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Nursing Grand Rounds Care of the Bariatric Patient February 15, 2012.

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Presentation on theme: "Nursing Grand Rounds Care of the Bariatric Patient February 15, 2012."— Presentation transcript:

1 Nursing Grand Rounds Care of the Bariatric Patient February 15, 2012

2 Presented and Planned by: Needham 3: Jessica Kaloyanides, RN Jessica Kaloyanides, RN Marjorie Petit, RN, BSN Marjorie Petit, RN, BSN Kayleen Sussman, RN Kayleen Sussman, RN Kelly Donahue, RN, BSN Kelly Donahue, RN, BSN Operating Room: Eric Starble, RN, BSN, CNOR Eric Starble, RN, BSN, CNOR Leslie Schneiderhan, RN, BSN, MEd, CNOR Leslie Schneiderhan, RN, BSN, MEd, CNOR Al Ghilardi Orthopedic Tech Photography Al Ghilardi Orthopedic Tech Photography Weight Management Center: Lisa C. Luz, RN, MSN, CBN Nutrition: Dana Eiesland, RD, LDN Stacey A. Nelson, BS, RD, LDN

3 Obesity Obesity is defined as having an excessive amount of body fat. Obesity is defined as having an excessive amount of body fat. Doctors often use Body Mass Index to determine obesity Doctors often use Body Mass Index to determine obesity BMIWeight status Below 18.5 Underweight Normal Overweight 30.0 and higher Obese 40.0 and higher Morbid obesity

4 Obesity in the US About one-third of U.S. adults (33.8%) are obese. (Center for Disease Control and Prevention) About one-third of U.S. adults (33.8%) are obese. (Center for Disease Control and Prevention) During past 20 years there has been a dramatic increase in obesity in the United States During past 20 years there has been a dramatic increase in obesity in the United States

5 The Dangers of Obesity Obesity results in many co-morbidities such as: Obesity results in many co-morbidities such as: sleep apnea sleep apnea joint disease joint disease hypertension hypertension stroke stroke diabetes diabetes respiratory diseases respiratory diseases World health organization estimated that being overweight and inactive accounts for ¼-1/3 of all cancers of the breast, colon, endometrium, kidney, and esophagus

6 Obesity Attitudes in Health Care self-report studies show that physicians, nurses, and other medical personnel view obese patients as: self-report studies show that physicians, nurses, and other medical personnel view obese patients as: non-compliant non-compliant lazy lazy dishonest dishonest lacking in self-control lacking in self-control unsuccessful unsuccessful sloppy sloppy

7 Surgical Weight Management Lisa C. Luz, RN, MSN, CBN

8 Surgical Weight Management Under the direction of expert bariatric surgeons: Under the direction of expert bariatric surgeons: Julie Kim, MD, FACS Julie Kim, MD, FACS Associates from TMC: Associates from TMC: Dr. Abeles, Dr. Shah, Dr. Tarnoff, fellows Dr. Abeles, Dr. Shah, Dr. Tarnoff, fellows Multidisciplinary Team Multidisciplinary Team Dietitian Dietitian Psychologist Psychologist Program Coordinator/Nurse Program Coordinator/Nurse Insurance Specialist Insurance Specialist

9 Who is a Surgical Candidate? Meets National Institutes of Health Criteria: Meets National Institutes of Health Criteria: BMI > 40 BMI > 40 >35 with significant obesity-related co-morbidities >35 with significant obesity-related co-morbidities 18 years or older 18 years or older No endocrine cause of obesity No endocrine cause of obesity Stable psychological condition Stable psychological condition Absence of drug or alcohol problem/Non-Smoking Absence of drug or alcohol problem/Non-Smoking Understands surgery and risks Understands surgery and risks Acceptable operative risks (patient and procedure) Acceptable operative risks (patient and procedure) Consensus after bariatric team evaluation: Consensus after bariatric team evaluation: psychologist, dietitian, surgeon psychologist, dietitian, surgeon Dedicated to lifestyle change and follow-up Dedicated to lifestyle change and follow-up

