Nursing Care for Bariatric Surgery
Obesity is a global problem, with over 69% of adults worldwide being obese. In the US alone, over 78 million adults are obese, with about 70% of the entire population falling under obese or overweight.
Physicians classify people as overweight once their Body Mass Indices (BMIs) go over the normal of about 25kb/m2, and as obese once the mark goes above 30. Obesity is brought about by various factors. For some people, it is genetic. Even babies can be obese. Eating unhealthy foods, especially processed sugar and meats, could also lead to obesity. Lifestyle choices such as not exercising could also bring about obesity.
Being obese is not a problem on its own. Rather, it increases the risk factor that a person will develop conditions such as hypertension, type 2 diabetes and cardiovascular diseases, all of which could be fatal. There are many ways to deal with obesity so that it doesn’t lead to the development of these conditions or helps manage them, and one of them is bariatric surgery.
An Overview of Bariatric Surgery
Many people know bariatric surgery as weight loss surgery. In short, it is an invasive procedure which people undergo to cut on their weight. Most individuals who undergo this procedure usually have two main reasons for doing so. The first is that they are obese, and need to shed many pounds over a short period but for a long time. The other reason an individual would undergo bariatric surgery would be as a last resort to losing weight, especially when dieting and exercising do not work.
There are four main types of bariatric surgery a person can undergo for weight loss. They are:
Gastric Sleeve: during this procedure, the surgeon takes out a portion of a person’s stomach and ties the rest up. By the end of the procedure, the patient remains with about one tenth the size of his original stomach. As a result, the patient cannot take in as much food as he used to. Not being able to eat as much food results in weight loss.
Gastric Bypass: a gastric bypass involves tying off most of the stomach and leaving a small part to form a pouch. When a person who has been through this type of procedure eats or drinks, food gets into the pouch. However, instead of going through the remaining part of the stomach, the food bypasses the remaining section and moves straight into the duodenum. One loses weight because the pouch can only hold small amounts of food at a time, which means one has to eat less.
Gastric Band, as known as Lap-Band or REALIZE Band: a band is put around the entrance of the stomach. The band can loosen and tighten around the opening of the stomach. When a person eats, the band relaxes to allow the food into the stomach. However, when the stomach becomes full, the band tightens, and no more food is let in. This tightening means that one can’t overeat.
Duodenal Switch: surgeons use this procedure for those with a BMI of 50 and over because it is complicated and risky. It involves two procedures. First, the surgeon removes a part of the stomach. He then connects the remaining part of the stomach to the lower part of the small intestines. The result is that the stomach becomes smaller and one, therefore, eats less, which is convenient for weight loss.
Intragastric Balloon: an inflatable balloon, typically saline or air, is placed in the stomach to displace the stomach's capacity. This procedure is less invasive, as it's typically placed for six months and requires no permanent anatomy changes. The gastric balloon category types include three FDA-approved balloons: Orbera, Reshape Duo, Obalon, with more intragastric balloons pending approval. The procedure is aimed at patients between 30 to 35 BMI.
Bariatric Surgery Assessment
Not everyone can undergo bariatric surgery. Because of the limited resources on both the side of the physicians and the patient and the risks associated with the process, patients have to be assessed before undergoing the procedure. Those who fit the following criteria are the ones who typically undergo bariatric surgery.
- Adults with a BMI of over 40kg/m2 and who are at risk or have comorbid diseases such as high blood pressure and diabetes. Teenagers with a BMI of over 35kg/m2 and obesity-related conditions may also undergo the surgery
- Those who know the risks and benefits of bariatric surgery and have given their consent to undergo the surgical procedure
- Those who are psychologically prepared to change their lifestyles for the better to cope with the effects of the surgery and keep the weight off. Changes include diet changes and modified exercise regimes
Those who undergo bariatric surgery can enjoy benefits such as long-term weight loss, reduced risk of developing lifestyle conditions such as cardiovascular problems, psychological elevation, and reduced morbidity.
During the entire process of bariatric surgery, from months before the procedure to weeks after it, a person’s medical team helps him prepare for and recover from bariatric surgery. One of the most important components of that medical team is the nursing staff.
Nursing Care for Bariatric Surgery
Nurses care for patients who undergo bariatric surgery before, during and after the surgery. They help patients cope with obesity and the effects of the procedure on their lives. Coping, according to the Mayo Clinic, involves setting goals, planning how to achieve them, receiving support and keeping records.
Nursing care for bariatric surgery can be divided into two broad categories:
Perioperative Nursing Care
Months before an individual goes through bariatric surgery, he receives care from nurses. Perioperative nurses are responsible have the following responsibilities about future bariatric surgery patients.
- They assess whether the patient should undergo the procedure. Nurses typically evaluate patients by questioning the latter about their medical history, paying particular attention to cardiovascular history as this affects the riskiness of the surgery. Nurses also check for other comorbidities and medication of patients being vetted for the procedure. Also, they are responsible for verifying the weight and BMI of patients who want to go through bariatric surgery
- They provide patients with information regarding the benefits and drawbacks of bariatric surgery
- Nurses guide patients in setting goals to do with weight loss and healthy lifestyle habits. As such, they act as sources of psychological and psychosocial support for bariatric surgery patients
- They train patients on how to adapt after the surgery. For instance, they could help the patients learn how to judge the size of shot glasses. Patients who can tell 4oz from 3oz, for example, have an easier time adjusting to their fluid diets after the procedure than those who cannot
Postoperative Nursing Care
During operations, nurses help surgeons by monitoring the vitals of the patients, particularly the cardiovascular vitals. After bariatric surgery, they help keep the patients alive and healthy. They also motivate patients through their recoveries. Some of the roles of nurses after bariatric surgery include pain management, fluid management and wound monitoring for the patients. Nurses also make considerations specific to patients who have undergone bariatric surgery including:
- Checking for staple-line leaks which are responsible for one in every weight loss surgery-related death
- Monitoring the eating habits of the patient for up to eight weeks after the surgery. They encourage patients to eat healthily and help them deal with eating disorders such as stress eating
- Encouraging patients to take up exercising
- Checking the nutrient levels of patients weeks into the new diets and advising them on what they need to eat
Challenges Nurses Face When Caring for Bariatric Surgery Patients
Because bariatric surgery is a specialized process, it requires specific equipment. Nurses may encounter problems caring for patients when they do not have this equipment. Additionally, caring for bariatric surgery patients is hard because it takes a lot of time and staff. It is also exhausting both physically and mentally.
Nursing remains important for bariatric surgery patients despite these problems. Nurses give these people support and take care of their medical needs. They also help the patient keep the weight off without medication aids. Therefore, each bariatric surgery patient should have a nurse to guide them through the procedure.
About The Author
John Wright works for Renew Bariatrics, an online guide for bariatric surgery and obesity.