LaGuardia Community College
City University of New York
Department of Natural and Applied Science
Practical Nursing Program
Class: SCL 117 – Medical-Surgical Nursing II
Group Presentation
By
Anaïse Ikama
Marie Jimenez
Petra Ramnarine
Edeneth Flores
Na Pang
Stacy Moyston-Duckie
Topic: Bariatric Surgery
Janell Trotman
Marjorie Johnson
Yvonne Prempeh
BARIATRIC SURGERY
I. Introduction – What is Bariatric surgery? - Yvonne
a. Discuss bariatric surgery itself and the purpose for the surgery
b. Discuss the different types of bariatric surgery
II. Requirements for Bariatric surgery - Petra
a. Discuss the criteria on how candidates are chosen for bariatric surgery
III. Gastric-bypass surgery - Janell
a. Discuss the different diet plan that the patient must follow Pre and post bariatric
surgery?
c. Discuss how nurses play a role in gastric-bypass surgery
IV. Pre-operative Nursing Care - Marjorie
a. Discuss the physiological and psychosocial assessment such as physical
examination and what nurses should look for in evaluating potential clients for
surgery. Are there any complications, risks or benefits?
b. Discuss informed consent and the nursing role
V. Post-operative Nursing Care - Stacy
a. Discuss the possible risks and complications after undergoing bariatric surgery
b. Discuss how nurses maintain and manage nursing care.
c. Discuss the most common medications given post-operatively and pain
management
VI. Prevention Methods of obesity - Na
a. Discuss how to prevent undergoing bariatric surgery (ex: diet, exercise etc.)
b. Discuss how nurses play a role in the prevention process (ex: community)
VII. Nursing Care Plan - Marie
a. Describe 2-3 nursing diagnosis for bariatric surgery and its nursing
interventions and rationales. Include the psychosocial aspect of a client postop bariatric surgery and how nurses can provide effective nursing care.
VIII. Discharge & Client Teaching – Anaïse & Edeneth
a. Client Teaching (include family teaching as well)
b. Follow-up – discuss continuing care to clients and what nurses should advise or
recommend clients
b. Conclusion – wrap up group discussion
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What is Bariatric Surgery?
~Yvonne Prempeh~
Bariatric surgery is a procedure performed either on the stomach and/or intestines to help people
with extreme obesity and those with a BMI between 35 and 40 who have health problems like type 2
diabetes or cardiac disease lose weight. There are different types of bariatric surgery that provide weight
lost, but we will focus on the two main ones: Lap-Band system and Roux-en-Y Gastric Bypass. However,
none of these procedures would work entirely, unless changes in the individual’s lifestyle such as proper
diet, physical activity are made (www.mayoclinic.com).
In Lap-Band System, an adjustable silicone elastic band is placed around the upper part of the
stomach creating a small pouch and restricting the passage of food to create a feeling of fullness. Once in
place, the band is inflated non-surgically through a port under the skin to further restrict the amount of
food intake. The band can be placed in 45 minutes and patients are typically hospitalized for less than 24
hours following surgery. With this procedure, patients usually lose 40-70% of excess weight within 1-3
years. If the patient does not lose weight, the band would be tightened, and later loosened to allow more
food, if necessary. This is a great benefit for women who become pregnant, as it allows more food intake
during pregnancy and tightened again after pregnancy to continue weight loss (www.mayoclinic.com).
The Roux-en-Y Gastric Bypass in the other hand is the most frequently performed weight loss
procedure in the United States. During this surgery, the upper stomach is stapled and attached to the small
intestines creating a small pouch that is completely divided from the remainder of the stomach. This
procedure creates a faster feeling of fullness and allows less absorption of calories. The procedure usually
takes about 2 hours and patients are hospitalized 2-3 days and back to normal activities in 1-3 weeks.
Patients usually lose between 60-80% of excess body weight. However following Roux-en-Y procedures,
dumping syndrome is frequently experienced. Therefore, as healthcare providers, our ultimate goal is the
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saving of lives and the restoration to optimal health with bariatric surgery, making weight loss significant
and the individual achieving optimal health a nurse’s duty of restoring health is thus achieved
(www.mayoclinic.com).
Requirements for Bariatric surgery
~Petra Ramnarine~
For an individual to get any bariatric surgery, the following criteria have to be assessed by the care
provider before undergoing bariatric surgery:

BMI (body mass index) of 40+ or 35+ and suffers from diabetes, heart
disease

80 -100 lbs overweight.

