Bariatric Surgery

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Bariatric Surgery

• Anaïse Ikama 
• Edeneth Flores 
• Janell Trotman
• Marie Jimenez   
• Marjorie Johnson  
• Petra Ramnarine 
• Stacy Moyston-Duckie 
• Yvonne Prempeh
• Na Pang

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What is Bariatric Surgery

• by
• Yvonne Prempeh

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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

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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

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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

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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

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Requirements for Bariatric surgery
by Petra Ramnarine
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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

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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

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Nutrition Diet plan for Bariatric Surgery
by Janell Trotman
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Nutrition

• Patient have to follow a strict diet before and
  after bariatric surgery.
• Patient must have a nutritional consultation.

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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.

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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.
• Dont drink fluids while eating

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Food Restrictions

• Avoid food high in fat and have no nutritional
  value.

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Food Restriction

• Avoid alcohol
• Avoid food high in sugar
• Limit snacking between meals

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Pre-operative Nursing Care

• By Marjorie Johnson

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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 patients mood, self-esteem and emotional
  status.

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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).

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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.

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Special Equipments

• With bariatric surgery patient, special
  equipments have to be ordered and explained to
  patients.

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Post-operative Nursing Care   

• By Stacy Moyston-Duckie

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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.

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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-fowlers 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.

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  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
  patients medication will be switched from PCA
  machine to a liquid medicine Roxicet liquid
  Percocet that will be taken by mouth every 4-6
  hours.

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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.

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Preventive Measures Against Obesity

• Diet
• Exercise
• Group support

• by
• Na Pang

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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.

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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.

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Nursing Care Plans for Bariatric Surgery

• by Marie Jimenez, SPN

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• For patients undergoing bariatric surgery, it is
  important to note that there are nursing care
  plans designated for the preoperative and
  postoperative phase.

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Pre-op Nursing DiagnosisDisturbed
Self-Conceptrelated to obesity inability to
lose weight by conventional methods
Nursing Outcome Nursing Intervention Nursing Rationale
Client will demonstrate positive self-concept AEB Verbalizing feelings Positive statements Active participation in self-care Assess for signs and symptoms of a disturbed self-concept Implement measures to assist client to increase self-esteem Measures for client to adapt to body changes Recognition allows for prompt intervention An increase in self-esteem has a positive effect on client Impact of changes in self-concept
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Post-op Nursing DiagnosisIneffective Breathing
Patternr/t increased RR associated with
fear/anxiety decreased RR associated with
depressant effect of anesthesia
Nursing Outcome Nursing Intervention Nursing Rationale
Client will maintain clear open airways AEB Normal breath sounds Normal rate depth of respirations Absence of dyspnea Assess for Signs Sx of an ineffective breathing pattern Monitor for i in oximetry results Place client in semi- to high fowlers position Instruct clients to use incentive spirometer q 1-2 h Recognition allows for prompt inter-vention Assist in evaluating respiratory status Allows for max. diaphragm excursion Promotes max. inhalation lung expansion
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• 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

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Discharge/Client teaching

• by
• Anaise E Ikama

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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      

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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

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Discharge and Client Teaching

• byEdeneth Flores

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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)

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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

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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.

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D/C and Client teaching

• Avoid heavy lifting
• Encourage ambulation and leg exercises

• Emphasize the importance of Follow-up visits
  patients condition
• Support groups