In the uncomplicated patient with a lesser BMI, skin and wound care are straightforward and uncomplicated. In the obese patient, additional assessment, interventions, and monitoring are required. New Applications for Endoscopy: The Emerging Field of Endoluminal and Transgastric Bariatric Surgery. The Emerging Field of Endoluminal and Transgastric Bariatric Surgery. American Society for the Metabolic and Bariatric Surgery. Preoperative preparation of the bariatric surgery patient. Perioperative management of the bariatric surgery patient: Focus on cardiac and anesthesia considerations. Assessment and management of the obese patient. Nursing care of the bariatric surgery patient. Perioperative management of the bariatric surgery patient.
Maintaining patient safety in the operating room is a major concern of surgeons, hospitals and surgical facilities. Patient safety in the operating room is a major concern for physicians, hospitals and surgical facilities alike. Appropriate positioning of the arms during breast surgery is important for preventing neuropraxia and for creation of breast symmetry when inspecting the patient in the seated position during the procedure. As this population has increased in number, so has the number of overweight patients seeking elective and cosmetic surgery. As discussed above, appropriate patient positioning is essential to the success and safety of any procedure. It is important for the surgical team to pay special attention to the genitalia and breasts when the patient is prone. The breasts in the postbariatric female patient are often large and ptotic. Safety and patient comfort in the operating room have become increasingly important. Special attention to unique issues surrounding the elderly, the obese and the massive weight loss patient is required for safe and effective surgery. Positioning of patients for operation; Stiefel RH Electricity, electrical safety, and instrumentation in the operating room. Intraoperative positioning and care of the obese patient. Safety considerations and avoiding complications in the massive weight loss patient.
She has a special interest in the care of patients after esophagectomy and has developed a teaching module for the nurses in her unit. His clinical and research interests focus on the multidisciplinary treatment of patients with gastrointestinal tumors. To detect changes within the esophagus before they progress to cancer, patients with known Barrett esophagus should undergo regular endoscopic examinations and esophageal biopsies. The overall prognosis for patients with locally advanced esophageal cancer is poor. 10 For patients with disease extending through the wall of the esophagus and or involvement of regional lymph nodes, 5-year survival is less than 15%. Surgical resection is the mainstay of treatment for patients with localized esophageal cancer. 11– , 14 We address the nursing care of patients who have surgical resection of esophageal neoplasms and patients who have prophylactic surgery for treatment of Barrett esophagus with high-grade dysplasia. Management of pain is key in these patients, and adequate pain control reduces the mortality and morbidity of patients after esophagectomy. Patients are usually intubated after surgery and may or may not be extubated the evening of surgery. For patients with chest tubes, assess the drainage every shift. 25 Monitor the tube for patency and assess the drainage for color and amount. Offer explanations and support to patients’ family members and friends to promote healthy interactions with the patients. Help patients focus on the future and set goals for a healthier diet and lifestyle. Discharge instructions for patients and their families or caregivers should include the following:
Critical thinking is necessary for the early recognition and treatment of post-operative complications. The presence of an inferior vena cava tumor thrombus in renal cell carcinoma adds complexity to the surgical procedure and the potential for complications. Knowledge of the common signs and symptoms of post-operative complications is critical to timely identification by nurses (see Table 1 ). (2007) reported 46.9% of the 32 patients with a Level IV thrombus and 25.7% of the 35 patients with a Level III thrombus experienced some type of early complication. To detect hemorrhage early, nurses monitor heart rate, blood pressure, urine output, and hemoglobin, and note if the patient reports of dizziness or pain. (2004) reported that venovenous bypass required significantly less time for anesthesia and surgery (p = 0.002) than the cardiopulmonary bypass with circulatory arrest. The anticoagulation necessary during cardiopulmonary bypass is not required for veno-venous bypass; therefore, coagulopathies are less likely to occur (Blute et al., 2004). When a veno-venous bypass is used, there is the potential for a hepatic venous hemorrhage (Wotkowicz et al., 2008). When a bypass procedure is necessary, the patient is generally monitored in the cardiac intensive care unit for one to two days. Nursing responsibilities include monitoring for bleeding and a PTT levels while the patient is receiving heparin infusion during hospitalization. It is imperative that nurses understand the increased risks associated with nephron sparing surgery, including hematoma, hemorrhage, and the development of urinary fistula (Hughes & Giallo-Uvino, 2007). Assessment for a urinary fistula involves monitoring surgically placed drains for increased output and sending drainage specimens if necessary to the laboratory for evaluation of the creatinine level. If nephron sparing surgery fails and a solitary kidney must be removed, the patient will require dialysis.