Having obesity related to physical problems that significantly interfere with
employment, physical morbidity or family function.

Prior weight loss efforts and whether the patients are satisfied with current
weight and appearance.

Any recent changes in appetite or weight.

Any medical problems such as cardiovascular disease and diabetes.

Assess height and weight, and to be compare with ideal body.

Any associated medical problems such as hypertension, diabetes, sleep apnea,
or orthopedic problems.

Letters from specialist or physician in support of the surgery and its particular
benefits (www.nycweightloss.com)
Obtaining authorization from insurance companies for obesity weight loss surgery can be a challenging
process. The surgeon could assist pt. in this process by giving them the sufficient documentation that will
improve their chances of obtaining an approval. Obtaining approval can take up to 4 weeks to complete.
Insurance Plans: Most private insurance plans and will arrange out-of-network benefits if available. Pt is
responsible for deductibles and co-pay amounts as outlined in their policy. Cash surgery fees for patients
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who want to pay cash for the procedure, which includes surgeons and assistant fees, hospital and
anesthesia charges, it must be paid pre-op (www.nycweightloss.com)
Discuss the different diet plan
~Janell Trotman~
Candidates that choose to do bariatric surgery, according to docshop website have to adhere to a
strict diet before and after surgery. Diet plays a major role on the outcome of the procedure. A meeting
with a dietician on a regular basis is needed to determine what kind of diet is appropriate for the client.
The patients caloric and nutrients needs should be assess based on medical history, weight and food
preference, (www.docshop.com)
Clients are started on a liquid diet 2 weeks before surgery. The patient is allowed to have 1000
calories per day and at least 50 grams of protein. Most of the client’s calories should come from protein/
meal replacement shakes. Protein is important for wound healing, which the client will need (nutrition
book). Supplement drinks like ensure, optifast, glucerna should be use. Clients who are undergoing
bariatric surgery need to eliminate caffeine, soda, alcoholic and beverages that contain a lot of sugar. It is
mandatory to adhere to this diet. A liquid diet helps shrink or “de-fat” liver. Shrinking of the liver makes
the procedure easier and less complicated.
Pre-operative Nursing Care
~Marjorie Johnson~
There are always risks with surgery, however as health care providers, we can follow steps to
minimize these risks by performing physical and psychosocial assessment of the patient. The psychosocial
assessment is obtained to evaluate the patient’s mood, self-esteem and emotional status. Some patients do
not view being overweight as a problem, which affects treatment and outcome. Ask patient about their
family history of obesity, the cause and duration of weight gain, what weight loss program they have tried.
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Also its effect on intimate relationships, especially sexually should be discussed (Amos, Keith D., Douglas
W Green, Valerie J Halpin. The Washington Manual of Surgery)
Some of the complications for bariatric surgery are: DVT, pulmonary Embolus, pneumonia,
dumping syndrome, loss of too much weight, injury to pelvic organ, and leaks from a break in the staple
line, and death (1% nationwide). Some of the benefits of bariatric surgery are: Reduce hypertension,
normal cholesterol in 2-3 months, sleep apnea and gastro esophageal reflux disease are improved or
resolved, the quality of life is markedly better and patients with Typ2 diabetes obtain normal blood sugar
within a few days after surgery. (Amos, Keith D., Douglas W Green, Valerie J Halpin. The Washington
Manual of Surgery)
The patient has the right to be informed of the tests, treatments, or procedures, therefore, should be
asked to sign a consent; a legal piece of paper that tells exactly what will be done to the patient. form that
gives caregivers permission to certain tests, treatments, or procedures. If unable to give his/her consent,
someone who has permission could sign the form instead. With bariatric surgery patient, special
equipments have to be ordered and explained to patients (Amos, Keith D., Douglas W Green, Valerie J
Halpin. The Washington Manual of Surgery)
.
Post-operative Nursing Care
~Stacy Moyston-Duckie~
Bariatric-surgery patients are at risk for developing complications related to surgery and
postoperative respiratory and gastrointestinal disorders. According to the International Bariatric surgery
registry, the leading cause of death following bariatric surgery is pulmonary embolism, Anastomotic
