Comprehensive Nursing Report: Bariatric Surgery Patient Management

This nursing report comprehensively examines the care of adult patients undergoing bariatric surgery. It begins with a discussion of pre-operative patient assessment, emphasizing the identification of potential risks related to respiratory and cardiovascular systems, including the use of questionnaires like STOP-BANG for obstructive sleep apnea. The report then delves into intra-operative considerations, such as airway management, blood pressure monitoring, and thermal regulation, highlighting the unique challenges posed by obese patients. Post-operative nursing care is thoroughly addressed, covering potential complications like pulmonary issues and cardiovascular function changes. The report also includes discharge education for patients and their families, focusing on medication schedules, dietary modifications, and the importance of a healthy lifestyle. Overall, the report provides a detailed guide to the multifaceted nursing care required throughout the bariatric surgery process, emphasizing patient education and family involvement to ensure optimal outcomes.

NURSING REPORT
(An adult patient with severe obesity who is scheduled to
undergo bariatric surgery)

Table of Contents
INTRODUCTION...........................................................................................................................1
Pre-operative patients assessment and patient/family education................................................1
Intra-operative consideration .....................................................................................................3
Post-operative nursing care.........................................................................................................4
Discharge education for patient and families..............................................................................6
CONCLUSION................................................................................................................................7
REFERENCES................................................................................................................................8

INTRODUCTION
Obesity is the condition in which body fat of individual gets increased, that impacts
negatively on person's health. It is the medical issue which causes due to having excessive food,
lack of physical activity and genetic susceptibility. In the modern technological era medical
professionals are adopting procedure of bariatric surgery for treating obesity patients. It is the
process in which size of stomach get reduced with a gastric band. This treatment support people
in loosing their weight (Mechanick and et.al, 2013). Bariatric surgery is the procedure which
assists adult patients in recovering from diabetes and improving cardiovascular risk factors. With
the help of this surgery practitioner have reduced mortality rate of obesity patients from 40% to
23%. Present report will discuss pre-operative patient assessment those who are suffering from
severe obesity and going to schedule bariatric surgery for this medical issue. Intra-operative
considerations will be described for service users those who are undergoing to this particular
procedure (Sjöström, 2013). Post-operative nursing care and discharge education for obesity
patients and their families will be explained in this study.
Pre-operative patients assessment and patient/family education
Nationally representative have given report on obesity patients from 2009 to 2010.
Report indicates that Australia is the country where 35.5% adult population is suffering from
obesity. Health survey of England shows that thee are 1.7% men members and 3.1% women
those who are obese (Chang and et.al, 2014). Data reflects that 340768 bariatric surgeries held
worldwide in the year 2011.
Pre-operative patients assessment
Most of the patients those who are undergoing to bariatric surgery are relatively healthy
but risk is as same as normal weight persons. The main of pre-operative assessment is to identify
presence of obesity in the patient and if person has high risk then doctors and medical staff try to
minimize risk of postoperative complication (Mingrone and et.al, 2015). Due to obesity not only
respiratory, cardiovascular system, get affected but also other body parts also get affected. Care
providers focus on below maintained elements in the pre-operative assessment phase of obesity
patients:
Respiratory System (Airway and intubation)
In the pre-assessment process medical professionals try to identify whether adult patient
has difficulty in airway or not. There are many service users those who are suffering from severe
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obesity problem and they found difficulty in their airway (Pham and et.al, 2014). This problem
generally occurred in the person who is >50 age.
Obstructive sleep Apnoea (OSA)
It is another part of pre-operative assessment which is very common in obesity patients.
It is generally presents in 10-20% people those who have morbidly obese. These are such people
which are in severe condition and if untreated then it may lead to pulmonary hypertension and
heart failure. Strong predictors of OSA have disclosed that obesity patients have presence of
diabetes and hypertension. Thus, medical professionals are required to treat such persons
accordingly before their bariatric surgery. STOP-BANG questionnaire is generally used to
screening the condition of patients which determine presence of predictive factors in the obesity
patients (Noria and Grantcharov, 2013). If value of STOP-BANG is 5 or more then it can be said
that presence of OSA is very high.
