Nursing Case Study: Post-Operative Complications of Sleeve Gastrectomy

This nursing case study examines the case of Kathleen Johnson, a patient who underwent a sleeve gastrectomy. The assignment delves into the aetiology and pathophysiology of her morbid obesity and type 2 diabetes, highlighting the role of factors like endoplasmic reticulum stress, tobacco, and alcohol addiction. It then analyzes the patient's post-operative complications, including respiratory distress, elevated heart rate, hypertension, and pain, utilizing the ABCDE approach for assessment. The study explores the underlying pathophysiology of these complications and outlines the nursing care priorities, such as managing respiratory and cardiovascular issues, and pain. Furthermore, it emphasizes the importance of interdisciplinary healthcare, including dieticians, alcohol and drug counselors, and social workers, to ensure comprehensive patient recovery and well-being. The case study concludes with a summary of the key findings and the significance of interdisciplinary interventions.

Running head: NURSING CASE STUDY
Nursing case study
Name of the student:
Name of the university:
Author note:

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Table of Contents
Introduction: 3
Aetiology and pathophysiology of the patient’s presenting condition: 3
Pathophysiology of the patient’s post-operative deterioration: 5
Interdisciplinary healthcare: 7
Conclusion: 8
References: 9

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Introduction:
Obesity is one of the greatest public health priorities of the nation and almost half of the
population of the developing nations are suffering from obesity or are at risk for the disease.
There are various external and internal factors that contribute to the development of the obesity
in the most of the individuals and each of the factors differ in different patients, their lifestyle
and genetic predisposition plays a very important role in the development of such health
conditions. That is the reason many of the patients and health care providers opt for the sleeve
gastrectomy, however for many of the patents that are extremely obese have the chance of
postoperative complications (Gill et al., 2010). This assignment will attempt to discover the
factors associated with the sleeve gastrectomy surgeries and the underlying pathophysiology of
post operative complications.
Aetiology and pathophysiology of the patient’s presenting condition:
Gastrectomy can be defined as the surgery where some or the other part of the stomach is
removed out of the patient body in an attempt to treat acute or chronic diseases of the stomach or
as a intervention option targeted at weight loss for patients with morbid obesity. Gastrectomy is a
simple surgical procedure and can be of three different types (Himpens, Dobbeleir & Peeters,
2010). According to the case study, the patient had been suffering from morbid obesity which
might have contributed to the type 2 diabetes she had been also diagnosed with. According to the
research, close to 90% of the people suffering type 2 diabetes also have morbid obesity. Hence
the aetiology of the type two diabetes of the patient in the case study, Kathleen Johnson, is also
linked to morbid obesity.

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Elaborating more on the possible etiology or pathophysiology route of the type 2 diabetes
and obesity, there is a significantly important the link between the both of the co-morbodities.
The endoplasmic reticulum stress is a very important aspect that leads directly to the occurence
of impaired insulin optimization and usage in the body, which, in turn direct culminates to the
incidence of type 2 diabetes. It has to be mentioned that as the patient, Kathline had been
extreme obese at the BMI of 40 above, the chances of her endoplasmic reticulum stress being
over activated is extremely high. According to the Lemanu et al. (2013), this particular
phenomenon initiates a chain reaction in the body that triggers aberrant glucose production in the
lover of the patient. As it is a key facilitating factor leading to eventual insulin resistance in the
patients, for Kathline Jones as well this is the most plausible pathophysiology of her obesity and
resultant type 2 Diabetes.
Along with that it has been mentioned here as well, that the patient in the case study had
Tobacco addiction and well, as the psychological burden of her obesity and her altered body
image she smoked one packet of cigarette a day in an attempt to cope with the stress. Along with
that, Kathleen also had an alcohol addiction with drinking four beers and several glasses of
whisky a day. It has to be understood that excessive tobacco usage has a graded effect on the
aggravation of both obesity and type 2 diabetes. Along with that alcohol addiction also pay a key
role in further complicating the obesity and diabetes management of the patient. In case of
Kathleen, the patient under consideration in the case study, the added risk of caffeine addiction
contributed to counteracting the benefits she might have had attained for her dieting and altered
the desired outcome of the self management if both of her Comorbid disorders that she
attempted. And hence the patient had been instructed to have sleeve gastrectomy surgery in a

