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Bariatric Surgery

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Bariatric Surgery Ana se Ikama Edeneth Flores Janell Trotman Marie Jimenez Marjorie Johnson Petra Ramnarine Stacy Moyston-Duckie Yvonne Prempeh – PowerPoint PPT presentation

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Title: Bariatric Surgery


1
Bariatric Surgery
  • Anaïse Ikama 
  • Edeneth Flores 
  • Janell Trotman
  • Marie Jimenez   
  • Marjorie Johnson  
  • Petra Ramnarine 
  • Stacy Moyston-Duckie 
  • Yvonne Prempeh
  • Na Pang

2
What is Bariatric Surgery
  • by
  • Yvonne Prempeh

3
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

4
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

5
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

6
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

7
Requirements for Bariatric surgery
by Petra Ramnarine
8
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

9
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

10
Nutrition Diet plan for Bariatric Surgery
by Janell Trotman
11
Nutrition
  • Patient have to follow a strict diet before and
    after bariatric surgery.
  • Patient must have a nutritional consultation.

12
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.

13
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

14
Food Restrictions
  • Avoid food high in fat and have no nutritional
    value.

15
Food Restriction
  • Avoid alcohol
  • Avoid food high in sugar
  • Limit snacking between meals

16
Pre-operative Nursing Care
  • By Marjorie Johnson

17
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.

18
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).

19
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.

20
Special Equipments
  • With bariatric surgery patient, special
    equipments have to be ordered and explained to
    patients.

21
Post-operative Nursing Care   
  • By Stacy Moyston-Duckie

22
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.

23
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.

24
  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.

25
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.

26
Preventive Measures Against Obesity
  • Diet
  • Exercise
  • Group support
  • by
  • Na Pang

27
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.

28
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.

29
Nursing Care Plans for Bariatric Surgery
  • by Marie Jimenez, SPN

30
  • For patients undergoing bariatric surgery, it is
    important to note that there are nursing care
    plans designated for the preoperative and
    postoperative phase.

31
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
32
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
33
  • 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

34
Discharge/Client teaching
  • by
  • Anaise E Ikama

35
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      

36
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

37
Discharge and Client Teaching
  • byEdeneth Flores

38
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)

39
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

40
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.

41
D/C and Client teaching
  • Avoid heavy lifting
  • Encourage ambulation and leg exercises
  • Emphasize the importance of Follow-up visits
    patients condition
  • Support groups
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