Cardiovascular system
It is another part of pre-operative assessment of obesity patients those who are
undergoing to bariatric surgery. In this condition of cardiovascular system is identified by
practitioners so that they can take necessary measures before their bariatric surgery. Due to this
risk of sudden cardiac death can get increased to great extent (Wee and et.al, 2014).
Diabetes
Obesity is associated with insulin resistance. If glycaemic control system of patient is
poor in the pre-operative period then it may create problem of increase morbidity. Thus, doctors
recommended the person to control over glycaemic.
Patient/family education
Bariatric surgery is the way through which individual can loss their weight immediately.
When size of stomach of patient is reduced by surgery then he/she become unable to each large
quantity's food for longer duration (Discharge Instructions for Bariatric (Obesity) Surgery,
2017). That leads to reduce weight of the person rapidly. It is fact that mostly people loose their
weight within one year. In the pre-operative phase doctors give advice to patients to make
effective control over their diet. Medical professionals give them diet chart which they have to
follow properly. Apart from this most of the obesity patients also suffer from high diabetes,
hypertension, high blood pressure etc. thus they get knowledge from the practitioners that to take
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timely medicines for their BP and hypertension problems (Recovering from Bariatric Surgery,
2017).
It is necessary for the adult persons those who are suffering from sever obesity and
undergone to bariatric surgery they have knowledge about the bariatric surgery. They need to
understand that this surgery will not preclude them from the need to adopt healthy life style. If
the person is aiming to undergo with bariatric surgery then individual need to alter their exercise
schedule and have to regimen their diet before their surgery (Favorable Changes in Cardiac
Geometry and Function Following Gastric Bypass Surgery, 2013).
Family members are required to know about process of bariatric surgery. They need to
know about medicine scheduling and diet schedule. By this way they will be able to take care of
suffered obesity patient.
Intra-operative consideration
After pre-operative assessment there is also chances that patient can experience problems.
It is essential for the medical professionals that to give proper care to patients so that they can
recover soon from their medical issues (The impact of bariatric surgery on renal and cardiac
functions in morbidly obese patients, 2012).
Airway management
Intubation is common problem in obese patients. Medical professionals have to formulate
effective airway management plan for the patients in this phase so that they do not face issue
related to breathing. In this stage doctors and nursing staff assist the person with induction of
aesthetics (Changes in breathing pattern and thoracoabdominal motion after bariatric surgery: A
longitudinal study, 2012). During the laryngoscopy weight of head get increased. In this
condition medical professionals are required to suggest people that their head tilt needs to be
under sheets.
Blood pressure measurement
Patients need to be sure that they use appropriately sized blood pressure cuff. But doctors
recommend to these obesity patients that to use oversized cuffs. Practitioners also need to
monitor patients well so that their condition can be improved.
Foley Catheters
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A massive abdomen is required retraction by tape. That supports in the intra-operative
phase to patients and helps in making effective control over their weight (Postoperative Care of
the Bariatric Surgery Patient, 2012).
Intravenous access
the excessive fat can create problem for obese patients because due to which, it becomes
harder to locate deeper veins. In such condition ordinary rubber tourniquet become ineffective.
By using appropriately sized blood pressure cuffs care providers can distend person's veins
better. It is fact that neck of these patients are short ad thick. Thus, central line is neck is not
feasible for these obese patients (Wee and et.al, 2014).
Thermal regulation
Maintenance of temperature in bariatric surgery is very important. If patients avoid
hypothermia preventions then it may increase metabolic demand in the body of human being.
Medical professionals are required to monitor temperature in patient's body. Care providers need
to maintain appropriate intervention as well (Pham and et.al, 2014). With the help of forced air
warmers doctors can warm the diligent.
Electrocautery
Electrocautery current gets altered due to additional adipose on patients. It is essential to
return electrode placement to continue by using the largest sized pad.
