Medications and Therapies

  • Pain management post-op includes:
    • Pain control pump
    • Oral opioid analgesics
  • Antiemetics for nausea and vomiting
  • Vitamins/minerals post-surgery: Vitamin D, B-Complex, iron, calcium

Expected Outcomes

  • Pain control achieved
  • No nausea experienced

Potential Complications

  • Anastomotic leak
  • Infection

Psycho-Social/Sexuality/Gender Concerns

  • Obese patients may experience:
    • Depression, anxiety, poor self-image
    • Social withdrawal

Delegation of Tasks

  • Collaborative team approach for bariatric patient care to prevent physical strain on one member

Safety and Infection Control

  • Employ good body mechanics
  • Monitor for skin breakdown in obese patients

Resource Allocation

  • Dietician consultation essential for long-term weight management
  • Relevant organizations:
    • American Society of Bariatric and Metabolic Surgery
    • Overeaters Anonymous
    • American Obesity Association
  • Panniculectomy can be performed once weight is stable (18-24 months post-op)

Pathophysiology of Bariatric Surgery

  • Two types of surgeries:
    • Restrictive: Limits food volume
    • Types: Adjustable banded gastroplasty, sleeve gastrectomy
    • Malabsorption: Interferes with nutrient absorption
    • Example: Roux-en-Y gastric bypass
  • Surgical criteria:
    • BMI >40 or BMI >35 with comorbidities
    • Ability to perform ADLs
    • Support system presence
    • History of failed non-surgical attempts
    • Compliance with post-op care expected

Medical Diagnosis

  • Risk of pulmonary/thromboembolic complications in obese patients
  • Duration of post-op hospitalization:
    • Minimally invasive: ~24 hours
    • Open surgery: 2-3 days

Nursing Priorities/Patient Teaching

  • Airway management as a priority post-op
  • Pain control management (PCA then oral)
  • Use of special weight-rated beds to avoid pressure ulcers
  • Care with skinfold areas to prevent breakdown
  • Proper equipment for moving obese patients
  • NG tube management (do not reposition)
  • Clear liquid diet introduced slowly; liquid/pureed food for 6 weeks
  • Monitor for signs of anastomotic leaks
  • Post-op care includes:
    • Abdominal binder, semi-fowler's position
    • Oxygen therapy, compression stockings, anticoagulation therapy
    • Early ambulation post-op day 1
    • Daily measurement of abdominal girth
  • Focus on long-term weight management:
    • Increase physical activity, decrease fat intake, small frequent nutrient-rich meals
    • Educate on managing common bowel changes