safe situation.
Discuss negative self-concepts and self-talk, “No one wants to be with a fat person,” “Who would be interested in talking to me?” May be impeding positive social interactions.
Encourage use of positive self-talk such as telling one-self “I am OK,” or “I can enjoy social activities and do not need to be controlled by what others think or say.” Positive strategies enhance feelings of comfort and support efforts for change.
Refer for ongoing family or individual therapy as indicated. Patient benefits from involvement of SO to provide support and encouragement.
Deficient Knowledge

May be related to

  • Lack of/misinterpretation of information
  • Lack of interest in learning, lack of recall
  • Inaccurate/incomplete information presented

Possibly evidenced by

  • Statements of lack of/request for information about obesity and nutritional requirements
  • Verbalization of problem with weight reduction
  • Inadequate follow-through with previous diet and exercise instructions

Desired Outcomes

  • Verbalize understanding of need for lifestyle changes to maintain/control weight.
  • Establish individual goal and plan for attaining that goal.
  • Begin to look for information about nutrition and ways to control weight.
Nursing Interventions Rationale
Determine level of nutritional knowledge and what patient believes is most urgent need. Necessary to know what additional information to provide. When patient’s views are listened to, trust is enhanced.
Identify individual holistic long-term goals for health (lowering blood pressure, controlling serum lipid and glucose levels). A high relapse rate at 5-year follow-up suggests obesity cannot be reliably reversed and cured. Shifting the focus from initial weight loss and percentage of body fat to overall wellness may enhance rehabilitation.
Provide information about ways to maintain satisfactory food intake in settings away from home. “Smart” eating when dining out or when traveling helps individual manage weight while still enjoying social outlets.
Identify other sources of information like books, tapes, community classes, groups. Using different avenues of accessing information furthers patient’s learning. Involvement with others who are also losing weight can provide support.
Emphasize necessity of continued follow-up care and counseling, especially when plateaus occur. As weight is lost, changes in metabolism occur, interfering with further loss by creating a plateau as the body activates a survival mechanism, attempting to prevent “starvation.” This requires new strategies and aggressive support to continue weight loss.
Identify alternatives to chosen activity program to accommodate weather, travel, and so on. Discuss use of mechanical devices and equipment for reducing. Promotes continuation of program. Note: Fat loss occurs on a generalized overall basis, and there is no evidence that spot reducing or mechanical devices aid in weight loss in specific areas; however, specific types of exercise or equipment may be useful in toning specific body parts.
Determine optimal exercise heart rate. Demonstrate proper technique to monitor pulse. Promotes safety as patient exercises to tolerance, not peer pressure.
Discuss necessity of good skin care, especially during summer months and following exercise. Prevents skin breakdown in moist skinfolds.
Identify alternative ways to “reward” self and family for accomplishments or to provide solace. Reduces likelihood of relying on food to deal with feelings.
Encourage involvement in social activities that are not centered around food (bike ride or nature hike, attending musical event, group sporting activities). Provides opportunity for pleasure and relaxation without “temptation.” Activities and exercise may also use calories to help maintain desired weight.