Transcript Bariatric Surgery - Nursing Center

Bariatric Surgery
By Sue Gabriel, ARNP, CCRN, MSN
Nursing made Incredibly Easy! January/February 2006
2.5 ANCC/AACN contact hours
Online: www.nursingcenter.com
© 2006 by Lippincott Williams & Wilkins. All world rights reserved.
Obesity Defined
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Body mass index (BMI) > 30 kg/m2
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Morbidly obese: BMI > 40 kg/m2 or more
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Goal of bariatric surgery is weight
reduction
Candidates for Bariatric Surgery
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BMI > 40 kg/m2, or more than 35 kg/m2 with a comorbidity of sleep
apnea, diabetes, hypertension, degenerative joint disease, asthma,
or history of stroke
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18 years or older
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Obese for 5 years or more
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Unsuccessfully attempted weight loss using other methods
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Able to complete intense screening process, including commitment
to long-term weight loss
Types of Bariatric Surgery
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Restrictive-Creates a gastric pouch with a narrow outlet,
so patient “feels full” sooner; examples: gastroplasty,
gastric banding
• Vertical banded gastroplasty: Surgical staples create a
small gastric pouch and a “band” as an outlet for the
pouch
• Circumgastric banding: Adjustable, inflatable band placed
around fundus of stomach
Types, continued
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Malabsorptive-Bypasses a significant amount
of small intestine, greatly reducing amount of
calories/nutrients absorbed
• Jejunocolic bypass: Reroutes the jejunum
directly to the colon
• Jejunoileal bypass: Small intestine attached
to the distal ileum
Combination Surgery
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Most effective procedures combine restrictive
and malabsorptive types of surgery
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Gold standard in the U.S. is the Roux-en-Y
gastric bypass; creates a small stomach pouch
with a connection to the jejunum
• Food ingested bypasses 90% of stomach
• Can be done laparoscopically
Preoperative Teaching
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Deep breathing/coughing
exercises to be done post-op
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Possible need for abdominal
binder/wound dressings postop
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I.V. and drains to be in place
post-op
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BP/pulmonary function: Should
be peak pre-op
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DVT prophylaxis
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Need for reliable birth control
for childbearing-age patients,
especially during post-op
period
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Pain management options
post-op
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Lifelong commitment to weight
loss
Post-Operative Nursing Care
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Frequently monitor patient’s BP, cardiac function, I & O;
tachycardia/hypertension common post-op in this
population
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Pain management is a priority
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DVT prevention: Early ambulation, sequential
compression devices, anticoagulation
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Aggressive pulmonary toilet
A New Diet
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NPO immediately post-op
Once bowel sounds return, patient starts small
meals; 600-800 calories/day
Clear liquids progressing to regular diet
Diet rich in protein, low in sugars/fats
Drink liquids separate from meals
Eat slowly/chew food thoroughly
Long-Term Implications

Increased risk for abdominal hernia, gall bladder
disease; dietary supplement containing bile
salts, cholecystectomy may be recommended
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Nutritional deficiencies: Recommend daily
vitamin, calcium supplement
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Follow-up important both physically and
psychosocially