NRSG258 Case Study: Comprehensive Post-Sleeve Gastrectomy Care

This case study examines the post-operative care of Kathleen Johnson, a 45-year-old patient with obesity and type 2 diabetes who underwent a laparoscopic sleeve gastrectomy. The analysis covers the aetiology and pathophysiology of her conditions, the surgical procedure's impact on weight loss and diabetes management, and potential post-operative complications. It addresses the importance of monitoring vital signs, managing pain, preventing pulmonary embolism and deep vein thrombosis, and maintaining fluid balance. The study also highlights the role of an interdisciplinary healthcare team, including nurses, ICU physicians, physiotherapists, and dietitians, in providing comprehensive care, promoting early ambulation, managing pain, and addressing addiction issues. The ultimate goal is to ensure Kathleen's safe recovery and long-term health improvement through continuous support and lifestyle modifications.

Kathleen Johnson 1
Introduction:
Kathleen Johnson who is 45 years of age is suffering from obesity along with this she
also has type 2 diabetes. As a result of diabetes and obesity, she is living a stressful life as a
result of which she uses to have heavy alcoholic drinks and smoke to come out of the stress.
Kathleen Johnson weighs around (BMI 40kg/m2) which in turn are the cause of type 2
diabetes in her. Obesity is a serious chronic disease which in turn leads to many serious
diseases such as cardiovascular disease, diabeteies and joint and bone diseases (Topart,
2011). Obesity is not only concerned with the cosmetic but increases the risk related to the
health issues and severe chronic diseases. An extreme obesity results likely to have health
issues concerned with weight (Rebibo, Dhahri & Regimbeau, 2016). Obesity is diagnosed in
the case when the body mass index that is BMI of an individual is 30 BMI or greater than
this. In case of Kathleen according to her weight status BMI 40kg/m2; she comes under the
category of extremely obesity. In case of Kathleen Johnson, the cause of the obesity are her
stressful life and the unhealthy diet that involves the excessive use of the alcohol and
smoking as a daily habit with the consumption of the several coffee cups in a day which
results in hormonal and behavioural influence on the body weight of the Kathleen Johnson.
The sedentary lifestyle of the Kathleen Johnson results in to take more calories per day and
thus lowering her quality of life.
Aetiology and path physiology of the patient’s
Laparoscopic sleeve gastrectomy is a secure and established treatment to control
obesity and involves the elimination of largely the antrum and the fundus of the stomach, in
this manner generating a sleeve or gastric tube that confine the oral intake (Topart, 2011).
The surgery thus results in reducing the size of the stomach to the banana size and thus

Kathleen Johnson 2
results in reducing the patient's weight and in turn this is also beneficial for the type 2
diabetes (Rebibo, Dhahri & Regimbeau, 2016). The sleeve gastrectomy surgery for the
weight loss among the obese patient suffering from type 2 diabetes is effectual in recovering
glycaemic control with type 2 diabetes and marks a significant development in together
diastolic and systolic myocardial function (Rebibo, Dhahri & Regimbeau, 2016).
Laparoscopic sleeve gastrectomy surgery is one of the promising bariatric procedures for the
morbid obesity treatment as in the case of the Kathleen Johnson who weighs around (BMI
40kg/m2). The Laparoscopic sleeve gastrectomy surgery results in reducing the size of the
stomach, which in turn leads to less eating among the patients with this less absorption of the
calories in the body (Honoré, McLeod & Hopkins, 2018). Weight loss is promoted among
the surgery with changing the hormonal signals between the brain, stomach, and liver and
establish the lower set point (Honoré, McLeod & Hopkins, 2018). Surgery manages in
resolving the health with controlling the type 2 diabetes condition and results in significant
improvement in the health conditions that are related to the obesity. As a result of the surgery,
there are significant changes in the hormones and the digestive organs which in turn results in
reducing the hunger and thus increasing the metabolism (Honoré, McLeod & Hopkins, 2018).
After the surgery the patient feels less hunger for food that is as a result of a reduction in the
ghrelin hormone which is due to the removal of the stomach portion that is largely
responsible for the production of the gherlin hormone.
Post-operative deterioration
For reducing the risk of the deterioration after the surgery, it is necessary for the
nurses to follow and understand the standard principles which reduce the risk of infection
among the patient (Vilallonga, Fort, Caubet, Gonzalez & Armengol, 2013).