In this article, the incidence, etiologies, and long-term consequences of obesity are described. Overweight and obesity are common health conditions, and the prevalence of these conditions is increasing nationally and globally. The National Institutes of Health describes obesity as a complex and multifactoral condition. In obese patients tubes and catheters can burrow into the skin and soft tissue. This article has reviewed sequelae resulting from obesity along with the nursing care needed to care for the physical and emotional needs of obese patients ( Camden, Shaver, & Cole, 2007 ). Best practices for sensitive care and the obese patient. The challenges of obesity and skin integrity. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. Prevalence of overweight and obesity in the United States 1999-2004. Obesity and the Metabolic Syndrome in children and adolescents. Epidemiologic and economic consequences of the global epidemics of obesity and diabetes. Obesity and the skin: skin physiology and skin manifestations of obesity.
Postoperative Nursing Care of Gastric Bypass Patients. The incidence of morbid obesity is increasing epidemically in the United States. Nurses’ application of current nursing literature and standards of care for postoperative gastric bypass patients puts nurses in a pivotal position to affect both early and late outcomes of these patients after surgery. Recognition and identification of unique nursing considerations and use of critical thinking skills to best meet the needs of postoperative gastric bypass patients, including how obesity affects hemodynamic parameters and airway management, are highlighted. Discuss the prevalence of obesity in the United States. Discuss the postoperative nursing care for bariatric patients.
The Massachusetts General Hospital Weight Center is a fully integrated center that supports the spectrum of needs for people of all ages seeking help with obesity and weight loss. Learn more about the new patient orientation and consultation at the Mass General Weight Center. Pediatric and Adolescent Programs: The Mass General Weight Center provides full evaluation and care, including medical and surgical interventions, for children and adolescents who are overweight or obese. The Mass General Weight Center is now seeing adult patients in Danvers, MA, for medical and surgical weight management. The genetics of weight regulation and obesity. The Mass General Weight Center is strongly committed to advancing our understanding of the causes, complications and effective treatment of weight disorders. Learn more about Weight Center research in the Obesity, Metabolism and Nutrition Institute. Patients need to be referred to the Mass General Weight Center. Decisions about patient care are made collaboratively with the patient, the Weight Center team and the referring physician. Instead, he was referred to the Mass General Weight Center for life-changing obesity treatment. 50 Staniford Street is on the right. The Mass General Weight Center is located approximately four blocks from the parking garages.
Objective: To describe the unique nursing responsibilities involved in providing nursing care to severely obese weight loss surgery patients and to develop evidence-based guidelines for safe patient care. Results: This Task Group found that safe and competent nursing care requires assessment of, and provision for, the complex physical and psychological needs of weight loss surgery patients. We developed evidence-based guidelines for preoperative, perioperative, and postoperative care that address risk factors unique to severely obese patients. This role should start with a patient's first contact with the system and continue through discharge and follow-up. We found no evidence-based research pertaining to perioperative nursing care of the WLS patient. Describes the Roux-en-Y method of gastric bypass and identifies pre- and postoperative nursing care. Describes the special needs of the critically ill morbidly obese patient with a focus on the care of patients after obesity surgery. Review of the special considerations for pre- and postoperative care. Recognizes the importance of discharge teaching and psychosocial issues for the bariatric patient. Describes psychological needs of the patient and nursing bias associated with obesity. Competency-based nursing care is essential to ensure the safety of WLS patients and nursing staff. Nurses should be able to demonstrate skill and knowledge in the use of special equipment for patients with severe obesity. Educational in-service sessions on the unique physical and emotional needs ( 8 , 9 ) of WLS patients. Preoperative nursing care should include a comprehensive admission assessment, identification of the patient's support system (family and/or friends), and education of the patient and family about the surgery and postoperative care. Sample clinical pathway for the postoperative nursing care of the WLS patient.