10 The Surgical Process Information Session Information Session Preliminary Application Preliminary Application Health History Questionnaire Health History Questionnaire Immersion Day Immersion Day Psychologist/Behavioral Assessment Psychologist/Behavioral Assessment Nutritional Counseling Nutritional Counseling Medical Clearance from PCP or Specialist Medical Clearance from PCP or Specialist Medical Testing: Labs, X-ray, EKG Medical Testing: Labs, X-ray, EKG Consultation with Surgeon Consultation with Surgeon Support Groups Support Groups Insurance Approval Insurance Approval

11 The Surgical Process Mental Health Evaluation Mental Health Evaluation  Preparing for new Life  Identify the support needed to be successful  Individual Nutrition Appointments  Minimum 2 visits (for insurance approval)  Individual Diet Planning and Education  Medical Testing  Labs, Chest X-ray, EKG and any testing TBD by team

12 The Surgical Process  Surgical Consultation  One on One consultation to answer all questions and individual concerns  Medical Clearance  By PCP, or specialist  Support Groups~ Make the Difference This process takes approximately 3-6 months! This process takes approximately 3-6 months!

13 Bariatric Surgery Eric Starble RN Bariatric Surgery Eric Starble RN

14 Review of the Digestive System Esophagus Esophagus Stomach Stomach Small Intestine (Duodenum, Jejunum, Ileum) Small Intestine (Duodenum, Jejunum, Ileum) Large Intestine Large Intestine

15 Bariatric Surgery Today Three Types of Most Commonly Performed Bariatric Surgery Procedures Biliopancreatic Diversion with Duodenal Switch Malabsorptive Roux-en-Y Gastric Bypass Combination Adjustable Band Gastroplasty Restrictive

16 Restrictive Surgery Relatively easy surgical procedure Relatively easy surgical procedure Less dietary deficiencies Less dietary deficiencies Less weight loss Less weight loss More late failures due to dilation More late failures due to dilation Less effective with sweet eaters Less effective with sweet eaters Significant dietary compliance Significant dietary compliance Adjustable Band Gastroplasty

17 Malabsorptive Surgery Greater sustained weight loss with less dietary compliance Greater sustained weight loss with less dietary compliance Increased risk of malnutrition and vitamin deficiency Increased risk of malnutrition and vitamin deficiency Constant follow–up to monitor increased risk Constant follow–up to monitor increased risk Intermittent diarrhea Intermittent diarrhea Biliopancreatic Diversion with Duodenal Switch

18 Laparoscopic Sleeve Gastrectomy Restrictive procedure Restrictive procedure Purpose: Suppression of hunger hormones Purpose: Suppression of hunger hormones No intestinal connection No intestinal connection Considered a standard procedure by national society (ASMBS) Considered a standard procedure by national society (ASMBS) Newer procedure Newer procedure Covered by many but not all insurance companies Covered by many but not all insurance companies

19 Mechanics of Sleeve Gastrectomy Permanent removal of the lateral portion of the stomach Permanent removal of the lateral portion of the stomach Creates a long, narrow, "banana" shaped stomach or "sleeve" Creates a long, narrow, "banana" shaped stomach or "sleeve" Reduces the capacity of the stomach by 2/3rds Reduces the capacity of the stomach by 2/3rds No foreign body or needle sticks required No foreign body or needle sticks required The body's natural pyloric and gastroesophageal valve act to restrict the passage of food with removal of many of the hunger hormones The body's natural pyloric and gastroesophageal valve act to restrict the passage of food with removal of many of the hunger hormones

20 Laparoscopic Sleeve Gastrectomy

21 Roux-en-Y Gastric-Bypass Long-term sustained weight loss Long-term sustained weight loss No protein-calorie malabsorption No protein-calorie malabsorption Little vitamin or mineral deficiencies Little vitamin or mineral deficiencies Technically difficult procedure Technically difficult procedure Roux-en-Y Gastric Bypass

