Bariatric Surgery

Question 1

Commonly occuring nursing diagnoses for the patient with bariatric surgery

Answer 1

1. Impaired Physical Mobility r/t excessive body weight and post-operative pain
2. Risk for impaired skin integrity r/t altered nutritional state, immobility, multiple skin folds, excess moisture
3. Ineffective breathing patterns r/t decreased lung expansion
4. Acute pain r/t surgical incision

Question 2

Common therapeutic nursing interventions and rationale to be implemented in caring for a patient with morbid obesity/bariatric surgery

Answer 2

Immediate Post-Op

1. ABC’s, TCDB, incentive spirometer, VS
2. Pain
3. Bowel Sounds, flatus, distention
4. Early ambulation
5. Prevention of thrombophlebitis: SCD’s, TED hose, Anticoagulation is ordered, ROM
6. Skin Assessment, both wound and skin folds
7. Skin care to keep skin dry due to perspiration
8. Splinting of abdominal wound to prevent dehiscence
9. NG care is NG present
10. I/O
11. 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

Question 3

Potential Complications associated with bariatric surgery

Answer 3

1. Dumping Syndrome
2. Skin folds
3. Adhesions
4. Depression

Question 4

Bariatrics

Answer 4

branch of medicine that deals with the causes, prevention, and treatment of obesity

Question 5

Common patient problems and therapeutic interventions to manage problems following bariatric surgery

Answer 5

• 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

Question 6

What is bariatric surgery?

Answer 6

Surgical treatment for morbid obesity

Question 7

Obesity

Answer 7

when body mass index is greater than 30

Question 8

What qualifies a patient to undergo bariatric surgery to treat obesity?

Answer 8

1. BMI > or = to 35 with medical complications such as HTN or DM
2. DMI > or = 40 without complications
3. No age limit but risks increase if you’re older than 65 and the surgery remains controversial in people under age 18
4. Understands risks and benefits of surgical procedure
5. Has been obese for >5 years
6. Tried and failed other weight loss methods, such as diets and medications
7. Has no serious endocrine abnormalities which have led to the obesity
8. Psychiatric and social stability
9. Willingness to cooperate with long term management
10. Able to f/u long term with medical team including MD, social work, nutrition
11. Would benefit patient by decreasing long term medical complications associated with morbid obesity

Question 9

Three broad categories of bariatric surgery

Answer 9

1. Restrictive
2. Malabsorptive
3. Combination of restrictive and malabsorptive

Question 10

Restrictive

Answer 10

Smaller Stomach. Pouch holds 30 mL or less. Digestion is not altered. Ex. Banding procedure

Question 11

Malabsorptive

Answer 11

Incomplete uptake of nutrients - stomach pouch and portion of small intestine bypassed-food not completely digested. Ex. Bypass procedure

Question 12

Combination of restrictive and malaborptive

Answer 12

Stomach pouch made smaller and portion of small intestine bypassed allowing less uptake of nutrients

Question 13

Causes of bariatric surgery

Answer 13

1. Severe obesity (more than 100 pounds over normal body weight, BMI >35)
2. Increases inportion sizes over time
3. Sedentary lifestyle

Question 14

Surgical Interventions

Answer 14

• Gastroplasty
• Gastric Bypass

Question 15

Gastroplasty

Answer 15

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.

Question 16

Gastric Bypass

Answer 16

Stomach size decreased with a gastric pouch that is anastomosed from direct emptying into the jejunum (roux-en-Y procedure)

Question 17

Dumping Syndrome

Answer 17

• Can happen when a patient has high sugary/concentrated sweets
• Hyperosmolar meal causes rapid shift of fluid from extra/intra cellular spaces into the small intestine
• Causes distention stimulating peristalsis

Question 18

S/S of Dumping Syndrome

Answer 18

1. Weakness
2. Palpitations
3. Sweating
4. Nausea
5. Abdominal pain
6. Diarrhea

Question 19

Lifelong Nutrition Considerations for patients who have had bariatric surgery

Answer 19

1. MVI and mineral supplements daily
2. Chew food thoroughly
3. No drinks with meals
4. Avoid high sugary foods
5. Eat and drink slowly
6. Try new foods one at a time