Post-operative nursing care
It is fact that all around the world cases of obesity are increasing rapidly. There are
various methods which are used by doctors to treat patients with obesity. Bariatric surgery has
gained popularity in this respect. After the surgery patients face may issues related to their
health. After completing the bariatric surgery doctors are required to provide proper care to such
patients so that their health can be improved. Patients are needed to be triaged appropriately, they
need proper care from nursing staff so that health of the person can be recovered soon. After the
surgery many patients directly send to general care area (Mechanick and et.al, 2013). Admission
in an intensive care department is very common after the operation of stomach. On other hand
adult obesity patients those who are suffering from sleep apnea, asthma, heart issues. They spend
some more days in intensive care unit. In this unit specialist doctors monitor condition of the
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patients so that health condition of the person can be improved. Airway management is difficult
for the patients those who are with short, thick necks.
Potential for alteration in respiratory function postoperatively
After bariatric surgery respiratory system's functions get changed frequently. Hypoxemia
with patient-controlled analgesia is very common alteration after this phase. The most effective
change has been occurred in patients that individual become able to breath properly after this
bariatric surgery. Breathing patterns variables become similar to control group people after this
surgery of obesity patients. It is fact that body mass of human get decreased after the surgery
from 51.2 to 34.4 kg/m2 within twelve month of surgery ( et.al, 2013.
Sjöström, 2013). PC20 methacholine improved and it reaches from 0.84 to 6.2 mg/ml. On other
hand c-reactive protein can get reduced from 8.6 to 1.7 mg/L. In addition, symptoms of Asthama
also get decreased to great extent.
Illustration 1: Changes after operation in obesity patients
Source: (Changes in breathing pattern and thoracoabdominal motion after bariatric
surgery: A longitudinal study, 2012)
Potential for alteration in cardiovascular function postoperatively
Cardiovascular ailments are associated with obesity patients. After this surgey risk of
cardiovascular can be minimized to great extent. After the bariatric surgery LV and RV functions
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can be improved in obesity patients. In the post-operative phase volumes and LV cavity
dimension become normal and thickness of wall can middly increased. That is positive for
obesity patients because they can live healthy life after this surgery (Postoperative Care of the
Bariatric Surgery Patient, 2012).
Potential for complications
Pulmonary complications
Most of the obesity patients face respiratory issue in the post-operative phase in bariatric
surgery. Rate of pneumonia is quit high in these patients. Apart from this prolonged mechanical
ventilation and weaning difficulty is quit high in these people. Furthermore, post-operative
period can also increase risk of obesity patients and can create respirator complications. That
creates issues related to breathing, expiratory flow limitation (Recovering from Bariatric
Surgery, 2017).
Non-invasive ventilator support (CPAP and NIV)
It is fact that most of the patients in post-operative phase face the respirator failure
condition and doctors use CPAP and NIV. With the help of CPAP patients can get ventilatory
support for restoring and maintaining lung volumes. Atelectasis respiratory failure is another
common risk in this operation.
Discharge education for patient and families
Medical professionals give instruction to obesity patients at the time of their discharge.
This knowledge can support these persons in minimizing their risk after the operation. It is fact
that if individual follow their instruction then risk of these people can be reduced and they can
loss their weight within one year after the bariatric surgery. They give knowledge about
medicine schedule and what type of physical exercise they need to do regularly. By this way
patients can get recovered soon (Wee and et.al, 2014). In addition to this doctors give instruction
to family members about take care of diet schedule of the persons. They are required to give
patient hygienic food. Family members get education at the time to their family members
discharge about come again for the regular check up. They make them understand that avoidance
can be risky for the patients and it can cause heart failure as well so they are required to care
properly to the obesity person so that individual can get recovered as soon as possible.
 Education related to eating given by doctors to patients and their family members. Follow
diet and drink liquids can be beneficial for these obesity people. Patient need to each
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slowly and have to take timer at lest of 30 mint after this surgery (Discharge Instructions
for Bariatric (Obesity) Surgery, 2017).