Kathleen Johnson 3
The respiration rate of the Kathleen Johnson after the surgery is normal with an increased
blood pressure that is 190/100 which is quite high and needs to be controlled. The pulse beat
is also high with receiving the severe pain ranging seven. The most common care
intervention for the nursing diagnoses of the pain is one the vital sign, which is necessary for
the evaluation of the absence or presence of pain that is on the basis of the tissue injury and
through the activation of nociceptive transducers at the place of surgical injury (Gagner,
Deitel, Erickson & Crosby, 2013). Such care needs awareness from nurses, who have to
enquire patients if they are in ache and scrutinize their facial movements, expression, and
positioning, in order to improve characterize, position, and measure the strength of pain
(Gagner, Deitel, Erickson & Crosby, 2013).
The postoperative paradigm of care includes certain care for the prevention of pulmonary
embolism and deep venous thrombosis that comprise utilization of devices such as pneumatic
compression devices, low molecular weight, and unfractionated heparin (Gagner, Deitel,
Erickson & Crosby, 2013). The presence of the gastric fluid in the Nasogastric tube is due to
the excessive drinking habits of the Kathleen which not only includes the alcoholic drinks
abut also several cups of the coffee in a day which results into the production of the gastric
fluid. The gastric fluid is observed and hence Kathleen is to kept hydrated with the IV
solutions ad once the fluid is cleared through evaluation she must begin to take the fluids
orally which should begin with the water ad after the clear fluids. The urine output in the
Kathleen was observed to be low which is the result of high oxalate food intake and in turn is
related to the low excretion of the urine (Meireles & Saraidaridis, 2017). The normal output
of the urine normal is to be around 50-60 ml per hour but in the case of Kathleen it is very
low and needs attention
Interdisciplinary healthcare team

Kathleen Johnson 4
High quality care is required for Kathleen after the surgery which is to reduce any
cause of infection and to keep her comfortable ad oriented. The specific care that is required
after the post operation is to encourage the early ambulation (Meireles & Saraidaridis, 2017).
After the operation patient was given sips of water and intravenous fluid was managed at the
rate that is suitable for weight. Opioid analgesia is set aside to the lowest amount. The lower
molecular mass heparin was observed as cavernous vein thrombosis prophylaxis. The diet
with the leak ruled was administered for clearing the fluids which are then followed by the
soft food (Creange, Beitner & Ren-Fielding, 2016). Kathleen will be discharged after two
days of surgery while observing that the oral intake done by her is adequate with good control
over the pain and when the independent mobilisation of her reaches the preoperative level
(Meireles & Saraidaridis, 2017). The pain score is rated 7 from 10 which is under severe
pains hence needs intravenous PCA, epidurals and opioid infusion.
In the case of Kathleen, she is addictive to smoking and alcohol which in turn results into
certain harmful effects such as ventilator disorders and includes the sleep obstructive sleep
apnea-hypopnoea syndrome, and is frequent in the individuals serving form the class 2
obesity (Coşkun, 2017). Consequently, the anticipation of smoking commencement and
smoking termination are helpful in the lessening of comorbidities, mortality, and
complications. With this, the health care professional is accountable for guiding, detecting
and treating patients in danger of diseases related to smoking (Coşkun, 2017). As Kathleen
was suffering from the diabetes 2 hence should be advised the sugar free and no carbonated
fluids with this the strict management of fluid intake and urine output is to be observed for
determine the status of the fluid volume (Cesana et al., 2014).
Along with the nursing care, the ICU physician is also required which will take due care of
the treatment and to prevent the complications among the patient in future. The ICU

Kathleen Johnson 5
psychosis in the case is a result of the risk of hyperactive and hypoactive delirium (Cesana et
al., 2014). The physiotherapist will help in making the movements of the body after the
surgery which is supposed to be ineffective. Along with this the nutrition professional or
dietician also acts as a vital part of multidisciplinary care she is stimulated with diet
education, nutritional assessment, concerning postoperative consumption behaviours, and
preoperative efforts for weight loss. Preoperative low-calorie diet for the six 6 weeks is to
reduce the volume of the liver by 20% and hence improving the access of the upper stomach
during the surgery (Horak, Pauig, Keidan & Kerns, 2004). For accessing the weight loss,
comorbidities resolution, and complications that are long term, Kathleen is to be provided
with the continuous support and counselled to eat minute, frequent meals that are high in
protein and with low content of carbohydrate. The physician addressing the issues related to
the weight loss and act as the best source of health information for the patient and as the
health care provider increases the motivation of the patient for weight loss (Horak, Pauig,
Keidan & Kerns, 2004). In the multidisciplinary team, the nurse acts as the key within the
patient contact and the nexus for communiqué among team members. Nurses have the
exceptional position to instruct patients, make them feel contented and established, and
increase right of entry to the kind of information that will help straight most advantageous
treatment strategies (Horak, Pauig, Keidan & Kerns, 2004).

Kathleen Johnson 6
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Creange, C., Beitner, M., & Ren-Fielding, C. (2016). Laparoscopic Adjustable Gastric Band
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436-438.

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Topart, P. (2011). Comment on: Laparoscopic repeat sleeve gastrectomy versus duodenal
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Vilallonga, R., Fort, J., Caubet, E., Gonzalez, O., & Armengol, M. (2013). Robotic Sleeve
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