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grave attempt to surgically intervene and control her continually increasing body weight and get
deteriorating diabetes type 2 (Mortensen et al., 2014).
Pathophysiology of the patient’s post-operative deterioration:
Due to the physiological changes and the impact of the external factors like her addiction to
alcohol, tobacco or her caffeine dependency, her obesity and her diabetes both became
uncontrollable for the patient. As a result for her deteriorating health and altered body image of
the patient, she was admitted to the hospital for a sleeve gastrectomy surgical operation. She had
been commenced for the operation under general anesthesia however there are some post
operative complications that the patient had been suffering from (Damms-Machado et al., 2012).
The assessment of the post operative complications are generally carried out with ABCDE
approach.
For airway and breathing assessment, the respiration rate of the patient had been at 28 per
minute whereas the normal breathing rate of a person is 10 to 12 breaths per minute. Along with
that the patient had also been exhibiting signs of accelerated heart rate under circulation
assessment. Where the patient had a pulse rate at 130 beats per minute, the normal heart rate of
the any individual is 100 beats per minute in general. Elaborating more on the vital signs of the
patient, it has to be understood that the patient had been exhibiting signs of postoperative
respiratory complication which is a very common phenomenon for patients due to anesthesia
effect and surgical anxiety. It has to be mentioned in this context that the effect of general
anesthesia and the ventilation that the patients are generally put on for such surgical procedure
can temporarily impair the pulmonary functions of the patient which can lead to the
postoperative complications as such in the PARU unit (Sarkhosh et al., 2013).

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Along with that it has to be mentioned here as well that the excessive and uncontrolled
obesity of the patient in this condition could also have contributed to the respiratory
complications that has been recorded in the patient. It has to be mentioned here that the patient
had been extremely obese at the BMI of 40 kg/ m2. According to the Gagner et al. (2013), the
excessive weight on the thoracic cage and the abdomen of the patient often detrimental impacts
the respiratory physiology of an Individual. On a more elaborative note, this extra weight on the
major part of the respiratory apparatus alters the respiratory compliance in the patient and can
also disrupt the respiratory muscle functions of the patient leading to various respiratory
complications post surgery and leading to airway resistance.
Furthermore, it has also been observed in the patient that she had been showing signs of high
blood pressure or hypertension at the rate of 190/100, when the normal blood pressure of any
individual is at 120/80. The pathophysiology related to the excessive blood pressure in the
patient is mainly related to the uncontrolled type 2 diabetes in the patient. It has to be mentioned
that the uncontrolled diabetes acts like a key contributor to the pathways of patients
accumulating hypertension. It has to be understood that for the obese people the impact of the
imbalanced dietary pattern and in turn uncontrolled energy uptake- expenditure exchange leads
to many hypertension trajectories. Along with that it has to be mentioned that for the diabetic
patients, the insulin resistance often leads to high blood pressure post administration of
anesthesia (Boza et al., 2012).
Moreover for circulation assessment of the patient, it has to be mentioned that the for obese
patients the increased sodium uptake in the post anesthetic phase can further increase the chances
of high blood pressure of the patient. In case of the disability assessment under the ABCDE
approach the consciousness of the patient is checked and the assessments include glucose level

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monitoring, urine dip check and assessment of DKA or diabetic ketoacidosis is carried. The last
assessment is the exposure assessment of the patient, the pain scale o the patent is checked. In
case for the patient in the case study, the skin integrity of the patient is checked for any rashes.
Along with that, it has to be mentioned that for surgical wound it is very important for the
nursing professional to assess the catheter output and the signs of internal bleeding. As the pain
score of the patient had been at 7 and the indwelling catheter release of 5 ml in last hour the most
pertinent pathophysiology for the pain is infection.
With respect to the care priorities of the patient, it has to be mentioned that the patient had
been suffering from high respiratory rate, high pulse rate, elevated body temperature,
hypertension, and acute pain due to bleeding and acute infection. Hence the acre priorities for the
patient will need to focus on managing the respiratory rate of the patient, external oxygen
therapy can be provide to the patient. The high pulse rate and high blood pressure of the patient
can be managed with the help of the beta blockers. For the pain management the patient can be
prescribed non-steroidal pain medication along with effective and systematic infection control
and would management can be carried out with antibiotics and meticulous and aseptic wound
cleaning and catheter refill (Alqahtani et al., 2012).
Interdisciplinary healthcare:
Along with the nursing care that the patient in the case study will require, for a more
systematic and targeted recovery, Kathleen will require the assistance of the interdisciplinary
team as well. First and foremost the patent will require the assistance of a dietician to control her
obesity effectively. The assistance from a dietician will help her take control of her everyday
calorie intake and will give her the opportunity to maintain a balanced and effective diet that will

