Care of the Obese in Advanced Practice Nursing: Communication, Assessment, and Treatment PDF
Preview Care of the Obese in Advanced Practice Nursing: Communication, Assessment, and Treatment
Care of the Obese in Advanced Practice Nursing Lisa L. M. Maher, DNP, ARNP, FNP-BC, received her BS in wellness from Waldorf College in Forest City, Iowa, in 2003, her BSN from Allen College in Waterloo, Iowa, in 2005, and her MSN from Graceland University in Independence, Missouri, in 2008. In 2011, she received her DNP from the University of Iowa in Iowa City. She is board certi- fied as a family nurse practitioner (FNP) through the American Nurses Credentialing Center (ANCC). She is the current president of the Cedar Valley (Iowa) chapter of Preven- tive Cardiovascular Nurses Association (PCNA) in Waterloo, Iowa. Dr. Maher has been employed as a nurse practitioner (NP) at the Cedar Valley Cardio- vascular Center since 2008. She specializes in treatment of general cardiology, sleep apnea, weight loss, and risk factor modification. She started the Cedar Valley Center for Lifestyle Medicine Clinic in 2008 and the Cedar Valley Cardiovascular Center Sleep Clinic in 2009. Care of the Obese in Advanced Practice Nursing Communication, Assessment, and Treatment Lisa L. M. Maher, DNP, ARNP, FNP-BC Copyright © 2016 Springer Publishing Company, LLC All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permis- sion of Springer Publishing Company, LLC, or authorization through payment of the appropriate fees to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400, fax 978-646-8600, [email protected] or on the Web at www.copyright.com. Springer Publishing Company, LLC 11 West 42nd Street New York, NY 10036 www.springerpub.com Acquisitions Editor: Joseph Morita Production Editor: Kris Parrish Composition: Westchester Publishing Services ISBN: 978-0-8261-2357-2 e-book ISBN: 978-0-8261-2358-9 15 16 17 18 / 5 4 3 2 1 The author and the publisher of this work have made every effort to use sources believed to be reliable to provide information that is accurate and compatible with the standards generally accepted at the time of publication. Because medical science is continually advancing, our knowledge base continues to expand. Therefore, as new information becomes available, changes in procedures become necessary. We recom- mend that the reader always consult current research and specific institutional policies before performing any clinical procedure. The author and publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or reliance on, the information contained in this book. The publisher has no responsibility for the persistence or accuracy of URLs for external or third-party Internet websites referred to in this publication and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Library of Congress Cataloging-in-Publication Data Maher, Lisa L. M., author. Care of the obese in advanced practice nursing : communication, assessment, and treatment / Lisa L. M. Maher. p. ; cm. Includes bibliographical references. ISBN 978-0-8261-2357-2 (hard copy : alk. paper) — ISBN 978-0-8261-2358-9 (ebook) I. Title. [DNLM: 1. Obesity—nursing. 2. Advanced Practice Nursing—methods. 3. Obesity—therapy. WD 210] RC628 616.3'980231—dc23 2015029702 Special discounts on bulk quantities of our books are available to corporations, professional associa- tions, pharmaceutical companies, health care organizations, and other qualifying groups. If you are interested in a custom book, including chapters from more than one of our titles, we can provide that service as well. For details, please contact: Special Sales Department, Springer Publishing Company, LLC 11 West 42nd Street, 15th Floor, New York, NY 10036-8002 Phone: 877-687-7476 or 212-431-4370; Fax: 212-941-7842 E-mail: [email protected] Printed in the United States of America by Bradford & Bigelow. This book is dedicated