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NUR 201 Week 9 > Bariatric Surgery > Flashcards

Bariatric Surgery Flashcards

1
Q

Classification of Body Weight & Obesity

A

Primary & secondary obesity

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2
Q

?

  • Chromosomal & congenital anomalies
  • Metabolic problems
  • CNS lesions & disorder(s)
A

Secondary obesity

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3
Q

?

  • Excess caloric intake for the body’s metabolic demands
A

Primary obesity

! The majority of obese people have primary obesity (they’re eating too much & exercising too little; also are eating foods that are nutritionally deficient)

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4
Q

Patient Assessment

  • Body mass index (BMI)
  • Waist circumference
  • Waist-to-hip ratio
  • Determination of body shape
A

> BMI & waist circumference are widely used; they’re cost-effective & reliable in practice settings

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5
Q

Cardiovascular Problems

  • Obesity is a significant risk factor for CVD

> Android obesity pts @ greater risk
* ↑ LDLs
* High TG’s
* ↓ HDLs

A
  • Obesity is assoc w/HTN which occurs b/c of inc circulating blood volume, abn vasoconstriction, inc inflammation, & inc in sleep apnea which raises BP
  • Altered lipid metabolism & HTN can lead to long-term risk of heart dz & CVA; excess body fat can also lead to chronic inflammation throughout body esp in blood vessels which can in turn inc risk of HD
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6
Q

Diabetes Mellitus

Type 2 diabetes
* Hyperinsulinemia
* Insulin resistance
* Glucose intolerance

! Weight loss & exercise improve glucose control

A
  • More than 80% of people w/type 2 DM are obese or overweight

! A reduction of 7% of a person’s weight can reduce the risk of diabetes by 58%

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7
Q

GI & Liver Problems

  • GERD
  • Gallstones
  • NASH
    > Can eventually lead to cirrhosis
    ! Weight loss can improve
A
  • Gallstones occur d/t supersaturation of bile w/cholesterol
  • NASH occurs when lipids deposit in the liver, leading to a fatty liver
    > Assoc w/elevated hepatic glucose production & can eventually lead to cirrhosis & be fatal
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8
Q

Respiratory & Sleep Problems

  • Sleep apnea
    > Snoring & hypoventilation
  • Obesity hypoventilation syndrome
    > Reduced chest wall compliance
    > ↑ work of breathing
    > ↓ total lung capacity & functional residual capacity
A
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9
Q

The level of __ falls in patients who are sleep deprived, thus promoting appetite

A

leptin

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10
Q

Musculoskeletal Problems

  • Osteoarthritis
    > Stress on weight-bearing joints (knees & hips)

> Obesity triggers inflammatory mediators

A

> Cartilage deterioration

> ↑ incidences of hyperuricemia & gout

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11
Q

Cancer

  • Obesity is 1 of the most important, known preventable causes of cancer
    > Breast, endometrial, kidney, colorectal, & GB cancers are linked to excess body fat
A
  • 20% in women; 15% in men
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12
Q

Psychosocial Problems

  • Stigmatization
    > Low self-esteem
    > Social isolation
    > Depression
A
  • Discrimination in employment, education, & healthcare
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13
Q

?

  • A viable & popular option for treating obesity
  • Currently the only treatment found to have a successful & lasting impact on sustained wt loss for severely obese individuals
A

Bariatric Surgery

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14
Q

Criteria for surgery

  • BMI ≥ 40 kg/m2
A
  • BMI ≥ 35 kg/m2 w/1 or more obesity-related complications
    > HTN, type 2 DM, HF, sleep apnea
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15
Q

Must be screened for

  • Psychological, physical, & behavioral conditions that have been assoc w/poor surgical outcomes
  • Illnesses known to reduce life expectancy & not likely to be improved w/weight reduction
A
  • Pts are not good candidates for bariatric surgery if they have untreated depression, binge-eating disorders, & drug & alcohol abuse that may interfere w/the commitment req’d to lifelong behavioral changes
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16
Q

Other criteria -

  • Advanced cancer
  • End-stage renal, liver, and cardiopulmonary dz
  • Severe coagulopathy
  • Inability to comply w/nutritional requirements
A
17
Q

Bariatric Surgery - 3 broad categories

  • Restrictive
  • Malabsorptive
  • Combination of restrictive & malabsorptive
A
18
Q

___ surgery

The length of the SI is decreased, so there is less food absorbed

A

Malabsorptive

19
Q

___ surgery

The stomach is reduced in size; there is less food eaten

A

Restrictive

20
Q

A majority of these procedures are done laparoscopically, thus decreasing any postop complications or recuperation (as opposed to having an open procedure)

A

There are less wound infections, shorter hospital stays, & a faster recovery period

21
Q
  • Adjustable gastric banding (AGB)
  • Vertical sleeve gastrectomy
  • Vertical banded gastroplasty (VBG)
A
  • Biliopancreatic diversion (BPD) w/duodenal switch
  • Roux-en-Y bypass
22
Q

?