The pivotal role of nursing personnel in burn care. The article discusses many such scenarios in burn patients and outlines the nursing care plans. Positive patient outcomes are dependent on the composition of the burn care team and close collaboration among its members. Nurses are conducting nursing research and contributing to evidence-based practice of burn care. Practice guidelines, critical pathways and nursing care plans are all tools that help define and refine the nurse’s role in burn care. Clinical judgment and critical thinking are equally vital to the process. The resulting research studies should generate evidence-based practice and greatly impact future burn care. The revised and updated recommendations represent the work of the 2004 to 2006 Committee on the Organization and Delivery of Burn Care.[ 3 ] These outcomes and interventions are written as the nursing care plan and serve as a written guide for all health care professionals. An example of a written nursing care plan for the patient in the resuscitative and acute care phases of a major burn injury is provided in by Molter et.al and Ahrns-Klas.[ 8 , 9 ] Implementation is the action portion of the nursing process and care plan. Both need to be documented and the plan of care modified accordingly. The nursing process is both dynamic and interactive. In creating the care plan, the nurse uses theory, nursing judgment and clinical expertise. In many ways, the nursing process and written plan of care help define the nurse’s role.
Signs and symptoms of type 2 diabetes often develop slowly. In fact, you can have type 2 diabetes for years and not know it. Type 2 diabetes affects your ability to heal and resist infections. See your doctor if you notice any type 2 diabetes symptoms. The less active you are, the greater your risk of type 2 diabetes. The risk of type 2 diabetes increases if your parent or sibling has type 2 diabetes. The risk of type 2 diabetes increases as you get older, especially after age 45. If you developed gestational diabetes when you were pregnant, your risk of developing type 2 diabetes increases. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma. Type 2 diabetes may increase the risk of Alzheimer's disease. Type 2 diabetes mellitus.
Who, after all, wants to go under the knife? The question, then, is, how much pain will there be? “Pain often depends on the degree of invasiveness,” says Matthew Kroh, MD, a surgeon at the Cleveland Clinic who specializes in laparoscopic and robotic surgery. With the types of surgery Kroh performs, many of which are minimally invasive, post-op pain is much lower than it was before such procedures were developed. “Recovery from pain is so much faster now,” he says. “I try to oversell the pain. A very common complication after surgery, it occurs when a patient is not able to breathe in enough air to fill the lungs . Post-op pain is one of the primary culprits, Kroh says. Mucus, normally cleared by breathing and coughing , builds up in the lungs, and that can cause pneumonia , especially in older patients, Kroh says.
The statement also notes that VSG is an absolute contraindication for patients with Barrett’s esophagus. Programs that use the ASMBS guidelines consider VSG to be a restrictive procedure and may follow the recommendations listed for them. The recommendations, which provide general information about early postoperative nutrition and micronutrients specifically for VSG, are summarized in Table 3. While long-term research is needed to elucidate the evidence-based practice most appropriate for dietary counseling with VSG patients, dietitians should consider participating in research that reports findings and validates nutrition recommendations. VSG is a unique procedure set apart from other bariatric procedures, such as gastric bypass, the adjustable band, and BPD-DS. Describe the history of vertical sleeve gastrectomy (VSG) as a stand-alone bariatric procedure and distinguish its mechanism of action and efficacy. Vertical sleeve gastrectomy (VSG) as a stand-alone bariatric procedure first began as which of the following? When and for what purpose is the liver-shrinking diet recommended? Bariatric surgery: the past, present, and future. The Magenstrasse and Mill operation for morbid obesity. Morbid obesity and the sleeve gastrectomy: how does it work? Consensus conference statement bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers. Pre- and postoperative nutritional deficiencies in obese patients undergoing laparoscopic sleeve gastrectomy. Nutrition care for patients undergoing laparoscopic sleeve gastrectomy for weight loss. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery.
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While not all premature babies experience complications, being born too early can cause short-term and long-term health problems for preemies. Breathing problems. Heart problems. The most common heart problems premature babies experience are patent ductus arteriosus (PDA) and low blood pressure (hypotension). Brain problems. Hypothermia in a preemie can lead to breathing problems and low blood sugar levels. Gastrointestinal problems. Blood problems. Preemies are at risk of blood problems such as anemia and infant jaundice. Metabolism problems. Premature babies often have problems with their metabolism. Vision problems. Hearing problems. Dental problems. Premature babies are more likely to have chronic health issues — some of which may require hospital care — than are full-term infants.
