Medical Surgical Nursing: Obesity and Bariatric Surgery

<18.5 BMI

underweight

18.5-24.9 BMI

normal weight

25-29.9 BMI

overweight

30-34.9 BMI

obese class 1

35-39.9 BMI

Obese class 2

>40 BMI

extreme obesity

Leptin

A hormone produced by adipose (fat) cells that acts as a satiety factor in signaling fullness.

Ghrelin

A hunger-arousing hormone secreted by an empty stomach

Basic Metabolic Rate

the body's resting rate of energy expenditure

First Line Treatment for Obesity

Nonpharmacologic strategies like diet, exercise, and behavior changes.

Medication Therapy For Obesity

GLP-1s

GLP-1 agonists

semaglutide

Semaglutide MOA

Suppresses Glucagon and delays gastric emptying, while also signaling decreased appetite to the brain

BBW of Semaglutide

Thyroid tumors

Adverse Effects of Semaglutide

Nausea, Hypoglycemia, Cholecystitis, AKI

Why must a patient on a GLP-1 be NPO longer?

Delayed Gastric Emptying

Surgical management of obesity

Bariatric Surgery

Bariatric Surgery Reccomendations

- BMI >40

- BMI of 35 With Complications

Types of Bariatric Surgery

restrictive, malabsorptive, combination

Restrictive Bariatric Surgery

Limits capacity of stomach and slows gastric emptying

types of restrictive bariatric surgery

- adjustable gastric banding

- sleeve gastrectomy

Sleeve Gastrectomy

- Resection of 75% of stomach, causing early satiety

- Risks: Pernicious Anemia and Malabsorption of Vitamin B12

Gastric Band

- synthetic material that makes stomach smaller

- synthetic material is filled with saline and can be adjusted

- Risk of erosion of band

Malabsorptive bariatric surgery

- Surgical bypass to shorten the small intestines

- Decreased caloric consumption as well as decreased nutrient absorption

- Risk of Malabsorption and Vitamin Deficiency

Combination bariatric surgery

Roux-en-Y gastric bypass

Complications of Bariatric Surgery

- Pulmonary embolism

- Infection

- Anastomosis leak

- Dumping syndrome

Dumping Syndrome

Undigested food moving too quickly from stomach into the small intestines causing osmotic fluid to go travel to small intestines to "dilute" bolus of food

Dumping Syndrome S/S

Fullness, faintness, diaphoresis, tachycardia, palpitations, hypotension, nausea, abdominal distinction, cramping, diarrhea, weakness, and syncope.

early dumping syndrome

-Symptoms of dumping syndrome are most common during a meal or within 15 to 30 minutes following a meal.

Nausea

Vomiting

Abdominal cramps

Diarrhea

Feeling of fullness

Late dumping syndrome

occurs 90 minutes to 3 hours after eating Caused by a release of an excessive amount of insulin. Observe for dizziness, light-headedness, palpitations, diaphoreses, confusion

Treatment for Dumping Syndrome

-Semi-recumbent with meals

-lie down after meals

-No liquid with meals (drink in between meals)

-decrease carbs (they empty first)

-Lay on left side to keep food in the stomach (stomach is angled to the left)

Diet for Dumping Syndrome

High Protein, Low Carbs

Anastomosis Leak

- Leakage of gastric fluid into peritoneal area

- Medical Emergency, Risk of Sepsis

Earliest sign of anastomosis leak

- Tachycardia

- Followed by: Fever, Pain, Decreased U.O, Hypotension ( late )

Treatment for Anastomosis Leak

- NPO

- IV Fluids and Antibiotics

Hospitalization of Bariatric Surgery

1-2 Days to watch for complications

Teaching after Bariatric Surgery

- 6 small meals

- Water in between meals

- Chew food fully

What is the lifting restriciton after a barriatric surgery?

8lbs

Deficient Fluid Volume

A nursing diagnosis indicating a decrease in the body's fluid volume, which can lead to dehydration and electrolyte imbalances.

Imbalanced Nutrition

A nursing diagnosis that refers to an insufficient or excessive intake of nutrients, affecting the patient's overall health.

Pain/Anxiety

A nursing diagnosis that addresses the patient's experience of pain and anxiety, which may require management and intervention.

Disturbed Body Image

A nursing diagnosis that indicates a negative perception of one's physical appearance or body function, often impacting self-esteem.

Nursing Intervention: NG Tube

Do not reposition the NG tube, as it can perforate the stomach.

Nursing Intervention: Clear Liquids

Introduce clear liquids as ordered to maintain hydration and support nutrition.

Collaboration with Healthcare Professionals

Collaborate with dietitians, psychologists, and physical/occupational therapists to provide comprehensive care.

Lifting Restrictions

Implement lifting restrictions to prevent injury and promote patient safety.

B12 Injections Requirement

B12 injections are required instead of oral intake due to lack of absorption in the stomach.

Signs and Symptoms of Dumping Syndrome

Monitor for signs and symptoms of dumping syndrome, which can occur after gastric surgery.

Water-Soluble Vitamins

Includes Vitamin C and B Vitamins, which are essential for various bodily functions and must be consumed regularly.

Fat-Soluble Vitamins

Includes Vitamins A, D, E, and K, which are stored in the body's fatty tissues and liver.