Topic 12: Obesity and Gastric Bypass Surgery

metabolic syndrome

group of disorders that increase the risk of developing CV disease, stroke, or DM and is classified by 3 or more of the following:

• Waist circumference > 40 inches in men or > 35 inches in women

• Triglycerides > 150

• HDL < 40 in men or < 50 in women

• BP > 130 SBP or > 85 DBP

• Fasting glucose > 100

• insulin resistance

• reduce LDL cholesterol

• stop smoking

• lower BP

• reduce glucose levels

what lifestyle modifications are the first line interventions for metabolic syndrome

BMI greater than 40 or BMI greater than 35 with other significant comorbidities like HTN, T2 DM, HF, sleep apnea

what is the criteria for bariatric surgery

adjustable gastric banding (AGB)

restrictive bariatric surgery that limits the stomach size with an inflatable band size around the fundus of the stomach, and the restrictiveness of the band creates a sense off fullness because the upper part of the stomach will hold less food and create a feeling of satiety; can be modified or reversed as needed

sleeve gastrectomy

restrictive bariatric surgery that is nonreversible and 75% of the stomach is removed resulting in elimination of hormones produced in the stomach that stimulates hormone (gherlin) but stomach function is preserved

Roux-enY procedure (RYGB)

a combo of restrictive and malabsorptive surgery that is the gold standard for bariatric surgery; a gastric pouch is attached directly to the small intestine so food bypasses stomach and upper small intestine so less food is absorbed, this sustains long-term weight loss, improves BG control, reverse diabetes, and helps with sleep apnea

• dumping syndrome

• iron and cobalamin deficiency

what are complications of Roux-en-Y surgical procedure (RYGB)

dumping syndrome

complication after gastric bypass surgery in which gastric contents empty too fast into the small intestine that begins 15-30 mins after eating

• avoid sugary foods

• do not drink fluids while eating

• rest for 30 mins after meals

what is management for dumping syndrome

maestro rechargeable syndrome

a combo of restrictive and malabsorptive surgery in which an electrical simulator are surgically placed in the abdomen that sends electrical impulses to the vagus nerve, which regulates stomach emptying and signaling the brain that the stomach feels full; used in obese pts that have failed at least one supervised weight management program

• have the room ready for the patient before arrival

  • larger BP cuff, gown, wheelchair

• practice cough, deep breathing, turning, positioning, use of incentive spirometry, CPAP use if needed

• obtain longer IV cath

what does pre op care before gastric bypass surgery include

• elevate HOB to 35-40 degrees (makes it easier to breathe)

• monitor airway

• manage pain

• diligent turning and ambulating

• evaluate wound closely

• careful transition to new diet

  • high protein, low carb/fat/roughage

  • 6 small meals/day

  • no fluids with meals

what does post op care before gastric bypass surgery include

esophageal cancer

malignant neoplasm of esophagus that is not very common and has a 5 yr survival rate due to metastasis throughout other organs in that area

• usually symptoms present when the disease is advanced

• progressive dysphagia is MC

  • initially only with meat, then with soft foods, and then liquids

  • concerned about aspiration and food intake

• sore throat, choking, hoarseness if tumor is in upper third of esophagus

what are S/S of esophageal cancer

• PN initially

• J tube or G feeding tube may be placed

• swallow study must be done before patient can have oral fluids

• gradual progression to small, frequent, bland meals

• maintain upright position while eating

what are nutrition considerations after surgery to remove esophageal cancer

• NG tube in place, drainage will be bloody for 8-12 hours and then will turn to greenish/yello

  • do not reposition or reinsert NG without HCP approval

• turning and deep breathing every 2 hours

• should be maintained at least 2 hours in semi/high fowlers after eatinga nd monitor for complications

what are post op consideration after an esophageal surgery

smoked foods, pickled foods, salted meats

what are common causes of gastric cancer

• unexplained weight loss

• pale from slow bleeding

• indigestion

• abdominal pain

• anemia

• early satiety (feels full fast)

• ascites

• stool guaiac positive

what are S/S of gastric cancer

• weakness, sweating 

• palpitations, dizzy

• abdominal cramps

• borborygmi

• urde to defecate 

what are the S/S of dumping syndrome

postprandial hypoglycemia

result of uncontrolled gastric emptying (dumping syndrome) of bolus high in carbs to the small intestine that results in hyperglycemia which causes the release of an excessive amounts of insulin leading to secondary hypoglycemia 2 hours after meals

bile reflux gastritis

prolonged contact with vile that leads to damaged mucosa, chronic gastritis, and recurrence of PUD; continuous distress increases after meals and vomiting temporarily relieves distress

cholestyramine

what binds with bile salts that are the source of gastric irritation that can help relive irritation associated with bile reflux gastritis

• patient should reduce fluids to 4 oz/meals

• small, dry feedings daily

• low carbs, mod fat and protein

• restrict sugar with meals to prevent hypoglycemia

• may have NG to decompress/decrease pressure on suture line

  • may be bright red and then turn yellow/green

  • MUST BE WORKING

• splint with a pillow to encourage deep breathing

what are post op considerations after a gastric resection

pernicious anemia

what is a long-term complication of gastric resection surgery due to the loss of intrinsic factor that requires cobalamin replacement therapy 

perforation (watch for increase in temp)

what is a possible complication of getting endoscopy of the stomach

• nausea

• neutropenic infections (immunocompromised)

• bleeding from thrombocytopenia

what are the side effects of leukemia treatment

• epi

• diphenhydramine

• oxygen

• NS 

what is treatment for anaphylactic shock

anaphylactic, septic, hypovolemic

what type of shock’s treatment includes aggressive fluid resuscitation

immobilize the cervical spine

what is the first thing to do if a trauma to the head or neck

sepsis

what is the biggest RF for DIC

RN (CANNOT delegate to LPN/UAP)

who can get consent from patient and be the 2nd check for blood transfusion