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Med Surg 1 > Bariatric Surgical Procedures (Online Lecture) > Flashcards

Bariatric Surgical Procedures (Online Lecture) Flashcards

1
Q

morbid obesity

A

more than two times ideal body weight or body mass index >40kg/m2 or more than 100 pounds greater than ideal body weight

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2
Q

medical management includes weight loss diet in conjunction with

A

behavior modification

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3
Q

first approach aimed at weight loss and then maintence, how do we do this?

A

setting goals for weight loss
improving diet
increasing physical activity
addressing barriers to change
self monitoring
need adequate rest
involved in plan

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4
Q

why do we need adequate rest

A

sleep loss increase coritsol which leads to weight gain

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5
Q

pharmacologic management includes medications that

A

inhibit reuptake of serotonin and norepinephrine
and/or prevent digestion of fats

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6
Q

when do we use pharmacologic

A

diet/lifestyle tried first

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7
Q

would we monitor the patient while on meds

A

yes

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8
Q

minimally invasive management

A

vagal blocking therapy

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9
Q

surgical management

A

roux en Y
gastric banding
sleeve gastrectomy
biliopancreatic diversion

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10
Q

vagal blocking therapy

A

pacemaker delivering pulses to block vagus nerve which decreases gastric contraction and emptying leading to feeling full, decreasing cravings which lead to less caloric intake

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11
Q

surgical management only preferable after

A

other measures have failed, insurance coverage varies widely can help treat comorbidities

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12
Q

preop care
- similar to any other abdominal surgical procedure

A

review of lab studies
ECG
lipid and liver panels
consent

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13
Q

NPO time period

A

12 hr and clear liquid 48 hr period before

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14
Q

vertical banded gastroplsty

A

vertical line of staples placed to create a small stomach pouch to which a band is connected to provide an outlet to the small intestine

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15
Q

circumgastric banding

A

limits size of stomach by placement of inflatable band around funds of stomach
this band can be inflated or deflated to change the size of stomach as the client looses weight

works by making initial stomach part smaller so patient gets fuller quicker and will consume less calories

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16
Q

gastric bypass

A

gastric resection combined with malabsorption surgery
clients stomach, duodenum and part of jejunum is bypassed so fewer calories are absorbed

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17
Q

banding malabsoption issues

A

no malabsorption issues compared to other procedures because the food is digested and absorbed as it would normally be

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18
Q

bilopancreatic diversion anatomy change

A

removal of part of the stomach
large portion of intestine is bypassed

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19
Q

bilopancreatic diversion action

A

reduce amount of food consumption = smaller stomach significant amount of bowel is bypassed which equals decreased absorption of calories and nutrients impact gut hormones that control hunger, fullness, and blood sugar control

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20
Q

bilopancreatic diversion often done for what patients

A

diabetic

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21
Q

laparoscopic vs open

A

laparoscopic is 1-2 days in the hospital which is not likely to have complications

open 4-5 days in the hospital

22
Q

pain control

A

helps us prevent other complications (atelectasis)
PCA: opioid
oral: this is after they can handle oral liquids

23
Q

NGT management

A

never reposition tube: movement can disrupt suture line
- if pulled out notify MD immediately
removed 2nd or 3rd day upon return of bowel sounds and flatus which is done by surgeon

24
Q

post op reintroduction of foods
- first

A

clear liquids 1 ounce cups

25
Q

post op reintroduction of foods
- after clear liquids 1 ounce cups

A

pureed foods, juice, soups and milk products added 24-48 hours after clear liquid tolerated

26
Q

post op reintroduction of foods
- after pureed foods, soups and milk products

A

increase volume to 1 ounce over 5 mins or until satisfied

27
Q

post op reintroduction of foods
- how long are they on diet of liquids or pureed foods

A

6 weeks

28
Q

post op reintroduction of foods
- after 6 weeks

A

regular foods

29
Q

post op reintroduction of foods
- when patient is on regular foods the emphasis is on

A

nutrient dense foods

30
Q

post op reintroduction of foods
- when patient is on regular foods what is the protocol they should follow

A

smaller more frequent meals- not to exceed 1 cup size
high fowler position
nutrient dense foods
consume fluids before or after meals (30-60 mins)

31
Q

what will occur if too much liquid is ingested

A

nausea, vomiting, discomfort will occur

32
Q

what are some equipment we will need

A

bariatric bed/chair/commode
lifts/trapeze

33
Q

this patients will require meticulous

A

skin care

34
Q

complications

A

hemorrhage
deep vein thrombosis
bowel obstruction
dysphagia

35
Q

intra abdominal hemorrhage

A

increase RR/HR, urine output, restlessness, anxiety
vomiting of blood/stool/drain

36
Q

if patient is bleeding within first 72 hours it is caused by a

A

dislodged staple = surgery

37
Q

if a patient is bleeding within 72 hr- month is caused by a

A

gastric ulder

38
Q

deep vein thrombosis
- prevention

A

SCD stocking, profilaxis, heparin, ambulation

39
Q

bowel obstruction

A

do not insert a NGT

40
Q

dysphagia

A

education
- typically most severe 4-6 weeks
- may persist for 6 months
- eat slowly, chew completely, avoid tough foods

41
Q

dumping syndrome what happens

A

vasomotor and GI response
results from food entering small intestine instead of stomach

42
Q

dumping syndrome s/s

A

tachycardia, nausea, diarrhea, abdominal cramping

43
Q

dumping syndrome occurs how long after eating

A

15 mins- 2 hours

44
Q

how is dumping syndrome relieved

A

having a BM or bowels are empty

45
Q

dumping syndrome vasomotor response

A

food moving quickly which increases glucose which increases the release of insulin which then causes a reactive hypoglycemia
- palpations
- pallor
- dizziness
- warmth
- headache

46
Q

dumping syndrome can cause

A

reluctant to eat which leads to anorexia

47
Q

what is one way to avoid dumping syndrome

A

eat food slowly and chewing completely

48
Q

dehiscence prevention

A

binder

49
Q

what foods should post op patients avoid

A

high protein foods
high in sugar and fat
alcoholic beverages

50
Q

life style modifications

A

increased physical activity

51
Q

what other surgery is needed after weight stabilizes

A

plastic for excess skin

52
Q
A

Med Surg 1 (47 decks)

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