Bariatric SurgeryBariatric Surgery

Anaïse Ikama Anaïse Ikama Edeneth Flores Edeneth Flores Janell TrotmanJanell TrotmanMarie Jimenez   Marie Jimenez   Marjorie Johnson  Marjorie Johnson  Petra Ramnarine Petra Ramnarine Stacy Moyston-Duckie Stacy Moyston-Duckie Yvonne PrempehYvonne PrempehNa PangNa Pang

What is Bariatric Surgery What is Bariatric Surgery

bybyYvonne PrempehYvonne Prempeh

What is bariatric What is bariatric surgery?surgery?

Bariatric surgery is the term forBariatric surgery is the term for operations to help operations to help promote weight loss. promote weight loss.

There are three types of bariatric surgery: There are three types of bariatric surgery: LAP- BAND® system, LAP- BAND® system, Vertical Banded Vertical Banded Gastroplasty(VBD), & Gastroplasty(VBD), & Roux-en-Y Gastric BypassRoux-en-Y Gastric Bypass

LAP – BAND® SYSTEMLAP – BAND® SYSTEM

An adjustable An adjustable silicone elastic band silicone elastic band is placed around the is placed around the upper part of the upper part of the stomach creating a stomach creating a small pouch and small pouch and restricting the restricting the passage of food passage of food

VERTICAL BANDED VERTICAL BANDED GASTROPLASTY (VBG)GASTROPLASTY (VBG)

VBG is a purely VBG is a purely restrictive procedure restrictive procedure in which the upper in which the upper stomach is stapled stomach is stapled and divided, forming and divided, forming a small pouch that a small pouch that reduces the size of reduces the size of the stomach and the the stomach and the amount of food the amount of food the stomach can hold stomach can hold

ROUX-EN-Y GASTRIC BYPASSROUX-EN-Y GASTRIC BYPASS

Roux-en-Y Gastric Roux-en-Y Gastric Bypass is the most Bypass is the most frequently performed frequently performed weight loss procedure in weight loss procedure in the United States the United States

During this surgery, the During this surgery, the upper stomach is stapled upper stomach is stapled creating a small pouch creating a small pouch that is completely divided that is completely divided from the remainder of from the remainder of the stomach the stomach

Requirements Requirements for Bariatric surgeryfor Bariatric surgery

by

Petra Ramnarine

Criteria before surgeryCriteria before surgery

BMI of 40+BMI of 40+ 80 - 100lbs overweight80 - 100lbs overweight Diabetes, heart disease or severe apneaDiabetes, heart disease or severe apnea Related physical problems that Related physical problems that

significantly employment, physical significantly employment, physical mobility or physical functionmobility or physical function

Criteria for insurance Criteria for insurance companiescompanies

Obtaining approval can take up to 4 Obtaining approval can take up to 4 weeks from insurance companyweeks from insurance company

Pt will be responsible for out of pocket Pt will be responsible for out of pocket fees as outlined in policiesfees as outlined in policies

Nutrition: Diet plan Nutrition: Diet plan for Bariatric Surgeryfor Bariatric Surgery

by Janell Trotman

Nutrition Nutrition

Patient have to follow a strict diet before Patient have to follow a strict diet before and after bariatric surgery.and after bariatric surgery.

Patient must have a nutritional Patient must have a nutritional consultation. consultation.

Pre-Post Operative Pre-Post Operative NutritionNutrition

Clients are started on a puree or liquid Clients are started on a puree or liquid diet 2 weeks before surgery.diet 2 weeks before surgery.

Most of the caloric intake should contain Most of the caloric intake should contain mostly of protein. mostly of protein.

Caffeine, soda, alcoholic and beverages Caffeine, soda, alcoholic and beverages that contain sugar should be avoided.that contain sugar should be avoided.

Food Restriction Food Restriction

It is important to chew food thoroughly and It is important to chew food thoroughly and slowslow

It is important wait 2-3 minutes after It is important wait 2-3 minutes after swallowing before putting the next bite of swallowing before putting the next bite of food in your mouth.food in your mouth.

Don’t drink fluids while eatingDon’t drink fluids while eating

Food Restrictions Food Restrictions

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

Food RestrictionFood Restriction

Avoid alcoholAvoid alcohol Avoid food high Avoid food high

in sugarin sugar Limit snacking Limit snacking

between mealsbetween meals

Pre-operative Nursing Pre-operative Nursing CareCare By Marjorie JohnsonBy Marjorie Johnson

Pre-operative Nursing CarePre-operative Nursing Care

There are always risks with surgery, however There are always risks with surgery, however as health care providers, we can follow steps as health care providers, we can follow steps to minimize these risks by performing physical to minimize these risks by performing physical and psychosocial assessment of the patient. and psychosocial assessment of the patient. The psychosocial assessment is obtained to The psychosocial assessment is obtained to evaluate the patient’s mood, self-esteem and evaluate the patient’s mood, self-esteem and emotional status. emotional status.