to current and future advanced practice nurses. Continue to educate with compassion. This book is also dedicated to Brook, my loving husband. Contents Preface xi Acknowledgments xv Share Care of the Obese in Advanced Practice Nursing: Communication, Assessment, and Treatment PART I: INTRODUCTION 1. Obesity: The Epidemic, Trends, and Causes 3 The Epidemic 3 Trends 6 Causes 9 2. Definition of Obesity and Obesity Terms 19 3. The Many Roles of the Advanced Practice Nurse 27 Certified Nurse Practitioner (CNP) 28 Certified Registered Nurse Anesthetist (CRNA) 29 Certified Nurse-Midwife (CNM) 30 Clinical Nurse Specialist (CNS) 30 Case Study 1 33 PART II: COMMUNICATION 4. Addressing Pediatric Obesity 39 Risk Factors 39 Growth Charts 41 The Provider–Pediatric Patient Relationship 42 5. How to Initiate the Weight Conversation With Patients 43 Weight Discrimination—Provider 43 Weight Discrimination—Patient 45 The Provider–Patient Relationship 46 Therapeutic Communication 47 Ethical Principles 49 Addressing Legal Issues—Malpractice 49 6. Patients’ Stories 53 Case Study 2 85 viii ■ Contents PART III: ASSESSMENT 7. Overview of Genetics and Pathophysiology of Obesity 91 Energy Balance 91 Environmental and Genetic Factors 92 Genetic Syndromes 93 Gene and Protein Function 93 Pathophysiology 94 8. Behaviors, Addiction, and Eating Disorders 99 Behaviors and Addiction 99 Eating Disorders 101 Unintentional Weight Loss 104 9. Which “Way” Is the Right “Weigh?” 107 Measuring Body Fat 107 10. Physical Assessment of the Adult Obese Patient 113 11. Physical Assessment of the Pediatric Obese Patient 123 12. Physical Activity, Exercise Assessment, and Patient Recommendations 129 History of Physical Activity Recommendations 129 Key Concepts of Physical Activity 130 Patient Evaluation 130 Objective Methods to Assess Physical Activity 132 Effects of Exercise Response and Training 132 Exercise Testing 133 Exercise Programming 135 Special Considerations 156 13. Dietary Assessment and Patient Recommendations 157 Jennifer Roth Starting With a New Patient 158 Nutrition Screening 158 Monitoring Patients’ Eating Patterns and Habits 158 Daily Food Record or Journal 159 Estimating Needs for Weight Loss 161 Diet Composition 162 Portion Control 163 Recommendations 163 Counseling to Improve Behavior Change 164 14. Psychological Assessment 167 Case Study 3 173 PART IV: DISEASE MANAGEMENT 15. Disease Management and the Role of the Advanced Practice Nurse 179 16. Obesity-Related Diseases 183 Hypertension 183 Dyslipidemia 189 Contents ■ ix Cardiovascular Disease 193 Diabetes Mellitus 198 Obesity and the Pulmonary System 201 Osteoarthritis 204 Polycystic Ovary Syndrome 205 Metabolic Syndrome 208 17. Obesity-Related Diseases: A Pediatric Focus 213 Hypertension 214 Dyslipidemia 216 Diabetes Mellitus 218 Obstructive Sleep Apnea 220 Asthma 222 18. Prevention 227 Prevention Guidelines 227 School Opportunities for Prevention Focus 228 19. Weight Cycling 233 Commonalities in Weight Cycling 234 Health Consequences of Weight Cycling 236 Case Study 4 241 PART V: TREATMENT 20. Treatment of Addiction and Eating Disorders 247 Food Addiction 247 Eating Disorders—Anorexia and Bulimia 249 21. Pharmacological Therapy 253 Pharmacotherapy for Obesity 253 FDA-Approved Obesity Medications 255 Off-Label Drug Use 259 Nonprescription Medications 262 FDA-Withdrawn Medications 263 22. Surgical Therapy 265 Candidates for Bariatric Surgery 265 Medical Clearance for Bariatric Surgery 266 Surgical Procedures 267 Postoperative Complications 269 Long-Term Follow-Up 270 23. Costs Associated With Obesity Treatment and Insurance Coverage 275 Costs Associated With Obesity 275 Insurance Coverage 276 24. Treatment of the Obese Pediatric Patient 281 Medical Treatment 281 Pharmacological Therapy 283 Bariatric Surgery 284 25. What Is Lifestyle Medicine? 287
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