Nursing Assignment: Post-Operative Care of a Bariatric Surgery Patient

This report provides a comprehensive analysis of a nursing assignment focusing on the case of Kathleen Johnson, a 45-year-old woman with obesity and type 2 diabetes who underwent sleeve gastrectomy. The report begins by examining the etiology and pathophysiology of obesity, highlighting factors such as metabolic, genetic, and behavioral influences. It then delves into Kathleen's post-operative condition, specifically analyzing her vital signs in the post-anesthetic recovery room (PARU), including elevated respiratory and pulse rates, hypertension, low urine output, and pain. The pathophysiology behind these deteriorating symptoms is discussed, linking them to factors such as obesity, smoking, and diabetes. Furthermore, the report outlines appropriate nursing management strategies, including medication, dietary changes, respiratory monitoring, fluid therapy, and health education. The role of an interdisciplinary healthcare team, including dieticians, physiotherapists, and bariatric consultants, is emphasized to ensure comprehensive patient care and promote long-term health outcomes. The report concludes by summarizing the planning care process for Kathleen, emphasizing the importance of a collaborative approach to manage obesity and diabetes effectively.

Running head: NURSING ASSIGNMENT
Nursing assignment
Name of the student:
Name of the University:
Author’s note

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Introduction:
The report reviews the case study of Kathleen Johnson, a 45 year old woman with obesity
and Type 2 diabetes. Due to the problem of overweight and challenges in managing appearance,
she was admitted to the hospital for sleeve gastrectomy surgery. The report discusses about the
etiology and pathophysiology of patient’s presenting condition (obesity) and then reviews her
observation after 2 hours in post-anesthetic recovery room (PARU) to detect deterioration and
the pathophysiology behind the deteriorating symptoms. Based on this justification, appropriate
nursing management and role of interdisciplinary health care team to manage patient’s condition
is provided.
Etiology and pathophysiology of patient’s presenting condition
Since Kathleen has been admitted to the hospital for sleeve gastrectomy surgery, it is
evident that obesity is main presenting condition in patient. Her BMI is 40kg/m2 and due to
weight gain and appearance issue, she had to undergo sleeve gastrectomy surgery. Obesity is a
clinical condition leading to excessive deposition of fat or adipose tissue in the body of a person.
Any person having a BMI of over 30 kg/m2 is regarded as obese (Cummings & Cohen, 2016).
The etiology of obesity involved multiple factors. For instance, metabolic factors, diet, genetic
factor and physical activity level play a role in regulation of body weight. Although genetic
factor also plays a role in risk of obesity, however behavioral, environmental, physiological and
socio-cultural factors also increase energy balance and contribute to obesity. The most common
behavioral and environmental risk factor obesity includes sedentary lifestyle, excess energy
intake and poor physical activity (Saunders, Chaput & Tremblay, 2014). Social link to increase
in weight includes impact of parent lifestyle and food habits on health behavior of children and

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youths Increase in weight is associated with other comorbidities such as insulin resistance, type 2
diabetes and cardiovascular disease (Bray 2014). Kathleen is a patient with type 2 diabetes and
struggling to control her diet and blood sugar level. To prevent risk of other complication, weight
loss surgery was important for her.
From the etiology of obesity, it is understood that genetic as well behavioral factors
increase the risk of excess fat deposit in patient. The adipocyte is the main cellular basis for
obesity and increased in size or number of these cells contributes to obesity. Although in normal
condition, fat is stored in the body for survival during starved state. However, when a person
takes high energy food in large amount, it results in excessive storage of fat and the end result for
which is obesity (Goossens & Blaak, 2015). Hence, the cause begin obesity is high calorie food
and the cellular basis for obesity is the adipocyte. In case of Kathleen, her obesity was untreated
before the surgery. Although she was gaining weight, she had not taken any preventive steps to
control the condition. For this reason, opting for sleeve gastrectomy was a necessary option for
her to manage her condition. Obesity mainly contributes to metabolic dysfunction and damages
the function of cardiac, liver, endocrine and intestinal gland if it left untreated (Saltiel & Olefsky,
2017). Hence, bariatric surgery is the best option for obesity management. Evidence has shown
that bariatric surgery leads to weight loss and contributes to improvement in metabolic disorders
like diabetes too (Reges et al., 2018). Sleeve gastrectomy is also one of the bariatric surgeries
that promotes weight loss and improved gyclemic control in patient (Fuchs et al., 2017).
Therefore, by opting for surgical option, Kathleen can improve her symptoms related to diabetes
too.
Pathophysiology and nursing management of the patient

