Bariatric Surgical Procedures (Online Lecture) Flashcards
morbid obesity
more than two times ideal body weight or body mass index >40kg/m2 or more than 100 pounds greater than ideal body weight
medical management includes weight loss diet in conjunction with
behavior modification
first approach aimed at weight loss and then maintence, how do we do this?
setting goals for weight loss
improving diet
increasing physical activity
addressing barriers to change
self monitoring
need adequate rest
involved in plan
why do we need adequate rest
sleep loss increase coritsol which leads to weight gain
pharmacologic management includes medications that
inhibit reuptake of serotonin and norepinephrine
and/or prevent digestion of fats
when do we use pharmacologic
diet/lifestyle tried first
would we monitor the patient while on meds
yes
minimally invasive management
vagal blocking therapy
surgical management
roux en Y
gastric banding
sleeve gastrectomy
biliopancreatic diversion
vagal blocking therapy
pacemaker delivering pulses to block vagus nerve which decreases gastric contraction and emptying leading to feeling full, decreasing cravings which lead to less caloric intake
surgical management only preferable after
other measures have failed, insurance coverage varies widely can help treat comorbidities
preop care
- similar to any other abdominal surgical procedure
review of lab studies
ECG
lipid and liver panels
consent
NPO time period
12 hr and clear liquid 48 hr period before
vertical banded gastroplsty
vertical line of staples placed to create a small stomach pouch to which a band is connected to provide an outlet to the small intestine
circumgastric banding
limits size of stomach by placement of inflatable band around funds of stomach
this band can be inflated or deflated to change the size of stomach as the client looses weight
works by making initial stomach part smaller so patient gets fuller quicker and will consume less calories
gastric bypass
gastric resection combined with malabsorption surgery
clients stomach, duodenum and part of jejunum is bypassed so fewer calories are absorbed
banding malabsoption issues
no malabsorption issues compared to other procedures because the food is digested and absorbed as it would normally be
bilopancreatic diversion anatomy change
removal of part of the stomach
large portion of intestine is bypassed
bilopancreatic diversion action
reduce amount of food consumption = smaller stomach significant amount of bowel is bypassed which equals decreased absorption of calories and nutrients impact gut hormones that control hunger, fullness, and blood sugar control
bilopancreatic diversion often done for what patients
diabetic
laparoscopic vs open
laparoscopic is 1-2 days in the hospital which is not likely to have complications
open 4-5 days in the hospital
pain control
helps us prevent other complications (atelectasis)
PCA: opioid
oral: this is after they can handle oral liquids
NGT management
never reposition tube: movement can disrupt suture line
- if pulled out notify MD immediately
removed 2nd or 3rd day upon return of bowel sounds and flatus which is done by surgeon
post op reintroduction of foods
- first
clear liquids 1 ounce cups
post op reintroduction of foods
- after clear liquids 1 ounce cups
pureed foods, juice, soups and milk products added 24-48 hours after clear liquid tolerated
post op reintroduction of foods
- after pureed foods, soups and milk products
increase volume to 1 ounce over 5 mins or until satisfied
post op reintroduction of foods
- how long are they on diet of liquids or pureed foods
6 weeks
post op reintroduction of foods
- after 6 weeks
regular foods
post op reintroduction of foods
- when patient is on regular foods the emphasis is on
nutrient dense foods
post op reintroduction of foods
- when patient is on regular foods what is the protocol they should follow
smaller more frequent meals- not to exceed 1 cup size
high fowler position
nutrient dense foods
consume fluids before or after meals (30-60 mins)
what will occur if too much liquid is ingested
nausea, vomiting, discomfort will occur
what are some equipment we will need
bariatric bed/chair/commode
lifts/trapeze
this patients will require meticulous
skin care
complications
hemorrhage
deep vein thrombosis
bowel obstruction
dysphagia
intra abdominal hemorrhage
increase RR/HR, urine output, restlessness, anxiety
vomiting of blood/stool/drain
if patient is bleeding within first 72 hours it is caused by a
dislodged staple = surgery
if a patient is bleeding within 72 hr- month is caused by a
gastric ulder
deep vein thrombosis
- prevention
SCD stocking, profilaxis, heparin, ambulation
bowel obstruction
do not insert a NGT
dysphagia
education
- typically most severe 4-6 weeks
- may persist for 6 months
- eat slowly, chew completely, avoid tough foods
dumping syndrome what happens
vasomotor and GI response
results from food entering small intestine instead of stomach
dumping syndrome s/s
tachycardia, nausea, diarrhea, abdominal cramping
dumping syndrome occurs how long after eating
15 mins- 2 hours
how is dumping syndrome relieved
having a BM or bowels are empty
dumping syndrome vasomotor response
food moving quickly which increases glucose which increases the release of insulin which then causes a reactive hypoglycemia
- palpations
- pallor
- dizziness
- warmth
- headache
dumping syndrome can cause
reluctant to eat which leads to anorexia
what is one way to avoid dumping syndrome
eat food slowly and chewing completely
dehiscence prevention
binder
what foods should post op patients avoid
high protein foods
high in sugar and fat
alcoholic beverages
life style modifications
increased physical activity
what other surgery is needed after weight stabilizes
plastic for excess skin