leaks and respiratory failure. Other complications are wound infections, incisional hernias, ulcers,
bleeding, constipation, cholelithiasis, dumping syndrome, dehiscence, vitamin and nutrient deficiencies.
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Typically, during the postoperative recovery period the nurse has to monitor and manage the
patient to reduce complications, by positioning the patients head at least 30 degrees semi-fowler’s
position to help breathing and by reducing the weight of abdominal adipose tissue pressing on the
diaphragm. Checking vital signs, assess for complications, and provide skin and wound care,
repositioning of the patient, and checking tubes and catheters q 2 hrs. The patient will perform frequent
respiratory exercise using incentive spirometry, and deep breathing. Assess abdominal changes in
appearance of volume gastric or percutaneous drains, presence of hematemesis or melena, and persistent
cough. These findings should be reported to the physician for appropriate medical intervention.
(www.aafp.org). Early ambulation also be encouraged to reduce the risk of immobility
www.finarticles.com).
Post-operative pain medications are given through ‘patient controlled analgesia’ (PCA) pump,
which dispenses (morphine) when the patient pushes a button. The patient will also receive IV injections
of Torodol, a similar drug to Motrin in relieving pain in abdominal muscle. After day two of the surgery,
the patient’s medication will be switched from PCA machine to a liquid medicine Roxicet – liquid
Percocet that will be taken by mouth every 4-6 hours (www.briatricsurgerypittsburgh.com).
Appetite suppressants such as Phentermine (Adepex-P, and Obsestin-30) are also ordered
because it acts directly on the appetite-control center in the CNS to suppress and reduce hunger;
Sibutramine (Meridia), which reduces hunger and increases sensations of satiety by inhibiting the uptake
of serotonin, norepinephrine, and dopamine (LeMone, 2008). Ursodiol, is taken twice a day, two weeks
after surgery. Actigall is taken to prevent gallstones from forming during rapid weight loss. Patients who
have done bariatric surgery will need to take vitamin and mineral supplement for the rest of their lives
(www.aasfp.org).
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Prevention
~Na Pang~
After bariatric surgery the patient is taught how to eat and exercise properly in order to reduce
complications. Drastic changes have been made to the digestive system and careful measures must be
taken to help the body re-adjust to these changes. Therefore, the patient must practice important eating
habits such as, not eating solid foods and drinking at the same time. In fact the patient is advised to stop
drinking 15 minutes prior to a meal, not drink fluids or liquids until 45 minutes after a meal, and stop
eating when he or she begins to feel full. Keeping a food journal is advisable, because it is an important
tool in helping the patient learns how to maintain his or her eating habits. Also, overeating can cause
vomiting (www. stronghealth.com).
Exercise after Bariatric Surgery: Exercise plays a crucial role after bariatric surgery and also
helps patients lose weight more rapidly. Exercise increases your metabolism, causing you to burn more
calories during your regular activities for the rest of the day. The benchmark amount of exercise is 30
minutes per day for a minimum of five days per week. This exercise can include walking. As weight
comes off, you may feel like raising that to jogging. You would have to do some sort of organized
walking, running, treadmill or stair machine activity daily (www. stronghealth.com)
Ongoing Support: Joining a support group is one of the best things a patient can do after
bariatric surgery to keep the weight off. Bariatric surgery requires many lifestyle and behavioral
changes, and patients usually need the support of family, friends, and healthcare professionals to help
get through any rough spots (www.archfami.ama-assn.org)
Nursing Care Plan
~Marie Jimenez~
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In nursing, to effectively carry out nursing interventions in providing quality patient care, the
development of nursing care plans is the key. For patients undergoing bariatric surgery, it is important
to note that there are nursing care plans designated for the preoperative and postoperative phase.
According to Ulrich & Canale, the following are nursing care plans for patients undergoing bariatric
surgery during the preoperative and post- operative phase of the surgery (Ulrich and Canale, 2005, Pp:
19, 48, 621 & 622).
Preoperative: Nursing Care Plan
Nursing Diagnosis
Nursing Outcome
Nursing Intervention
Nursing Rationale
1. Assess for signs and
symptoms of a disturbed
self-concept.
1. Early recognition of
