Topic 7: Bariatric Surgical Therapy

Question 1

Bariatric surgery

Answer 1

surgery on the stomach and/or intestines to help a person with extreme obesity lose weight

Question 2

Restrictive procedures

Answer 2

the stomach is reduced in size (less food eaten)

Question 3

Malabsorptive procedures

Answer 3

the small intestine is shortened or bypassed (less food absorbed)

Question 4

Before surgery assess client for:

Answer 4

· Psychological, physical and behavioral conditions

Question 5

what conditions can lead to poor outcomes

Answer 5

untreated depression, binge eating disorders, drug/alcohol abuse

Question 6

Restrictive Surgeries

Answer 6

· Adjustable Gastric Banding (AGB)
· Sleeve Gastrectomy (Gastric Sleeve)

Question 7

Adjustable Gastric Banding (AGB)

Answer 7

o Inflatable band encircles stomach, has least amount of complications

Question 8

Sleeve Gastrectomy (Gastric Sleeve)

Answer 8

o About 75% of the stomach is removed

Question 9

Combination of Restrictive & Malabsorptive Surgery

Answer 9

Roux-en-Y Gastric Bypass

Question 10

Roux-en-Y Gastric Bypass

Answer 10

considered gold standard
o Surgery on stomach to create pouch (restrictive)
o Small gastric pouch connected to jejunum
o Remaining stomach and first segment of small intestine are bypassed (malabsorptive)

Question 11

Pre-Op Care

Answer 11

· Assess for use of assistive devices. Not any physical limitations or mobility issues
· Perform baseline assessment, VS, pulse ox, height, weight, BMI, skin condition, nutritional status, heart, lung, bowel sounds, labs
· Explain the need for frequent assessment and interventions to prevent VTE
· Have proper sized hospital gowns, beds, BP cuffs, and transfer equipment

Question 12

Post-Op Care

Answer 12

· Assess and compare baseline VS
· Assess abdominal wound for the amount and type of drainage, condition of incision, and signs of infection
· Observe anastomosis leak (tachycardia, fever, tachypnea, chest and abdominal pain)
· Help patient turn, cough, deep breath and use incentive spirometer every 2 hours
· Protect incision against any straining that accompanies turning and coughing
· Give pain medications as needed
· Position patient upright at a minimum of 45-degree angle
· Maintain IV and/or oral fluid intake and monitor UO
· Institute measures to prevent VTE

Question 13

Post-Op Care: nutrition

Answer 13

o Start with room temp water and low-sugar clear liquids
o Tach the patient to avoid drinking with a straw
o Begin with 15 mL every 10-15 minutes, gradually increase to 90 mL every 30 minutes
o Move to a low-fat, full-liquid diet after 48 hours if tolerating clear liquids
o Observe for dehydration (thirst, decreased UO, HA, dizziness)

Question 14

The body stores anesthetics in adipose tissue: so, there is a risk for resedation, if this happens…

Answer 14

be prepared to perform a head-tilt or jaw-thrust maneuver and keep the patients oral and nasal airways open

Question 15

patient teaching

Answer 15

proper coughing and deep breathing techniques, incentive spirometer use, and methods of turning and positioning to prevent pulmonary complications

Question 16

what kind of diet is the patient discharged on

Answer 16

full liquid diet

Question 17

when can patient begin pureed to soft food diet with vitamin supplements

Answer 17

within 10 to 14 days

Question 18

when can patient begin normal diet

Answer 18

4 to 6 weeks after surgery

Question 19

eating and drinking instructions after surgery

Answer 19

Do not consume fluids with meals

Eat slowly and stop eating when feeling full