22 The Roux-en-Y Gastric Bypass 1. A small, 15 to 20cc, pouch is created at the top of the stomach. 2. The small bowel is divided. The biliopancreatic limb is reattached to the small bowel. 3. The other end is connected to the pouch, creating the Roux limb. Roux-en-Y Gastric Bypass

23 Small pouch releases food slowly, causing a sensation of fullness with very little food Small pouch releases food slowly, causing a sensation of fullness with very little food Biliopancreatic limb preserves the action of the digestive tract Biliopancreatic limb preserves the action of the digestive tract

24 Open and Laparoscopic Technique in Bariatric Surgery Open Open Increased post op pain, longer hospitalizations Increased post op pain, longer hospitalizations Increased incidence of wound complications - infections, hernias, seromas Increased incidence of wound complications - infections, hernias, seromas Return to work in 4-8 weeks Return to work in 4-8 weeks Laparoscopic Less post op pain, early mobility Wound complications are significantly reduced 2-3 day hospital stay Return to work in 1-3 weeks

25 What Happens in the OR?

26 Bariatric Surgery: Beyond the Surgery Bariatric Surgery will NOT work alone Bariatric Surgery will NOT work alone Intricate parts of your weight loss success: Intricate parts of your weight loss success: Commitment to: Commitment to: Diet Diet Exercise Exercise Support groups Support groups

27 Resolution of Comorbidities Schauer, et al, Ann Surg 2000 Oct;232(4): N=104 1 year post-op Number Prior to Surgery % Worse % No Change % Improved % Resolved Osteoarthritis Hypercholesterimia GERD Hypertension Sleep Apnea Hypertriglyceridemia Peripheral Edema Stress Incontinence Asthma Diabetes Average Average1.6%7.8%35.1%55.7% 90.8% Improved or Resolved

28 Possible Complications May Lead to Short or Long-term Hospitalization and/or Re-operation May Lead to Short or Long-term Hospitalization and/or Re-operation Infection, bleeding or leaking at suture/staple lines Infection, bleeding or leaking at suture/staple lines Blockage of the intestines or pouch Blockage of the intestines or pouch Dehydration Dehydration Blood clots in legs or lungs Blood clots in legs or lungs Vitamin and mineral deficiency Vitamin and mineral deficiency Protein malnutrition Protein malnutrition Incisional hernia Incisional hernia Death Death

29 Possible Side Effects Nausea and vomiting Nausea and vomiting Gas and bloating Gas and bloating Dumping syndrome Dumping syndrome Lactose intolerance Lactose intolerance Temporary hair thinning Temporary hair thinning Depression and psychological distress Depression and psychological distress Changes in bowel habits such as diarrhea, constipation, gas and/or foul smelling stool Changes in bowel habits such as diarrhea, constipation, gas and/or foul smelling stool

30 Post-Operative Summary On Average, Gastric-bypass Patients… Lose 65-80% of their excess body weight, the majority of it in the first 18 to 24 months after surgery. Lose 65-80% of their excess body weight, the majority of it in the first 18 to 24 months after surgery. May have rapid improvements in the morbid side effects of their obesity, such as type 2 diabetes, high blood pressure, sleep apnea, and high cholesterol levels. May have rapid improvements in the morbid side effects of their obesity, such as type 2 diabetes, high blood pressure, sleep apnea, and high cholesterol levels.