2. Implement measures to
assist client to increase
self-esteem.
2. An increase in selfesteem has a positive
effect on the client’s selfconcept.
3. Implement measures to
assist client to adapt to
changes in body
functioning and/or
appearance.
3. Measures that help
minimize changes in
appearance and/or body
functioning reduce the
impact of these changes on
self-concept.
Disturbed SelfConcept
Client will
demonstrate positive
self-concept as
related to
evidenced by verbalization of feelings,
obesity and inability
positive statements,
to lose weight by
and active
conventional methods participation in selfcare.
signs and symptoms of a
disturbed self-concept
allows for prompt
intervention.
Assessment is an important tool within the nursing process. Assessment provides vital clues
regarding how nursing care affects the psychosocial aspect of the patient. Nursing interventions that allow
the patient to gain control over how they perceive themselves greatly contributes to increasing their selfesteem. Nurses should provide patients undergoing bariatric surgery with emotional support and maintain
therapeutic communication throughout the preoperative phase of the surgery. Therapeutic communication
encourages self-awareness.
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Postoperative: Nursing Care Plan
Nursing Diagnosis
Nursing
Outcome
Ineffective
Breathing Pattern
related to
increased rate of
respirations
associated with fear
and anxiety
Client will
maintain an
effective
breathing
pattern
decreased rate of
respirations
associated with
depressant effect of
anesthesia
Nursing Intervention
Nursing Rationale
1. Assess for signs and
symptoms of an ineffective
breathing pattern (e.g. shallow
respirations, tachypnea, and
dypsnea).
2. Monitor for and report a
significant decrease in oximetry
results.
1. Early recognition of signs and
symptoms of an ineffective breathing
pattern allows for prompt intervention.
3. Place client in semi- to high
Fowler’s position unless
contraindicated.
3. A semi- to high Fowler’s position
allows for maximal diaphragmatic
excursion and lung expansion.
4. Instruct client to deep breathe
or use incentive spirometery
every 1-2 hours.
4. Deep breathing and use of an
incentive spirometery promote maximal
inhalation and lung expansion.
2. Oximetry is a noninvasive method of
measuring arterial oxygen saturation.
The results assist in evaluating
respiratory status
As a part of assessing the bariatric patient after surgery, it is important to assess the patient’s
airway and breathing. Nurses should be aware of certain protocols when symptomatic deviations of
breathing should occur for proper intervention to take place. The nursing interventions and rationales
listed above show how nurses can maintain and monitor for a patent airway. Following surgery, bariatric
patients should constantly be monitored for signs of respiratory distress. Any signs of respiratory distress
should be reported and documented immediately.
Client Teaching
~Anaïse E. Ikama~
Patient’s education is very important in the delivery of nursing care. Although the surgeon gives
a discharge instruction, we as patients’ advocate are responsible in reviewing these instructions with the
clients by clearly demonstrating and providing specific verbal and written information such as medications
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that need to be taken or avoided, diet restrictions, management of pain and when to contact their
physicians.
Let remind our patients that the hospital team is available by phone in case of emergency.
Discussing different ways to access help and how or when to do so is really important, therefore, should
be done prior to discharge. According to Johns Hopkins Center for bariatric surgery, patients should “call
911, and go to the ER for issues that require urgent medical attention, such as: chest pain, shortness of
breath and excessive abdominal pain…the office or the physician, [can be contacted] for non-emergent
issues, such as: nausea, vomiting, diarrhea or fever…redness, swelling, drainage or bleeding from the
incision” (www.hopkinsbayview.org).
Bariatric surgery is not a cure to obesity; it is however one step toward weighs loss. Emphasize
to the patient that great outcome of bariatric surgery cannot be met if the diet guidelines is not follow.
Remind them to be committed to the new lifestyle, be very careful regarding the guidelines given for the
diets. Stress the dietary changes for managing dumping syndrome such as “consuming about six small
meals a day rather than three larger ones...Avoiding fluid with meal… Consuming more low-carbohydrate
foods. In particular, concentrating on a diet low in simple carbohydrates such as sugar (found in sweets
like candy, cookies and cakes… Staying away from acidic foods, which are harder for some people to
