Bariatric Surgery.ppt

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1、Bariatric Surgery,Anase Ikama Edeneth Flores Janell Trotman Marie Jimenez Marjorie Johnson Petra Ramnarine Stacy Moyston-Duckie Yvonne Prempeh Na Pang,What is Bariatric Surgery,by Yvonne Prempeh,What is bariatric surgery?,Bariatric surgery is the term for operations to help promote weight loss. Ther

2、e are three types of bariatric surgery: LAP- BAND system, Vertical Banded Gastroplasty(VBD), & Roux-en-Y Gastric Bypass,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,VERTICAL BANDED GASTRO

3、PLASTY (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,ROUX-EN-Y GASTRIC BYPASS,Roux-en-Y Gastric Bypass is the most frequently performed weight loss

4、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,Requirements for Bariatric surgery,by Petra Ramnarine,Criteria before surgery,BMI of 40+ 80 - 100lbs overweight Diabetes, heart disease

5、 or severe apnea Related physical problems that significantly employment, physical mobility or physical function,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,Nutrition: Diet pla

6、n for Bariatric Surgery,by Janell Trotman,Nutrition,Patient have to follow a strict diet before and after bariatric surgery.Patient must have a nutritional consultation.,Pre-Post Operative Nutrition,Clients are started on a puree or liquid diet 2 weeks before surgery.Most of the caloric intake shoul

7、d contain mostly of protein. Caffeine, soda, alcoholic and beverages that contain sugar should be avoided.,Food Restriction,It is important to chew food thoroughly and slowIt is important wait 2-3 minutes after swallowing before putting the next bite of food in your mouth.Dont drink fluids while eat

8、ing,Food Restrictions,Avoid food high in fat and have no nutritional value.,Food Restriction,Avoid alcohol Avoid food high in sugar Limit snacking between meals,Pre-operative Nursing Care,By Marjorie Johnson,Pre-operative Nursing Care,There are always risks with surgery, however as health care provi

9、ders, 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.,Some of the complications for bariatric surgery,DVT, pulmonary Embolus, pneumo

10、nia, dumping syndrome, loss of too much weight, injury to pelvic organ, and leaks from a break in the staple line, and death (1% nationwide).,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 pa

11、per 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.,Special Equipments,With bariatric surgery patient, special equipment

12、s have to be ordered and explained to patients.,Post-operative Nursing Care,By Stacy Moyston-Duckie,Complications developed after Bariatric surgery,Bariatric-surgery patients are at risk for developing complications related to surgery and postoperative respiratory and gastrointestinal disorders. Acc

13、ording 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 syndr

14、ome, dehiscence, vitamin and nutrient deficiencies.,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 degr

15、ees 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 volu

16、me 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.,Pain Medications,Post-operative pain

17、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 medica

18、tion will be switched from PCA machine to a liquid medicine Roxicet liquid Percocet that will be taken by mouth every 4-6 hours.,Appetite suppressant medications,Appetite suppressants medications are given such as Phentermine (Adepex-P, and Obsestin-30) which acts directly on the appetite-control ce

19、nter 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 gallsto

20、nes 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.,Preventive Measures Against Obesity,by Na Pang,Diet Exercise Group support,Exercise,Exercise plays a crucial role after bariatric surgery

21、because Promotes good circulation, respiration Increases metabolism, reduces adipose tissuesHow 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, exerci

22、ses should be well-organized.,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

23、 through any rough spots.,Nursing Care Plans for Bariatric Surgery,by Marie Jimenez, SPN,For patients undergoing bariatric surgery, it is important to note that there are nursing care plans designated for the preoperative and postoperative phase.,Pre-op Nursing Diagnosis: Disturbed Self-Concept rela

24、ted to obesity & inability to lose weight by conventional methods,Post-op Nursing Diagnosis: Ineffective Breathing Pattern r/t increased RR associated with fear/anxiety & decreased RR associated with depressant effect of anesthesia,Assessment provides vital clues regarding how nursing care affects t

25、he 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,Discharge/C

26、lient teaching,by Anaise E Ikama,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 swimm

27、ing should not be attempted. Ambulate to prevent DVT Diet: eat small meals due to the small size of the stomach,Discharge/Client teaching,Report symptoms: To the ERIssues that require urgent medical attention, such as: chest pain, shortness of breath and excessiveabdominal pain Contact the physician

28、 For non-emergent issues such as: nausea, vomiting, diarrhea or fever, redness, swelling, drainage or bleeding from the incision,Discharge and Client Teaching,by Edeneth Flores,D/C and Client teaching:,Instruct patients to take their prescribed medications.,Some of the medications are: Analgesics (

29、pain) Anti-emetics (prevent dehydration) Vitamins ( to maintain the nutrition of the patient),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 i

30、f 2 or more of these symptoms persist:,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 ta

31、blespoons 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.,D/C and Client teaching:,Avoid heavy lifting Encourage ambulation and leg exercises,Emphasize the importance of Follow-up visits; patients condition Support groups,