31 Dana Eiesland, RD, LDN Stacey A. Nelson, RD, LDN Bariatric Surgery Nutrition Education

32 Pre-Surgery Nutrition Education : Immersion Day Post-op diet progression Long-term food selection guidelines Fluid guidelines Protein supplements Vitamin & mineral supplementation Reading nutrition fact labels Mindful eating (eating speed, environment) Self- monitoring (keeping daily food journal) Dietary changes to promote pre-op weight loss (ie. Meal planning, lean protein sources, snacks) Exercise Recommendations Education Provided:

33 Pre-op Bariatric “To Do” List ___ Read the Nutritional Guidelines ___ Buy everything on shopping list ___ Follow low-calorie diet (to lose ~5% of start weight pre-op) ___ Keep daily food dairy (Measure & weigh all food & drinks) ___ Count daily protein & fluid intake ___ Begin taking vitamin/mineral supplements ___ Practice using approved protein supplements ___ Exercise: Goal = 30 minutes most days ___ Practice eating slowly (30min/meal) ___ Practice drinking ONLY between meals; avoid drinking 30 minutes before & after eating ___ Avoid caffeine, soda, carbonation, juice, & sweetened beverages ___ Try Stage 4 (pureed & soft moist protein foods) for 2 full days ___ Attend support groups

34 Pre-Surgery Nutrition Education: Individual Counseling Min. 2 individual visits with Outpatient RD Re-enforce information provided at Immersion Day Re-enforce information provided at Immersion Day Pre-op weight loss Pre-op weight loss Practicing portion control Practicing portion control Meal planning Meal planning Self-monitoring of eating & physical activity Self-monitoring of eating & physical activity Strategies to adopt more mindful eating habits Strategies to adopt more mindful eating habits Increasing regular physical activity Increasing regular physical activity Increasing intake of fruits/vegetables/low-fat dairy &proteins/whole grains/water Increasing intake of fruits/vegetables/low-fat dairy &proteins/whole grains/water

35 Inpatient Bariatric Diet Diet stages 1-3 Nutrition Consult ordered upon admission Nutrition Consult ordered upon admission Review diet progression, stages 1-3 Review diet progression, stages 1-3 Discuss fluid intake journal: focused on hydration, sipping slowly, 1-4 oz/hour between meals, no straws Discuss fluid intake journal: focused on hydration, sipping slowly, 1-4 oz/hour between meals, no straws Work with inpatient team to identify and minimize complications post-op Work with inpatient team to identify and minimize complications post-op Confirm patient post-op RD appointment Confirm patient post-op RD appointment

36 Inpatient Bariatric Diet Diet stages 1-3 Stage 1: Water (provided by RN) Stage 1: Water (provided by RN) No straws No straws 1oz/hr 1oz/hr Fluid intake journal Fluid intake journal Stage 2: Clear Liquids (standard tray) Stage 2: Clear Liquids (standard tray) Non-carbonated, caffeine-free, sugar-free: Non-carbonated, caffeine-free, sugar-free: Water, diet cranberry juice, sugar-free jello and ice pops, broths, decaf coffee and tea Water, diet cranberry juice, sugar-free jello and ice pops, broths, decaf coffee and tea Stage 3: High Protein Full Liquids (self-order) Stage 3: High Protein Full Liquids (self-order) Low-fat, high protein food items: Low-fat, high protein food items: Broth, low-fat milk, protein shakes (SF CIB), tomato soup, low-fat yogurt, and diet custard/ pudding Broth, low-fat milk, protein shakes (SF CIB), tomato soup, low-fat yogurt, and diet custard/ pudding

37 Bariatric Diet Advancement Diet Stage 4 Stage 4: Soft & Moist Protein Stage 4: Soft & Moist Protein Start: 2 wks post-op; Duration 4-6 wks Start: 2 wks post-op; Duration 4-6 wks Examples of protein sources: Examples of protein sources: Chicken salad made w/ low-fat mayonnaise Chicken salad made w/ low-fat mayonnaise Chili made w/ lean ground turkey/beef Chili made w/ lean ground turkey/beef Moist fish/shellfish Moist fish/shellfish Avoid fluids 30 min before & after each meal/snack. Avoid fluids 30 min before & after each meal/snack. Will begin taking chewable/liquid vitamin & mineral supplements. Will begin taking chewable/liquid vitamin & mineral supplements. Multi-vitamin w/ iron 200% DRI, Vit D3 1000IU, Vit B mcg, Calcium Citrate mg Multi-vitamin w/ iron 200% DRI, Vit D3 1000IU, Vit B mcg, Calcium Citrate mg Keep daily food journal. Keep daily food journal.