Outcomes and Complications After Bariatric Surgery. 11 Furthermore, the American Diabetes Association recommends that patients with a BMI of 35 kg/m2 or greater and type 2 diabetes also be considered for bariatric surgery, especially if the diabetes has not been well controlled with lifestyle changes and pharmacotherapy. 13-18 A majority of patients seeking bariatric surgery are female (83%), white (60%), and have private insurance (78%). 14 AGB is a good option for obese patients who need bariatric surgery and want to avoid permanent rerouting of the gastrointestinal tract. The overall success of a patient's bariatric surgery and the rate and amount of weight lost postoperatively vary based on the patient and the type of surgery performed. Related conditions such as hypertension and hyperlipidemia have been shown to improve in patients who undergo bariatric surgery. Weight loss resulting from bariatric surgery has also been shown to improve the severity of lower back pain and to improve overall functionality. Patients who undergo bariatric surgery are at higher risk for deep vein thrombosis and pulmonary embolism. Patients should know that the use of a patient-controlled analgesia pump after surgery is common, 13 and that they may be prescribed additional analgesics as needed for breakthrough pain. Nutritional deficiencies are common after bariatric surgery, and patients are often prescribed a multivitamin regimen.
Innovative Practice Models for Acute and Critical Care. Quality Indicators in Acute and Critical Care. Tobacco Use and Smoking Cessation in Acute and Critical Care. Sedation and Sleep in Critical Care. This article reviews the pathophysiology of common hypermetabolic conditions and provides startegies to manage the complications associated with nutrition support. Meeting the nutritional needs of the bariatic (severely obese) patient in acute and critical care can be a challenge. This article reviews aspects of nutritional support of the bariatic patient including assessment, planning, implementation, and evaluation. The nutritional assessment is a key determinant in establishing risk for malnutrition and is also valuable in predicting outcomes in the critical care setting. Studies have demonstrated that nurses who are aware of the impact of nutrition and have operational aptitude can influence patient outcomes through early intervention. Knowledge of nutrition's effect in the acute and critically ill patient is integral for nursing to predict and promote outcomes successfully in the critical care setting. The critical care nurse must have an acute awareness of the nutritional requirements and the physiologic impact of age and the stress of illness on the nutritional status of the elderly critically ill patient. Therefore, effective insulin therapy along with appropriate nutrition support prescriptions provide a means for the critical care nurse and other health care team members to lower complications and enhance recovery in the ICU setting. It can also infect the patient in the acute care facility. Lack of clinical information about the WLS patient and the postoperative WLS patient can negatively affect quality of care and put the patient at unnecessary risk. Acute and critical care nurses must have a thorough understanding of the health implications of obesity, be familiar with common WLS procedures, and remain vigilant regarding the potential postoperative complications that can occur in this particular patient population.
Weight loss is achieved by reducing the size of the stomach with a gastric band or through removal of a portion of the stomach (sleeve gastrectomy or biliopancreatic diversion with duodenal switch) or by resecting and re-routing the small intestine to a small stomach pouch ( gastric bypass surgery ). The recent guidelines suggest that any patient with a BMI of more than 30 with comorbidities is a candidate for bariatric surgery. Weight loss is predominantly due to the restriction of nutrient intake that is created by the small gastric pouch and the narrow outlet. The procedure is performed laparoscopically and is not reversible. The balloon can be left in the stomach for a maximum of 6 months and results in an average weight loss of 5–9 BMI over half a year. Quoted costs for the intragastric balloon are surgeon-specific and vary by region. A common form of gastric bypass surgery is the Roux-en-Y gastric bypass, where a small stomach pouch is created with a stapler device and connected to the distal small intestine. The gastric bypass had been the most commonly performed operation for weight loss in the United States, and approximately 140,000 gastric bypass procedures were performed in 2005. Its market share has decreased since then and by 2011, the frequency of gastric bypass was thought to be less than 50% of the weight loss surgery market. There are certain patients who cannot tolerate the malabsorption and dumping syndrome associated with gastric bypass. Bariatric surgery in older patients has also been a topic of debate, centered on concerns for safety in this population; the relative benefits and risks in this population is not known. Open weight loss surgery began slowly in the 1950s with the intestinal bypass . Mason and Chikashi Ito at the University of Iowa developed the original gastric bypass for weight reduction which led to fewer complications than the intestinal bypass and for this reason Mason is known as the "father of obesity surgery".