Some of the Some of the complications for complications for bariatric surgery bariatric surgery

DVT, pulmonary Embolus, pneumonia, DVT, pulmonary Embolus, pneumonia, dumping syndrome, loss of too much dumping syndrome, loss of too much weight, injury to pelvic organ, and leaks weight, injury to pelvic organ, and leaks from a break in the staple line, and death from a break in the staple line, and death (1% nationwide). (1% nationwide).

Sign ConsentSign Consent

The patient has the right to be The patient has the right to be informed of the tests, informed of the tests, treatments, or procedures, treatments, or procedures, therefore, should be asked to therefore, should be asked to sign consent; a legal piece of sign consent; a legal piece of paper that tells exactly what paper that tells exactly what will be done to the patient. will be done to the patient. Forms that gives caregivers Forms that gives caregivers permission to certain tests, permission to certain tests, treatments, or procedures. If treatments, or procedures. If unable to give his/her unable to give his/her consent, someone who has consent, someone who has permission could sign the permission could sign the form instead. form instead.

Special EquipmentsSpecial Equipments

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

Post-operative Nursing Post-operative Nursing CareCare      

By Stacy Moyston-DuckieBy Stacy Moyston-Duckie

Complications developed Complications developed after Bariatric surgeryafter Bariatric surgery

Bariatric-surgery patients are at risk for developing Bariatric-surgery patients are at risk for developing complications related to surgery and postoperative complications related to surgery and postoperative respiratory and gastrointestinal disorders. respiratory and gastrointestinal disorders.

According to the International Bariatric surgery registry, According to the International Bariatric surgery registry, the leading cause of death following bariatric surgery is the leading cause of death following bariatric surgery is pulmonary embolism, anastomotic leaks and pulmonary embolism, anastomotic leaks and respiratory failure. respiratory failure.

Other complications are wound infections, incisional Other complications are wound infections, incisional hernias, ulcers, bleeding, constipation, cholelithiasis, hernias, ulcers, bleeding, constipation, cholelithiasis, dumping syndrome, dehiscence, vitamin and nutrient dumping syndrome, dehiscence, vitamin and nutrient deficiencies. deficiencies.

The role of the nurse in monitoring and The role of the nurse in monitoring and managing clients in postoperative managing clients in postoperative

Typically, during the postoperative recovery period the nurse has Typically, during the postoperative recovery period the nurse has to monitor and manage the patient to reduce complications, by to monitor and manage the patient to reduce complications, by positioning the patients head at least 30 degrees semi-fowler’s positioning the patients head at least 30 degrees semi-fowler’s position to help breathing and by reducing the weight of abdominal position to help breathing and by reducing the weight of abdominal adipose tissue pressing on the diaphragm. adipose tissue pressing on the diaphragm.

Checking vital signs, assess for complications, and provide skin Checking vital signs, assess for complications, and provide skin and wound care, breathing exercises using incentive spirometry.and wound care, breathing exercises using incentive spirometry.

Assess abdominal changes in appearance of volume gastric or Assess abdominal changes in appearance of volume gastric or percutaneous drains, presence of hematemesis or melena, and percutaneous drains, presence of hematemesis or melena, and persistent cough. These findings should be reported to the persistent cough. These findings should be reported to the physician for appropriate medical intervention. (physician for appropriate medical intervention. (www.aafp.orgwww.aafp.org). ).

Also encourage early ambulation to reduce the risk of immobility.Also encourage early ambulation to reduce the risk of immobility.

    Pain MedicationsPain Medications

Post-operative pain medications are given through Post-operative pain medications are given through ‘patient controlled analgesia’ (PCA) pump, which ‘patient controlled analgesia’ (PCA) pump, which dispenses (morphine) when the patient pushes a dispenses (morphine) when the patient pushes a button. They patient will also receive IV injections of button. They patient will also receive IV injections of Torodol. Torodol.

Torodol is similar to Motrin and helps relieve abdominal Torodol is similar to Motrin and helps relieve abdominal muscle pain. After day two surgery the patient’s muscle pain. After day two surgery the patient’s medication will be switched from PCA machine to a medication will be switched from PCA machine to a liquid medicine Roxicet – liquid Percocet that will be liquid medicine Roxicet – liquid Percocet that will be taken by mouth every 4-6 hours. taken by mouth every 4-6 hours.