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evade the chances of hyperglycaemia events (Lagerros & Rössner, 2013). The next member of
an interdisciplinary team that the patient will need is a alcohol and drug counsellor who will help
the patient take control of her binge drinking and tobacco addiction. Both one to one and group
therapies coupled with pharmacological interventions provided by the alcohol and drug
counsellor will help the patient find the motivation and necessary means to get over her
addiction. Lastly, the patient will require the assistance of a social worker will help the patient
with the benefits of community care with different physiotherapeutic session and group session
for her to be motivated at all times (Evert et al., 2014). Along with that the patient will be
supported with a 24*7 care worker for her own care along with her dementia patient father.
Conclusion:
On a concluding note, it has to be mentioned that the patient under case study had been
suffering from the consequences of excessive obesity and the chances of the patent suffering
from post operative complications is extrem3. It has to be mentioned that the sleeve gastrectomy
is a surgical procedure that has many complications in case of a patient with the obesity. This
case study could discover the different post operative complications that are associated with this
surgery and the underlying pathophysilogy associated with it. Along with that, this case study
outlined a comprehensive care including interdisciplinary interventions that would help her attain
recovery.

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References:
Alaeddine, M. H., Shamseddine, G. A., & Safadi, B. Y. (2017). Laparoscopic Sleeve
Gastrectomy. In Operative Dictations in General and Vascular Surgery (pp. 131-133).
Springer, Cham.
Alqahtani, A., Alamri, H., Elahmedi, M., & Mohammed, R. (2012). Laparoscopic sleeve
gastrectomy in adult and pediatric obese patients: a comparative study. Surgical
endoscopy, 26(11), 3094-3100.
American College of Cardiology, & American Heart Association Task Force on Practice
Guidelines. (2014). Expert Panel Report: Guidelines (2013) for the management of
overweight and obesity in adults. Obesity (Silver Spring, Md.), 22, S41.
Boza, C., Salinas, J., Salgado, N., Pérez, G., Raddatz, A., Funke, R., ... & Ibáñez, L. (2012).
Laparoscopic sleeve gastrectomy as a stand-alone procedure for morbid obesity: report of
1,000 cases and 3-year follow-up. Obesity surgery, 22(6), 866-871.
Damms-Machado, A., Friedrich, A., Kramer, K. M., Stingel, K., Meile, T., Küper, M. A., ...
& Bischoff, S. C. (2012). Pre-and postoperative nutritional deficiencies in obese patients
undergoing laparoscopic sleeve gastrectomy. Obesity surgery, 22(6), 881-889.
Evert, A. B., Boucher, J. L., Cypress, M., Dunbar, S. A., Franz, M. J., Mayer-Davis, E. J., ...
& Yancy, W. S. (2014). Nutrition therapy recommendations for the management of
adults with diabetes. Diabetes care, 37(Supplement 1), S120-S143.

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Gagner, M., Deitel, M., Erickson, A. L., & Crosby, R. D. (2013). Survey on laparoscopic
sleeve gastrectomy (LSG) at the Fourth International Consensus Summit on Sleeve
Gastrectomy. Obesity surgery, 23(12).
Gill, R. S., Birch, D. W., Shi, X., Sharma, A. M., & Karmali, S. (2010). Sleeve gastrectomy
and type 2 diabetes mellitus: a systematic review. Surgery for Obesity and Related
Diseases, 6(6), 707-713.
Himpens, J., Dobbeleir, J., & Peeters, G. (2010). Long-term results of laparoscopic sleeve
gastrectomy for obesity. Annals of surgery, 252(2), 319-324.
Lagerros, Y. T., & Rössner, S. (2013). Obesity management: what brings
success?. Therapeutic advances in gastroenterology, 6(1), 77-88.
Lemanu, D. P., Singh, P. P., Berridge, K., Burr, M., Birch, C., Babor, R., ... & Hill, A. G.
(2013). Randomized clinical trial of enhanced recovery versus standard care after
laparoscopic sleeve gastrectomy. British Journal of Surgery, 100(4), 482-489.
Ley, S. H., Hamdy, O., Mohan, V., & Hu, F. B. (2014). Prevention and management of type
2 diabetes: dietary components and nutritional strategies. The Lancet, 383(9933), 1999-
2007.
Mortensen, K., Nilsson, M., Slim, K., Schäfer, M., Mariette, C., Braga, M., ... & Lassen, K.
(2014). Consensus guidelines for enhanced recovery after gastrectomy. British Journal of
Surgery, 101(10), 1209-1229.
Sarkhosh, K., Birch, D. W., Sharma, A., & Karmali, S. (2013). Complications associated
with laparoscopic sleeve gastrectomy for morbid obesity: a surgeon’s guide. Canadian
journal of surgery, 56(5), 347.

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