  • Most common procedure
  • Limits stomach size w/an inflatable band around fundus of the stomach
    > Connected to a subcutaneous port then can be inflated or deflated to meet pt’s needs as wt is lost

! Creates a sense of fullness; can be modified or reversed @ a later date if necessary

Is this restrictive, malabsorptive, or both?

A

Adjustable gastric banding (AGB)

restrictive

23
Q

?

  • 85% of the stomach is removed; NOT reversible
  • Stomach function is preserved
  • Results in elimination of hormones produced in the stomach that stimulate hunger (?)

Is this restrictive, malabsorptive, or both?

A

Vertical sleeve gastrectomy

ghrelin

restrictive

! Pts who are morbidly obese lose more wt w/this procedure

24
Q

?

  • Has low complication rates
  • Excellent pt tolerance
  • Food bypasses 90% of stomach, duodenum, & a small segment of jejunum

Is this restrictive, malabsorptive, or both?

A

Roux-en-Y surgical procedure (RNYGB)

both

25
Q

Roux-en-Y

  • Is a robotic-assisted surgical procedure; results in quick wt loss but is more invasive w/a risk of postop complications

! Most commonly called “gastric bypass”

A
  • Parts of the stomach are bypassed so fewer calories are absorbed
26
Q

Combination Restrictive & Malabsorptive Surgery

  • __ __ is common >RYGB
    > Gastric contents empty too rapidly into the SI
    > Avoidance of sugary foods is recommended
A

Dumping syndrome

27
Q

Dumping syndrome

  • N/V, fainting, weakness, diaphoresis, & sometimes diarrhea
A

> Eat smaller portions that are low in sugar; don’t drink liquids w/meals; we want to slow the process down

28
Q

Preoperative Care

  • Determine
    > Assistive devices currently in use
    > Past & current health info (comorbidities inc risk of complications)
  • A team approach may be necessary (cardiologist, pulmonologist)
A
  • Have room ready for pt <arrival
  • Larger BP cuff
  • Larger gown
  • Pt transfer equipment (wheelchair w/removable arms)
29
Q
  • Practice cough & DB, turning, & positioning procedures
    > Teach spirometer use
    > Arrange for CPAP if used @ home
A
  • Obtain longer IV catheter
  • May have NG tube placed
30
Q

Postoperative Care

  • Close observations for complications
  • Transfer w/specially trained personnel
    > Stabilize airway
    > Manage pain
    > Elevate HOB to 30-45°
A
  • Evaluate for re-sedation
  • Be on the lookout for thrombus formation, anastomosis leak, & electrolyte imbalances
    > Ensure a patent airway when returning from surgery
31
Q
  • Diligent turning & ambulating
    > Excess adipose tissue compresses chest & abdomen
    ! Causes CO2 retention
    ! Hypoxemia, PHTN, polycythemia
A
  • Risk for DVT
    > Anti-embolism stockings, SCD’s, low weight heparin
  • Infection (bacterial/fungal), dehiscence, delayed healing
32
Q

Special Considerations: Postop Care

  • Considerable abdominal pain
    > Medicate as needed
    > Assess for anastomosis leaks
    > Evaluate wound condition closely
    > Attentive to placement of NG tube
    > Careful transition to new diet
A

> Monitor drainage & dressings; incision area

> If a pt vomits w/an NG tube in place, the tube may need to be repositioned; notify the surgeon immediately

33
Q

Ambulatory & Home Care

  • Following bariatric surgery, pts find it challenging to maintain a prescribed diet
    > Pt now has reduced intake b/c of anatomic changes
    > Attention to nutrition is important to prevent early &/or late complications
A

! Diet should be high in protein & low in carbs & fat; 6 small feedings daily; no fluids w/meals; restricted to <1000 mL/day

! In the late recovery phase we may see peptic ulcer formation, dumping syndrome, & small bowel obstructions

34
Q
  • Long-term follow-up care is important for physical & psychological reasons
    > Old diet patterns
    > Issues r/t the return of fertility in women
    > New body image
A

Cosmetic Surgeries

  • Ideal candidates have achieved weight reduction & have excess skin folds or fat
  • Chooses surgery for cosmetic reasons; lipectomy/liposuction
35
Q

Evaluation - Expected Outcomes

  • Long-term wt loss
  • Improvement in obesity-related co-morbidities
  • Integration of healthy practices into lifestyle
A
  • Improved self-image
  • Monitor for possible adverse effects
36
Q

Obesity: Gerontologic Considerations

  • Increased prevalence of obesity
    > Decreased energy expenditure contributes to inc body fat
A

> Exacerbates age-related problems
* ↓ mobility, urinary continence, hypoventilation, sleep apnea

  • ↓ quality of life
  • ↓ life expectancy by 6-7 yrs

NUR 201 Week 9 (4 decks)

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