Transcript Bariatric Surgery - LaGuardia ePortfolio

Bariatric Surgery
Anaïse Ikama
Edeneth Flores
Janell Trotman
Marie Jimenez
Marjorie Johnson
Petra Ramnarine
Stacy Moyston-Duckie
Yvonne Prempeh
Na Pang
What is Bariatric Surgery
by
Yvonne Prempeh
What is bariatric surgery?
 Bariatric surgery is the term for operations to help
promote weight loss.
 There are three types of bariatric surgery:
 LAP- BAND® system,
 Vertical Banded
 Gastroplasty(VBD), & Roux-en-Y Gastric Bypass
LAP – BAND® SYSTEM
 An adjustable
silicone elastic band
is placed around the
upper part of the
stomach creating a
small pouch and
restricting the
passage of food
VERTICAL BANDED
GASTROPLASTY (VBG)
 VBG is a purely
restrictive procedure
in which the upper
stomach is stapled
and divided, forming
a small pouch that
reduces the size of
the stomach and the
amount of food the
stomach can hold
ROUX-EN-Y GASTRIC
BYPASS
 Roux-en-Y Gastric
Bypass is the most
frequently performed
weight loss procedure in
the United States
 During this surgery, the
upper stomach is stapled
creating a small pouch
that is completely
divided from the
remainder of the
stomach
Requirements
for Bariatric surgery
by
Petra Ramnarine
Criteria before surgery