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Pathophysiology of patient’s post-operative deterioration
Kathleen observation after two hours in the PARU revealed several deteriorating signs
and symptoms. For instance, Kathleen respiratory rate was 28 breaths per minute whereas pulse
rate was 130 beats per minute. By comparing these vitals signs with normal parameters, it can be
said that respiratory rate of patient is abnormally high as normal respiratory rate is 12-20
breaths/min. His pulse rate is also an area of concern as it is above the normal value of 60-100
beats/min. Such abnormalities in Kathleen’s respiratory and pulse rate might have occurred due
to the effect of obesity, smoking and alcohol consumption in patient. Obesity is highly associated
with respiratory complication in obese patient. Obese patients tend to have higher respiratory rate
because of the impact on lung function (Pepin et al, 2016). Abdominal obesity and lung
dysnfunction affects systemic inflammation thus leading to respiratory disorder in patient
(Oppenheimer et al., 2014). The review of Kathleen’s history revealed that he was heavy smoker
and consumed four bottles bear every night. Cigarette smoking is one factor that has an impact
on pulse rate, breathing rate and oxygen consumption of an individual. This occurs because the
chemical found in cigarette aggravates the cilia, leads to the deposition of tar and narrows the air
passage. Such change in the lung is reason for abnormal respiratory rate in patient (Papathanasio
et al., 2013). Hence, patient’s presenting condition exacerbated his vital signs post operation.
The review of other vital signs in patient included blood pressure of 190/100 min. This
clearly indicates that Kathleen was hypertensive. The likelihood of hypertension might have
increased in patient due to the effect of surgery as well as due to obesity. Overweight and obese
patients are more likely to suffer from hypertension. Such association between obesity and
hypertension is seen due to the impact of obesity on metabolic functions. Other mechanisms
linking obesity to hypertension includes endothelial and vascular impairment, neuro-endocrine

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imbalance, maladaptive immune response and dietary factors (DeMarco, Aroor & Sowers,
2014). This explanation confirms that obesity is the reason for deteriorating post-operative sign
for Kathleen. Other factors that might have contributed to high blood pressure for patient
includes smoking and diabetes. The link between diabetes and hypertension has been established
because both have common pathways such as inflammation, oxidative stress and insulin
resistance. Low-grade inflammatory response and insulin resistant increased in type 2 diabetes
patient thus contributing to hypertension (Lingam et al., 2018). As Kathleen had undergone
sleeve gastrectomy surgery and effect of anesthesia and surgery might have also lead to
hypertension in patient (Brethauer et al., 2015).
Another sign of post operative deterioration found in Kathleen was low urine output and
pain score in patient. Kathleen’s indwelling urinary catheter (IDC) volume was 5mls in the last
hour, although the normal urine output per hour is 50-60 mL. Surgery is one of the reasons for
low urine output. Surgical blood loss and dehydration in patient decreases urine output and lead
to acute kidney injury on surgery patients. Poor renal perfusion and decreased urine output are
common complication seen in the post anesthesia care unit (Canales & Hatch, 2014). Hence, the
reason for such clinical deterioration in patient is clear. Another parameter that was affected for
patient post operatively was her pain score. Kathleen’s pain score was 7/10 and the severity of
the pain might also be the reason for presence of abnormal BP and respiratory rate. Blood
pressure of Kathleen might have increased due to effect of pain. Pain promotes sympathetic
activity thus leading to high blood pressure (Laquian et al., 2018). Hence, while deciding
treatment for patient, the effect of pain on other vital signs must be carefully examined.
Nursing management of patient post-operatively

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Based on analysis of post-operative deterioration in patient, the main care priorities for
patient are management of abnormal vital signs of patient hypertension, pain score and
respiratory rate and low urine output). Since Kathleen is obese and has diabetes, hence it is
necessary to improve respiratory and vascular function as leaving these sign untreated may
further complicate his condition (Mahajan, Lau & Sanders, 2015). The management of
hypertension can be done by providing hypertensive medication to patient. After consultation
with physician, the nurse can provide beta-blockers or angiotensive converting enzyme inhibitors
to control his blood pressure (Wolf et al., 2016). To promote recovery in patient, the nurse also
need to focus on dietary changes so that blood sugar level is maintained. Due to high pulse rate
and respiratory rate, the patient may have ineffective breathing pattern. Hence, the care priority
will be to assess respiratory rate and monitor ventilation status of Kathleen regularly. The rate
and depth of respiration and need for oxygenation can also be examined. To provide comfort to
patient, proper body alignment should be maintained too (Gordon, 2014). To address the issue of
low urine output, there is a need to provide both fluid and drug therapy to prevent dehydration.
During gastrectomy, some parts of her stomach were removed. Hence, it will be necessary to
monitor wound healing and prevent signs of infection in patient.
Apart from clinical intervention for management of vital signs, another care priority is to
provide health education to patient so that Kathleen could be motivated to make changes in her
lifestyle and eating habits. Since she is a smoker and consumer, making her quit both is
necessary to maintain her health in the long term. Smoking has deleterious impact on obese
patient and those with obesity (Lycett et al., 2015). Hence, the nurse needs to make Kathleen
aware about the harmful effect of smoking on alcohol consumption on her metabolic and

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respiratory function. After this education, the patient can be supported to quit smoking by means
of nicotine replacement therapy.
Involvement of interdisciplinary health care team for the care of patient:
Apart from nurses and medical team, the contribution of dietician is necessary to help
Kathleen take low calorie foods and avoid food containing high amount of salt and sugar.
Dietary intervention can reduce risk of diabetes related complication and prevent patient from
gaining weight. Secondly, the involvement of physiotherapist is necessary as due to surgery, her
mobility is affected. By collaborating with physiotherapist, Kathleen can learn to do exercise so
that she can build her muscle strength. The role of a bariatric consultant is also necessary to
educate Kathleen about her care needs and ways to manage her wound after discharged (Torti et
al., 2017).
Conclusion:
The report discussed about the process of planning care for Kathleen by examining her
medical history and discussing about the pathophysiology of obesity. The etiology and
pathophysiology of obesity gives the insight that presence of various risk factors predisposed
patient to obesity. The review of deterioration in vital signs and justifying them with the path
physiology also helped to understand the mechanism by which Kathleen faced such clinical
deterioration in patient. To enhance recovery in patient, proper collaboration between inter-
professional team is necessary too.

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