38 Bariatric Diet Advancement Diet Stage 5 Stage 5: Low Fat, Low Sugar, High Protein Stage 5: Low Fat, Low Sugar, High Protein Start: 4-6 wks post-op; Duration: lifelong Start: 4-6 wks post-op; Duration: lifelong Balanced solid food diet. Balanced solid food diet. Continue to practice mindful eating & separate fluids from your meals. Continue to practice mindful eating & separate fluids from your meals. Vitamin/Mineral supplementation for life. Vitamin/Mineral supplementation for life. For More Information on Diet Stages For More Information on Diet Stages Clinical Portal > Bariatric Center > Bariatric Nutrition Clinical Portal > Bariatric Center > Bariatric Nutrition

39 Immediate (2wks- 12mo. post-op): * Diet Advancement * Protein & Hydration Status * Vitamin & Mineral Status/ Supplementation * Lifestyle and Behavior Changes * Meal Planning & Appropriate Food Choices Long-Term (>1yr post-op): * Prevention of Vitamin/Mineral Deficits & Deficiencies * Co-morbid Conditions (i.e. DM, HTN, Dyslipidemia) * Managing Changes to Bowel Habits * Promotion of a Balanced Diet * Weight Maintenance & Weight Loss * Exercise * Promotion of Self-Care * Lifestyle & Behavior Changes Post-Op Nutrition & Support

40 Thank you! Dana Eiesland, RD, LDN (outpatient) Dana Eiesland, RD, LDN (outpatient) Stacey A. Nelson, RD, LDN (inpatient) Stacey A. Nelson, RD, LDN (inpatient) Pager: #6052 Pager: #6052

41 Postoperative Care on N-3 Postoperative Care on N-3 Jessica Kaloyanides RN Jessica Kaloyanides RN Marjorie Petit RN, BSN Marjorie Petit RN, BSN

42 PACU (Report from PACU RN- N3 RN 5 incisions total (one is JP drain) 5 incisions total (one is JP drain) 100mg IV thiamine for all pts. on arrival 100mg IV thiamine for all pts. on arrival Hct within 2hrs : Drop of 4 points wait on transfer to floor/redraw Hct within 2hrs : Drop of 4 points wait on transfer to floor/redraw If vomiting or spitting up blood CALL MD If vomiting or spitting up blood CALL MD Wake to assess every 10 min during first hr Wake to assess every 10 min during first hr Fentanyl  Dilaudid  PCA Fentanyl  Dilaudid  PCA Shoulder pain/left side trocar pain ( CO2 gas in abd) Shoulder pain/left side trocar pain ( CO2 gas in abd) Wean O2 to NC Wean O2 to NC

43 Setup of the bariatric room Bariatric bed – holds up to 750lbs Bariatric bed – holds up to 750lbs Bariatric tray fits under each bariatric bed Bariatric tray fits under each bariatric bed Telemetry monitor with continuous 02 monitoring Telemetry monitor with continuous 02 monitoring Pneumatic Compression Sleeves Pneumatic Compression Sleeves Incentive spirometry Incentive spirometry Bariatric menu Bariatric menu Moving IV pole: pt OOB ambulating same day as surgery (unless up to floor too late) Moving IV pole: pt OOB ambulating same day as surgery (unless up to floor too late)

44  Bariatric room pic (plus say pt will have lap sites)

45 Possible Complications: Anastomotic Leak Symptoms Symptoms tachycardia tachycardia fever fever abdominal pain abdominal pain purulent drain output purulent drain output nausea/vomiting nausea/vomiting shoulder pain shoulder pain hypotension hypotension Treatment surgical vs medical stability of patient size of leak