Appetite suppressant Appetite suppressant medicationsmedications

Appetite suppressants medications are given such as Appetite suppressants medications are given such as Phentermine (Adepex-P, and Obsestin-30) which acts directly on Phentermine (Adepex-P, and Obsestin-30) which acts directly on the appetite-control center in the CNS to suppress and reduce the appetite-control center in the CNS to suppress and reduce hunger. hunger.

Sibutramine (Meridia), also reduces hunger and increases Sibutramine (Meridia), also reduces hunger and increases sensations of satiety by inhibiting the uptake of serotonin, sensations of satiety by inhibiting the uptake of serotonin, norepinephrine, and dopamine norepinephrine, and dopamine

Ursodiol, this drug is to taken twice a day, two weeks after Ursodiol, this drug is to taken twice a day, two weeks after surgery. surgery.

Actigall is taken to prevent gallstones from forming during rapid Actigall is taken to prevent gallstones from forming during rapid weight loss. Patients who have done bariatric surgery will need to weight loss. Patients who have done bariatric surgery will need to take vitamin and mineral supplement for the rest of their lives.take vitamin and mineral supplement for the rest of their lives.

Preventive Measures Preventive Measures Against ObesityAgainst Obesity

bybyNa PangNa Pang

•Diet•Exercise•Group support

ExerciseExercise

Exercise plays a crucial role after bariatric Exercise plays a crucial role after bariatric surgery becausesurgery becausePromotes good circulation, respirationPromotes good circulation, respirationIncreases metabolism, reduces adipose tissuesIncreases metabolism, reduces adipose tissues

How to start an effective exercise patternHow to start an effective exercise patternWalking is the simple way to start the exercise Walking is the simple way to start the exercise

process process Then, try out different types of exercises to find Then, try out different types of exercises to find

one that is enjoyable, running, treadmill.one that is enjoyable, running, treadmill.However, exercises should be well-organized.However, exercises should be well-organized.

Ongoing SupportOngoing 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 Nursing Care Plans for Bariatric Surgeryfor Bariatric Surgery

by Marie Jimenez, SPNby Marie Jimenez, SPN

Nursing Care plans: Nursing Care plans: Bariatric Surgery Bariatric Surgery

Nursing Care plans: Nursing Care plans: Bariatric Surgery Bariatric Surgery

Pre-operative Nursing Diagnosis:Disturbed Self-Concept

Pre-operative Nursing Diagnosis:Disturbed Self-Concept

Post-operative Nursing Diagnosis:Ineffective Breathing Pattern

Post-operative Nursing Diagnosis:Ineffective Breathing Pattern

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

Pre-op Nursing Diagnosis:Pre-op Nursing Diagnosis:Disturbed Self-ConceptDisturbed Self-Concept

related to obesity & inability to lose weight by conventional related to obesity & inability to lose weight by conventional methodsmethods

Nursing OutcomeNursing Outcome Nursing InterventionNursing Intervention Nursing RationaleNursing Rationale

Client will Client will demonstrate positive demonstrate positive

self-concept self-concept

AEBAEB

Verbalizing feelingsVerbalizing feelingsPositive statementsPositive statementsActive participation Active participation in self-carein self-care

1.1. Assess for signs Assess for signs and symptoms of and symptoms of a disturbed self-a disturbed self-conceptconcept

2.2. Implement Implement measures to measures to assist client to assist client to increase self-increase self-esteemesteem

3.3. Measures for Measures for client to adapt to client to adapt to body changesbody changes

1.1. Recognition Recognition allows for allows for prompt prompt interventionintervention

2.2. An increase in An increase in self-esteem self-esteem has a positive has a positive effect on clienteffect on client

3.3. Impact of Impact of changes in changes in self-conceptself-concept

Post-op Nursing Diagnosis:Post-op Nursing Diagnosis:Ineffective Breathing Ineffective Breathing

PatternPatternr/t increased RR associated with fear/anxiety & decreased RR r/t increased RR associated with fear/anxiety & decreased RR

associated with depressant effect of anesthesiaassociated with depressant effect of anesthesiaNursing OutcomeNursing Outcome Nursing InterventionNursing Intervention Nursing RationaleNursing Rationale

Client will maintain Client will maintain clear open airways clear open airways

AEBAEB

Normal breath Normal breath soundssoundsNormal rate & depth Normal rate & depth of respirationsof respirationsAbsence of dyspneaAbsence of dyspnea