 Suggestion related to activities given by the medical professionals. Proper rest need to be
done by patient, increment in activities slowly need to be done. Patient should not left
any item more than 10 pounds.
 Patient and family members are required to breath deeply and do regular exercise. Take
medicines on time (Postoperative Care of the Bariatric Surgery Patient, 2012).
CONCLUSION
From the above study it can be concluded that bariatric surgery is most effective
procedure through which obesity patients can get recovered soon. It helps in reducing the weight
of the person within one year. Before this operation doctors have top check properly condition of
individual and have to take care individual after operation as well. It helps in improving health of
adult person soon.
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REFERENCES
Books and Journals
Chang, S. H. & et.al., (2014). The effectiveness and risks of bariatric surgery: an updated
systematic review and meta-analysis, 2003-2012. JAMA surgery. 149(3). pp.275-287.
Herder, C. & et.al., (2014). Adiponectin and bariatric surgery: associations with diabetes and
cardiovascular disease in the Swedish Obese Subjects Study. Diabetes Care. 37(5).
pp.1401-1409.
Mechanick, J. I. & et.al., (2013). Clinical practice guidelines for the perioperative nutritional,
metabolic, and nonsurgical support of the bariatric surgery patient—2013 update:
cosponsored by American Association of Clinical Endocrinologists, the Obesity Society,
and American Society for Metabolic & Bariatric Surgery.Obesity. 21(S1).
Mingrone, G. & et.al., (2015). Bariatric–metabolic surgery versus conventional medical treatment
in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre,
randomised controlled trial. The Lancet. 386(9997). pp.964-973.
Noria, S. F. & Grantcharov, T., (2013). Biological effects of bariatric surgery on obesity-related
comorbidities. Canadian Journal of Surgery. 56(1). pp.47.
Pham, S. & et.al., (2014). Comparison of the effectiveness of four bariatric surgery procedures in
obese patients with type 2 diabetes: a retrospective study. Journal of obesity. 2014.
Sjöström, L., (2013). Review of the key results from the Swedish Obese Subjects (SOS) trial–a
prospective controlled intervention study of bariatric surgery. Journal of internal
medicine. 273(3). pp.219-234.
Wee, C.C. & et.al., (2014). Sex, race, and consideration of bariatric surgery among primary care
patients with moderate to severe obesity. Journal of general internal medicine. 29(1).
pp.68-75.
Online
Changes in breathing pattern and thoracoabdominal motion after bariatric surgery: A longitudinal
study, 2012. [Online] Available through:
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<http://www.sciencedirect.com/science/article/pii/S1569904812000572>. [Accessed on
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Discharge Instructions for Bariatric (Obesity) Surgery, 2017. [Online] Available through:
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Favorable Changes in Cardiac Geometry and Function Following Gastric Bypass Surgery,
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<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3713780/>. [Accessed on 19th August
2017]
Postoperative Care of the Bariatric Surgery Patient, 2012. [Online] Available through:
<https://lms.rn.com/getpdf.php/1837.pdf>. [Accessed on February 2016].
Recovering from Bariatric Surgery, 2017. [Online] Available through:
<https://www.ucsfhealth.org/education/recovering_from_bariatric_surgery/>. [Accessed on
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The impact of bariatric surgery on renal and cardiac functions in morbidly obese patients, 2012.
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60UA5fh0Hw4XbXbPZs6JxgZ3J5vSZJBJLmL6hkMTgggXC32qb06iRohXCe-
iwn1KiHT5evvkUyXTGHrXD-
r1T4FtZ5ep8k4Lx2EnGUMvld199aumdhqeKNjDyLtG7WBueKDK6qtN~qImXtzeXjet7w
i7Gr5TZ35nfeZrBOR6qtHSxzbAj6GhibuAmF9jcUIBuUS1jC-
L2VgOqUnf1~PlYomCMZHhGozfn3z80SS76du1cboQMcj7OqbSP2tOrYP8kT9YnXKKl
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