46 Possible Complications: Pulmonary Embolism Symptoms Symptoms sudden SOB (active rest) sudden SOB (active rest) chest pain chest pain cough with bloody sputum cough with bloody sputum tachycardia tachycardia leg swelling/weak pulse leg swelling/weak pulse Treatment CXR/CCT anticoagulant therapy embolectomy

47 Possible Complications: Pneumonia Symptoms Symptoms classic symptoms classic symptoms sudden onset sudden onset fever/chills fever/chills coughing coughing chest pain chest pain Treatment CXR antibiotics

48 Possible Complications: Small Bowel Obstruction Symptoms Symptoms constipation constipation abdominal swelling abdominal swelling vomiting (green or fecal vomit) vomiting (green or fecal vomit) passing jelly like mucous passing jelly like mucous abdominal cramping abdominal cramping Treatment needs ABD CT/UGI Possible IR procedure (place drain) or return to OR

49 Possible Complications: Internal Bleeding (immediately post op) Symptoms Symptoms hypotension hypotension tachycardia tachycardia decreased hct decreased hct bloody drainage bloody drainage melena melena Causes r/t internal organ damage r/t stapled sites

50 Possible Complications: Infection Symptoms: Symptoms: fever fever foul smelling odor from lap sites/drain sites foul smelling odor from lap sites/drain sites lap sites or drain sites lap sites or drain sites yellow discharge yellow discharge Treatments antibiotics

51 General Nursing Guidelines: Activity Pt out of bed same day as surgery Pt out of bed same day as surgery Ambulate in hallway 3x per day Ambulate in hallway 3x per day Out of bed to chair as much as tolerated Out of bed to chair as much as tolerated IS 10x/hr while awake IS 10x/hr while awake

52 General Nursing Guidelines Foley DC post op day 2 Foley DC post op day 2 PCA pump/IV fluids DC post op day 2 when pt tolerating liquids PCA pump/IV fluids DC post op day 2 when pt tolerating liquids JP drain removed by MD post op day 2 JP drain removed by MD post op day 2 abd incisions checked Q4 abd incisions checked Q4 VS Q4 VS Q4 Maintain accurate I’s/O’s Maintain accurate I’s/O’s

53 Bariatric Diet Stage 1: Water Stage 1: Water Typically start day of surgery Typically start day of surgery NO STRAWS NO STRAWS Nurse to administer 1oz water per hr via med cup Nurse to administer 1oz water per hr via med cup Sip slowly and stop if feeling full Sip slowly and stop if feeling full All meds in IV or liquid form All meds in IV or liquid form IV fluid until tolerating liquid IV fluid until tolerating liquid

54 Discharge Instructions Activity: Activity: walk inside/outside walk inside/outside may climb stairs may climb stairs avoid rigorous exercise avoid rigorous exercise Pain: Pain: use pain meds as prescribed use pain meds as prescribed pain should improve over time/ call MD if pain is not under control pain should improve over time/ call MD if pain is not under control

55 Discharge Instructions Diet: Diet: stage 3 diet stage 3 diet each meal slowly over one hour each meal slowly over one hour drink at least 48 ounces of fluid per day, goal is 64 ounces per day drink at least 48 ounces of fluid per day, goal is 64 ounces per day grams protein a day grams protein a day no straws/no chewing gum no straws/no chewing gum Incision Care: Incision Care: adhesive will fall off on its own adhesive will fall off on its own if incision reddened, thick drainage or foul odor - call MD if incision reddened, thick drainage or foul odor - call MD