BMI of 40+
80 - 100lbs overweight
Diabetes, heart disease or severe apnea
Related physical problems that
significantly employment, physical
mobility or physical function
Criteria for insurance
companies
 Obtaining approval can take up to 4
weeks from insurance company
 Pt will be responsible for out of pocket
fees as outlined in policies
Nutrition: Diet plan
for Bariatric Surgery
by Janell Trotman
Nutrition
 Patient have to follow a strict diet before
and after bariatric surgery.
 Patient must have a nutritional
consultation.
Pre-Post Operative
Nutrition
 Clients are started on a puree or liquid
diet 2 weeks before surgery.
 Most of the caloric intake should contain
mostly of protein.
 Caffeine, soda, alcoholic and beverages
that contain sugar should be avoided.
Food Restriction
 It is important to chew food thoroughly
and slow
 It is important wait 2-3 minutes after
swallowing before putting the next bite of
food in your mouth.
 Don’t drink fluids while eating
Food Restrictions
 Avoid food high in
fat and have no
nutritional value.
Food Restriction
 Avoid alcohol
 Avoid food high
in sugar
 Limit snacking
between meals
Pre-operative
Nursing Care
By Marjorie Johnson
Pre-operative Nursing
Care
 There are always risks with surgery, however
as health care providers, we can follow steps
to minimize these risks by performing physical
and psychosocial assessment of the patient.
The psychosocial assessment is obtained to
evaluate the patient’s mood, self-esteem and
emotional status.
Some of the complications
for bariatric surgery
 DVT, pulmonary Embolus, pneumonia,
dumping syndrome, loss of too much
weight, injury to pelvic organ, and leaks
from a break in the staple line, and death
(1% nationwide).
Sign Consent
 The patient has the right to be
informed of the tests,
treatments, or procedures,
therefore, should be asked to
sign consent; a legal piece of
paper that tells exactly what
will be done to the patient.
Forms that gives caregivers
permission to certain tests,
treatments, or procedures. If
unable to give his/her
consent, someone who has
permission could sign the
form instead.
Special Equipments
 With bariatric surgery
patient, special
equipments have to
be ordered and
explained to patients.
Post-operative
Nursing Care
By Stacy Moyston-Duckie
Complications developed
after Bariatric surgery
 Bariatric-surgery patients are at risk for developing
complications related to surgery and postoperative
respiratory and gastrointestinal disorders.
 According to the International Bariatric surgery registry,
the leading cause of death following bariatric surgery is
pulmonary embolism, anastomotic leaks and
respiratory failure.
 Other complications are wound infections, incisional
hernias, ulcers, bleeding, constipation, cholelithiasis,
dumping syndrome, dehiscence, vitamin and nutrient
deficiencies.
The role of the nurse in monitoring and
managing clients in postoperative
 Typically, during the postoperative recovery period the nurse has
to monitor and manage the patient to reduce complications, by
positioning the patients head at least 30 degrees semi-fowler’s
position to help breathing and by reducing the weight of abdominal
adipose tissue pressing on the diaphragm.
 Checking vital signs, assess for complications, and provide skin
and wound care, breathing exercises using incentive spirometry.
 Assess abdominal changes in appearance of volume gastric or
percutaneous drains, presence of hematemesis or melena, and
persistent cough. These findings should be reported to the
physician for appropriate medical intervention. (www.aafp.org).
 Also encourage early ambulation to reduce the risk of immobility.
Pain Medications
 Post-operative pain medications are given through
‘patient controlled analgesia’ (PCA) pump, which
dispenses (morphine) when the patient pushes a
button. They patient will also receive IV injections of
Torodol.
 Torodol is similar to Motrin and helps relieve abdominal
muscle pain. After day two surgery the patient’s
medication will be switched from PCA machine to a
liquid medicine Roxicet – liquid Percocet that will be
taken by mouth every 4-6 hours.
Appetite suppressant
medications
 Appetite suppressants medications are given such as
Phentermine (Adepex-P, and Obsestin-30) which acts directly on
the appetite-control center in the CNS to suppress and reduce
hunger.
 Sibutramine (Meridia), also reduces hunger and increases
sensations of satiety by inhibiting the uptake of serotonin,
norepinephrine, and dopamine
 Ursodiol, this drug is to taken twice a day, two weeks after surgery.
 Actigall is taken to prevent gallstones from forming during rapid
weight loss. Patients who have done bariatric surgery will need to
take vitamin and mineral supplement for the rest of their lives.
Preventive Measures
Against Obesity
•Diet
•Exercise
•Group support
by
Na Pang
Exercise
Exercise plays a crucial role after bariatric
surgery because
Promotes good circulation, respiration
Increases metabolism, reduces adipose tissues
How to start an effective exercise pattern
Walking is the simple way to start the exercise
process
Then, try out different types of exercises to find
one that is enjoyable, running, treadmill.
However, exercises should be well-organized.
Ongoing Support
 Study shows that
 Support groups, one of the best things, after
bariatric surgery, keep the weight off.
 Rationale
 Surgery requires lifestyle and behavioral
changes, patients need the support of family,
friends, and healthcare professionals to help
them get through any rough spots.
Nursing Care Plans
for Bariatric Surgery
by Marie Jimenez, SPN
Nursing Care plans:
Bariatric Surgery
Pre-operative Nursing Diagnosis:
Disturbed Self-Concept
Post-operative Nursing Diagnosis:
Ineffective Breathing Pattern
For patients undergoing bariatric surgery, it is
important to note that there are nursing care plans
designated for the preoperative and postoperative
phase.
Pre-op Nursing Diagnosis:
Disturbed Self-Concept
related to obesity & inability to lose weight by conventional methods
Nursing Outcome
Nursing Intervention
Client will demonstrate 1.
positive self-concept
AEB
Verbalizing feelings
Positive statements
Active participation in
self-care
2.
3.
Assess for signs
and symptoms of
a disturbed selfconcept
Implement
measures to assist
client to increase
self-esteem
Measures for
client to adapt to
body changes
Nursing Rationale
1.
2.
3.
Recognition
allows for
prompt
intervention
An increase in
self-esteem has
a positive effect
on client
Impact of
changes in selfconcept
Post-op Nursing Diagnosis:
Ineffective Breathing Pattern
r/t increased RR associated with fear/anxiety & decreased RR
associated with depressant effect of anesthesia
Nursing Outcome
Nursing Intervention
1.
Assess for Signs &
Sx of an ineffective
breathing pattern
1.
2.
Monitor for i in
2.
Client will maintain
clear open airways
oximetry results
AEB
3.
Normal breath sounds
Normal rate & depth of
respirations
Absence of dyspnea
Nursing Rationale
4.
Place client in
semi- to high
fowlers position
Instruct clients to
use incentive
spirometer q 1-2 h
3.
4.
Recognition
allows for
prompt intervention
Assist in
evaluating
respiratory
status
Allows for max.
diaphragm
excursion
Promotes max.
inhalation &
lung expansion
Assessment provides vital clues
regarding how nursing care affects
the psychosocial aspect of the
patient
Therapeutic communication
encourages self-awareness
Nurses should be aware of
protocols when deviations of
breathing patterns occur for
proper interventions to take place
Any signs of respiratory distress
should be reported and
documented immediately
Discharge/Client
teaching
by
Anaise E Ikama
Discharge/Client teaching
 Medications: analgesics for
pain, anti-emetics to prevent
dehydration and vitamins to
ensure adequate intake of
nutrition
 Wound care should be taught
to prevent infections
 Activity progression any
abdominal exercises, weight
 Lifting or swimming should
not be attempted. Ambulate to
prevent DVT
 Diet: eat small meals due to
the small size of the
stomach
Discharge/Client teaching
 Report symptoms:
 To the ER
 Issues that require urgent
medical attention, such
as: chest pain, shortness of
breath and excessive
abdominal pain
 Contact the physician
 For non-emergent issues
such as: nausea, vomiting,
diarrhea or fever, redness,
swelling, drainage or bleeding
from the incision
Discharge and
Client Teaching
by
Edeneth Flores
D/C and Client teaching:
 Instruct patients to take
their prescribed
medications.
 Some of the medications
are:
 Analgesics ( pain)
 Anti-emetics (prevent
dehydration)
 Vitamins ( to maintain
the nutrition of the
patient)
D/C and Client teaching:
 Teach wound care:
 Teach about the S/S of
infection:
 Redness
 Swelling
 Pus/abnormal discharge from
the incision site
 Pain





Difficulty breathing
Vomiting
Fever
Epigastric pain
CALL MD if 2 or more of
these symptoms persist:
D/C and Client teaching:
NUTRITION
 Eat small snack due to small
capacity of the stomach.
 Chew food slowly and cut into
pieces.
 If able to tolerate liquids, the
surgeon will likely to
recommend having a puree
diet, then begin eating 3 meals
per day.
 Eat a few tablespoons at a time
to prevent the stretching of the
incision site.
 Eat a few tablespoons at a time
to prevent the stretching of the
incision site
 Includes protein to promote
healing.
D/C and Client teaching:
 Avoid heavy lifting
 Encourage ambulation
and leg exercises
 Emphasize the
importance of Follow-up
visits; patients condition
 Support groups