Bariatric Surgery

Question 1

What is the definition of morbid obesity?

Answer 1

• More than 2x ideal body weight
  OR
• BMI > 40 kg/m2
  OR
• > 100 pounds greater than ideal body weight

Question 2

In what ways can pharmacological medications for morbid obesity work?

Answer 2

1.) Inhibit reuptake of serotonin & norepinephrine
AND / OR
2.) Prevent digestion of fats

Used in people with BMI > 27 or who have other diagnoses secondary to obesity

Question 3

Pre-Op Care for Bariatric Surgery

Answer 3

• Review labs (CBC, electrolytes, BUN, CR, ECG, Lipid & liver panels)
• NPO (clear liquid diet 48 hours before & NPO after midnight the day of surgery)
• Evaluation for risk factors
• Patient teaching

Question 4

Post-Op Bariatric Surgery Management

Answer 4

Laproscopic Vs. Open Surgery
* Laproscopic = 1-2 days in the hospital
* Open Surgery = 4-5 days in the hospital

Pain Control
* PCA (patient controlled analgesics)
* Oral opioids

Nasogastric Tube Management
* Monitor I&Os
* Never reposition tube
* Removed on 2nd or 3rd day upon return of bowel sounds & flatus

Re-Introduction of Foods (can start once bowel sounds return)
* Clear liquids (1 oz cups)
* Pureed foods, juice, soups, & milk (24 - 48 hours after clear liquid is tolerated)
* Diet is limited to liquids or pureed foods for 6 weeks
* After 6 weeks, patient can progress to regular foods
* Nausea, vomiting, & discomfort will occur if too much liquid is ingested

Question 5

Signs & Symptoms of Hemorrhage (intra-abdominal hemorrhage in the case of a patient post bariatric surgery)

Answer 5

• ↑ HR
• ↑ RR
• ↓ Urine output
• ↓ BP
• Anxiety
• Restlessness

Question 5

Potential complications that can occur after bariatric surgery

Answer 5

• Hemorrhage (intra-abdominal)
• Deep Vein Thrombosis
• Bowel Obstruction (don’t place NGT)
• Dysphagia (usually most severe 4-6 weeks post-op; can last for 6 months)

Question 6

What is Dumping Syndrome? What are the signs & symptoms of dumping syndrome?

KNOW THIS!!!!!!

Answer 6

Occurs when food enters the small intestines (duodenum) too quickly from the stomach

Signs & Symptoms:
* Tachycardia
* N/V
* Abdominal Cramping
* Hypotension
* Diarrhea
* Diaphoresis
* Palpitations
* Pallor
* Dizziness / Lightheadedness
* Warmth
* Headache

Usually occurs 30 minutes after eating & is common after bariatric surgery

Question 7

Education regarding Vitamins & Minerals after Bariatric Surgery

Answer 7

• Patients may need to take vitamins and/or supplements like Vitamin B12, Iron, Calcium, etc. because of decreased nutrient uptake that occurs after bariatric surgery