Allow this favorite library to be seen by others. Keep this favorite library private. Find a copy in the library. Nutrition in critically ill adults: key processes and outcomes / Linda Harrington - Meeting the nutritional needs of the bariatric patient in acute care / Margaret M. Food and drug interactions in critically ill adults / Linda Harrington and Cris Gonzales - Nutritional status: assessing and understanding its value in the critical care setting / Les Rodriguez - Malnutrition and the critically ill elderly patient / Mary Beth Reid and Patti Allard-Gould - Benefits and methods of achieving strict glycemic control in the ICU / Susan R. Nutritional support in the critically injured / Vicki J.
Therapeutic principles of bloodless medical management, such as minimizing blood loss, maximizing oxygen delivery, and improving the red blood cell count, allows critical care nurses to conserve blood, anticipate and prepare for potential bleeding problems, and intervene before complications occur. A growing appreciation for the risks involved in transfusing donated blood, as well as the refusal of some patients to accept transfusion because of personal or religious beliefs, encouraged researchers and clinicians to develop techniques and strategies that allow transfusion-free surgery and medical care, that is, bloodless treatment. Blood conservation requires careful planning, proactive strategies to prevent or rapidly address complications, and vigilant monitoring of patients, all of which hinge upon the knowledge and skills of the critical care team. To this end, critical care nurses must know the rationale behind blood management in the intensive care unit (ICU), the issues associated with blood transfusion, and the principles of blood conservation. In 1995, Corwin et al 4 reviewed the occurrence of transfusion in a critical care setting and found that of the 23% of ICU patients who required long-term care (> 1 week), 85% received blood transfusions, with a mean of 9.5 units per patient. The large number of persons who receive and donate blood is of particular concern because of the risks associated with transfusion. The primary nursing principles for managing care include minimizing blood loss, maximizing oxygen delivery, and improving the red blood cell count to prevent and treat anemia in critically ill patients. 42 The stress of acute illness, blood loss, surgery, infection, pain, and anxiety can lead to greater than normal oxygen demand. Human recombinant erythropoietin (r-Hu EPO, epoetin alfa) reduces the need for transfusions in patients with anemia due to chronic renal failure, treatment for infection with human immunodeficiency virus, chemotherapy, and major surgery. Critical care nurses play a crucial role in reducing the need for blood transfusions in ICU patients undergoing bloodless treatment. Vigilant monitoring can improve the hemodynamic and oxygen status of these patients.
Discuss the postoperative nursing care for bariatric patients. Use of the reverse Trendelenburg position may improve oxygenation in patients with morbid obesity. Increases in total blood volume and resting cardiac output are characteristics of patients with morbid obesity; stroke volume is the factor that increases (cardiac output = stroke volume x heart rate). Because of the increased workload on the heart (and the potential for hypoxia), postoperative gastric bypass patients are at risk for acute myocardial ischemia, congestive heart failure, arrhythmias, and sudden cardiac death. Obscured anatomical landmarks and variation of the depth needed for insertion of central venous catheters for vascular access are challenges in patients with morbid obesity. Critically ill postoperative patients are at high risk for venous thromboembolism and subsequent pulmonary embolism associated with immobility, venous stasis, and the relatively hypercoagulable state. The preferred route of administration of pharmacological agents for patients with morbid obesity is the intravenous route. Patients with morbid obesity are at high risk for skin breakdown and delayed wound healing because of the decreased vascularity in adipose tissue. Among the greatest challenges in caring for patients with morbid obesity who are undergoing bariatric surgery are the psychosocial needs that arise. Commitment of patients and the healthcare team is essential for positive outcomes. Recognition and identification of unique nursing considerations and use of critical thinking skills to best meet the needs of postoperative gastric bypass patients are vital. The challenges to the healthcare team are to be knowledgeable of bariatric operations and complications and to plan carefully for the care of bariatric patients to achieve optimal outcomes. As more patients choose gastric bypass surgery for treatment of morbid obesity, the expertise of critical care, progressive care, and general care nurses most likely will have great impact in the postoperative outcomes of these patients.