56 Discharge Instructions Meds: Meds: one med at a time one med at a time cut or crush large pills cut or crush large pills vitamins and calcium post op visit vitamins and calcium post op visit don’t take NSAIDS until checking with MD don’t take NSAIDS until checking with MD Contact MD If: Contact MD If: uncontrolled nausea or vomiting uncontrolled nausea or vomiting unable to tolerate meal plan unable to tolerate meal plan redness, swelling or incision site/ fever of or greater redness, swelling or incision site/ fever of or greater diarrhea more than 24hrs /constipation more than 5 days diarrhea more than 24hrs /constipation more than 5 days

57 Patient Testimonials 64 Year old female 64 Year old female Surgery date: 7/20/2011 Surgery date: 7/20/2011 “My hospital experience was great. I’m very pleased with the program. I’ve done every diet and it’s gone nowhere. I was reluctant on surgery, but when I met the staff I was very impressed. I can’t say enough of Dr. Kim, she’s beyond great. Everyone was positive and reinforcing. My only regret is that I hadn’t done this sooner!” “My hospital experience was great. I’m very pleased with the program. I’ve done every diet and it’s gone nowhere. I was reluctant on surgery, but when I met the staff I was very impressed. I can’t say enough of Dr. Kim, she’s beyond great. Everyone was positive and reinforcing. My only regret is that I hadn’t done this sooner!”

58 Patient Testimonials 34 Year old female 34 Year old female Date of surgery: 8/1/2011 Date of surgery: 8/1/2011 “I’m feeling fantastic. The surgery has been a success. So far I’ve lost almost 90 pounds, and it’s the most amazing thing I’ve ever experienced. Life changing. Besides my kids it’s the most wonderful thing I’ve ever done.” “I’m feeling fantastic. The surgery has been a success. So far I’ve lost almost 90 pounds, and it’s the most amazing thing I’ve ever experienced. Life changing. Besides my kids it’s the most wonderful thing I’ve ever done.”

59 Patient Testimonials 51 Year old female 51 Year old female Date of surgery: 9/26/2011 Date of surgery: 9/26/2011 “Extremely thankful to the staff and couldn’t be happier with the surgery! I’ve lost 60 pounds. I no longer need insulin, and my hypoactive thyroid is now dormant.” “Extremely thankful to the staff and couldn’t be happier with the surgery! I’ve lost 60 pounds. I no longer need insulin, and my hypoactive thyroid is now dormant.”

60 Post-op Care and Follow-up Lisa C. Luz RN, MSN, CBN Lisa C. Luz RN, MSN, CBN

61 Follow-up: Initial Post-op visits 2 weeks, 6 weeks, 3 months Gastric Band: adjustment visit every 3-6 weeks Labs: every three months x1 year; then every 6 months Annual appointments after 2 years with Medical Team Plastic Surgery Pregnancy Lifetime Dietary, Behavior Modification, and Support Groups available to every patient!

62 Life long commitment Support group Nutrition classes Exercise guidance Guideline literature Office visits Newsletters, website, and telephone follow-up Weight Loss Surgery Post-Op Care and Follow-up

63 Improvements in overall health Improvements in quality of life Longer life expectancy Resolution/Improvement of: Type 2 DiabetesAsthma High blood pressureSkin problems Sleep apneaBone and joint disease CancerInfertility Heart diseaseFatty liver disease HeartburnUrinary incontinence Results of Bariatric Surgery

64 Surgery is ONLY a tool Surgery is NOT for everyone Surgery HAS risks Surgery is NOT a cure but rather a treatment Surgery does NOT FAIL the patient, the patient fails the surgery Long term effort and follow up ARE ESSENTIAL for success Some Surgery Truths

65 Patient Successes

66 “Rather than feel anger or revulsion toward this person, my first obligation, especially if I am in the helping professions is to understand him or her: to gain insight into what it is like to be him or her; to imagine and to interpret the world from his or her perspective of experience…” Source: John Banja, PhD Obesity, Responsibility, and Empathy, The Case Manager, Nov/Dec 2004

67 Thank you! Questions / Comments Questions / Comments


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