digest. Preparing meat and other foods by broiling, baking or grilling and Consuming adequate vitamins,
iron and calcium.
Encourage ambulating to prevent DVT. Recommend the patient to start exercising by walking
short distances, then increasing rate each day. However, any abdominal exercises, weight lifting or
swimming” should not be attempted. Activities that can be performed include “Light housework, climbing
stairs…
[lifting
nothing]
heavier
than
5
pounds,
(www.hopkinsbayview.org).
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shower
with
back
to
the
spray”
Wound care should be taught to prevent infections. Remind the patient to contact the hospital if
notice any redness, swelling, drainage or bleeding from the incision site. Finally there is nothing better
than having a variety of sympathy from different people as one recover and tries to maintain weigh loss.
Provide support groups to your patients as ideal way to learn the coping techniques and share experiences.
Follow-up
~Eveleth Flores~
Discharging a patient does not only focus on the instructions written by the surgeon regarding
home care, but also reinforcement of follow-up care. This type of care is very important following a
bariatric surgery. For a patient who just undergone bariatric surgery, he or she is expected to return to see
the surgeon at “ 2 weeks after surgery, every 3 months after surgery for the first year, every 6 months for
the following year and then annually” (www.hopkinsbayview.org).
Re-instruct patient to take their prescribed medications. Some of the commonly prescribed
medications are analgesics for pain, antiemetics to prevent dehydration (www.mayoclinic.com) and
vitamins. Vitamins are prescribed to make sure that the person is adequately receiving full nutrition, which
is one of the most important issues to touch on. Instruct patient to eat small snack due to the small size of
the stomach. It is a big challenge to change a lifestyle, to remind the patient to follow-up with their
nutritional dietician who will provide them guidance and support to help them maintain the new diet. “If a
patient is able to tolerate liquids well, the surgeon will likely recommend having a puree diet, and then
begin eating 3 meals diet per day” (www.bariatricedge.com). Also, Remind clients to “chew food slowly
and thoroughly and if possible to cut it into pieces. Informed patient to eat a few tablespoons at a time to
prevent the stretching of the incision site. Then, include protein on the diet such as beans to promote
healing (www.asbs.org).
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All in all, bariatric surgery is successful in producing (often substantial) weight loss, though one
must consider operative risk (including mortality) and side effects before making the decision to pursue
this treatment option. As patients’ advocate, let’s teach and emphasize the importance of follow- up visits
because it an important part of client teaching. Through this, the MD will be able to monitor the patient’s
condition, detect any serious complications that could happen after bariatric surgery and or the success of
the procedure
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Worked Cited
Book References
Amos, Keith D., Douglas W Green, Valerie J Halpin, The Washington Manual
of Surgery. 4th Ed. Lippincott, Williams & Wilkins, 2005 Philadelphia, PA
Ignatavicius, Donna D and M Linda Workman, Medical-Surgical Nursing 5th Ed.
Elsevier Saunders, 2006 St. Louis, MO
Lemone, P., Burke, K.. Medical-Surgical Nursing Critical Thinking in Client
Care 4th Ed. Person Prentice Hall. 2008. New Jersey
Ulrich, P. S., & Canale, W. S. (2005) (6th ed.) Nursing Care Planning Guides For Adults
in Acute, Extended, and Home Care Settings. St. Louis: Elsevier Saunders, 19, 48,
621, 622.
Internet References
www.aafp.org. “Caring for Patients after Bariatric Surgery” (April 15, 2006).
Retrieved January 19, 2008 from
http://www.aafp.org/afp/20060415/1403.html
www.asbs.org. “Gastric Bypass”. (2008). Retrieved January 15, 2008 from
http://www.bariatricedge.com/dtcf/pages/3_GastricBypass.htm?WT.srch=1&s_k
wcid=gastric%20bypass%20surgery|873494124
www.findarticles.com “Postoperative care of patients undergoing bariatric
surgery” (2007). Retrieved January 15, 2008 from
http://findarticles.com/p/articles/mi_m0FSS/is_6_15/ai_n17215957/pg_6
www.hopkinsbayview.org. “Johns Hopkins Center for bariatric surgery” (2005).
Retrieved January 18, 2008 from
http://www.hopkinsbayview.org/bariatrics/patientinformation.html
www.nycweightloss.com. “Bariatric surgery” retrieved January 5th, 2008 from
http://www.nycweightloss.com/services
www.Stronghealth.com. “Diet with bariatric surgery”(2008). Retrieved Jan 20,
2008 from http:// stronghealth.com
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