Bariatric Surgery Flashcards
Commonly occuring nursing diagnoses for the patient with bariatric surgery
- Impaired Physical Mobility r/t excessive body weight and post-operative pain
- Risk for impaired skin integrity r/t altered nutritional state, immobility, multiple skin folds, excess moisture
- Ineffective breathing patterns r/t decreased lung expansion
- Acute pain r/t surgical incision
Common therapeutic nursing interventions and rationale to be implemented in caring for a patient with morbid obesity/bariatric surgery
Immediate Post-Op
- ABC’s, TCDB, incentive spirometer, VS
- Pain
- Bowel Sounds, flatus, distention
- Early ambulation
- Prevention of thrombophlebitis: SCD’s, TED hose, Anticoagulation is ordered, ROM
- Skin Assessment, both wound and skin folds
- Skin care to keep skin dry due to perspiration
- Splinting of abdominal wound to prevent dehiscence
- NG care is NG present
- I/O
- Blue dye test if JP in place: patient drinks blue dye. Between 30 minutes and 1 hour monitor JP for blue dye which would indicate leak is present at surgical site
Potential Complications associated with bariatric surgery
- Dumping Syndrome
- Skin folds
- Adhesions
- Depression
Bariatrics
branch of medicine that deals with the causes, prevention, and treatment of obesity
Common patient problems and therapeutic interventions to manage problems following bariatric surgery
- Bariatric sized equipment must be used
- BP Cuff
- Commode
- Walker
- Bed
- W/C
- NPO 2 days
- Liquids for a few days
- Pureed once liquids tolerated for a few days
- Soft solid food after tolerating pureed for a few weeks, with MD approval
- Solid foods after about 8 weeks
What is bariatric surgery?
Surgical treatment for morbid obesity
Obesity
when body mass index is greater than 30
What qualifies a patient to undergo bariatric surgery to treat obesity?
- BMI > or = to 35 with medical complications such as HTN or DM
- DMI > or = 40 without complications
- No age limit but risks increase if you’re older than 65 and the surgery remains controversial in people under age 18
- Understands risks and benefits of surgical procedure
- Has been obese for >5 years
- Tried and failed other weight loss methods, such as diets and medications
- Has no serious endocrine abnormalities which have led to the obesity
- Psychiatric and social stability
- Willingness to cooperate with long term management
- Able to f/u long term with medical team including MD, social work, nutrition
- Would benefit patient by decreasing long term medical complications associated with morbid obesity
Three broad categories of bariatric surgery
- Restrictive
- Malabsorptive
- Combination of restrictive and malabsorptive
Restrictive
Smaller Stomach. Pouch holds 30 mL or less. Digestion is not altered. Ex. Banding procedure
Malabsorptive
Incomplete uptake of nutrients - stomach pouch and portion of small intestine bypassed-food not completely digested. Ex. Bypass procedure
Combination of restrictive and malaborptive
Stomach pouch made smaller and portion of small intestine bypassed allowing less uptake of nutrients
Causes of bariatric surgery
- Severe obesity (more than 100 pounds over normal body weight, BMI >35)
- Increases inportion sizes over time
- Sedentary lifestyle
Surgical Interventions
- Gastroplasty
- Gastric Bypass
Gastroplasty
Stomach partitioned into small pouch of about 30mL of less which limits capacity. The opening from this pouch into the rest of the GI tract may be banded to delay emptying.