1.1. Assess for Signs Assess for Signs & Sx of an & Sx of an ineffective ineffective breathing patternbreathing pattern

2.2. Monitor for Monitor for in in oximetry oximetry resultsresults

3.3. Place client in Place client in semi- to high semi- to high fowlers positionfowlers position

4.4. Instruct clients Instruct clients to use incentive to use incentive spirometer q 1-2 spirometer q 1-2 hh

1.1. Recognition Recognition allows for allows for prompt inter-prompt inter-ventionvention

2.2. Assist in Assist in evaluating evaluating respiratory respiratory statusstatus

3.3. Allows for max. Allows for max. diaphragm diaphragm excursionexcursion

4.4. Promotes max. Promotes max. inhalation & inhalation & lung expansionlung expansion

Assessment provides vital clues Assessment provides vital clues regarding how nursing care affects regarding how nursing care affects the psychosocial aspect of the the psychosocial aspect of the patientpatientTherapeutic communication Therapeutic communication encourages self-awarenessencourages self-awareness

Nurses should be aware of Nurses should be aware of protocols when deviations of protocols when deviations of breathing patterns occur for breathing patterns occur for proper interventions to take placeproper interventions to take placeAny signs of respiratory distress Any signs of respiratory distress should be reported and should be reported and documented immediatelydocumented immediately

Discharge/Client Discharge/Client teaching teaching

byby

Anaise E IkamaAnaise E Ikama

Discharge/Client teachingDischarge/Client teaching

Medications: analgesics for Medications: analgesics for pain, anti-emetics to prevent pain, anti-emetics to prevent dehydration and vitamins to dehydration and vitamins to ensure adequate intake of ensure adequate intake of nutritionnutrition

Wound care should be taught Wound care should be taught to prevent infectionsto prevent infections

Activity progression any Activity progression any abdominal exercises, weight abdominal exercises, weight

Lifting or swimming should Lifting or swimming should not be attemptednot be attempted. . Ambulate to Ambulate to prevent DVTprevent DVT

Diet: eat small mealsDiet: eat small meals due to due to the small size of the the small size of the stomach      stomach      

Discharge/Client teachingDischarge/Client teaching

Report symptoms:Report symptoms: To the ERTo the ER   Issues that require urgent Issues that require urgent

medical attention, such as: medical attention, such as:  chest pain, shortness of  chest pain, shortness of breath and excessivebreath and excessiveabdominal pain abdominal pain

Contact the physicianContact the physician For non-emergent issues such For non-emergent issues such

as: nausea, vomiting, diarrhea as: nausea, vomiting, diarrhea or fever, redness, swelling, or fever, redness, swelling, drainage or bleeding from the drainage or bleeding from the incisionincision

Discharge and Discharge and Client TeachingClient Teaching

bybyEdeneth FloresEdeneth Flores

D/C and Client teaching:D/C and Client teaching:

Instruct patients to take Instruct patients to take their prescribed their prescribed medications.medications.

Some of the medications Some of the medications are:are:

Analgesics ( pain)Analgesics ( pain) Anti-emetics (prevent Anti-emetics (prevent

dehydration)dehydration) Vitamins ( to maintain Vitamins ( to maintain

the nutrition of the the nutrition of the patient)patient)

D/C and Client teaching:D/C and Client teaching:

Teach wound care:Teach wound care: Teach about the S/S of Teach about the S/S of

infection:infection: RednessRedness SwellingSwelling Pus/abnormal discharge from Pus/abnormal discharge from

the incision sitethe incision site PainPain

Difficulty breathingDifficulty breathing VomitingVomiting FeverFever Epigastric painEpigastric pain CALL MD if 2 or more of CALL MD if 2 or more of

these symptoms persistthese symptoms persist::

D/C and Client teaching: D/C and Client teaching: NUTRITIONNUTRITION

Eat small snack due to small Eat small snack due to small capacity of the stomach.capacity of the stomach.

Chew food slowly and cut into Chew food slowly and cut into pieces.pieces.

If able to tolerate liquids, the If able to tolerate liquids, the surgeon will likely to surgeon will likely to recommend having a puree recommend having a puree diet, then begin eating 3 meals diet, then begin eating 3 meals per day.per day.

Eat a few tablespoons at a time Eat a few tablespoons at a time to prevent the stretching of the to prevent the stretching of the incision siteincision site..

Eat a few tablespoons at a time Eat a few tablespoons at a time to prevent the stretching of the to prevent the stretching of the incision siteincision site

Includes protein to promote Includes protein to promote healing.healing.

D/C and Client teaching:D/C and Client teaching:

Avoid heavy liftingAvoid heavy lifting Encourage ambulation Encourage ambulation

and leg exercisesand leg exercises

Emphasize the Emphasize the importance of Follow-up importance of Follow-up visits; patients conditionvisits; patients condition

Support groups Support groups