Nursing Care Plan Obesity : Surgical Interventions (Gastric Partitioning / Gastroplasty, Gastric Bypass)

Weight reduction surgery has been reported to improve several comorbid conditions such as sleep apnea, glucose intolerance and frank diabetes, hypertension, and hyperlipidemia. A number of surgical treatments for morbid obesity have been tried and discarded because of ineffectiveness or complications. The procedure of choice is vertical-banded gastroplasty, although the Roux-en-Y gastric bypass is also performed. Procedure may be performed via open abdominal incision or laparoscopy.

Gastroplasty (gastric stapling/banding): A small pouch with a restricted outlet is created across the stomach just distal to the gastroesophageal junction. A small opening remains, through which food passes into stomach. Vertical banded gastroplasty (VBG) is accomplished by placing rows of staples vertically in the strongest sidewall of the stomach and insertion of polypropyline band around the outlet of the resulting pouch.

Gastric bypass (Roux-en-Y): Anastomosis of a segment of the small intestine to upper portion of stomach that has been partitioned by a horizontal staple line or banding.

CARE SETTING

Inpatient acute surgical unit

RELATED CONCERNS

1. Eating disorders: obesity
2. Peritonitis
3. Psychosocial aspects of care
4. Surgical intervention
5. Thrombophlebitis: deep vein thrombosis
6. Patient Assessment Database

ACTIVITY/REST

May report: 

1. Difficulty sleeping
2. Exertional discomfort, inability to participate in desired activity/sports

EGO INTEGRITY

May report: 

1. Motivated to lose weight for oneself (or for gratification of others)
2. Repressed feelings of hostility toward authority figures
3. History of psychiatric illness/treatment

May exhibit: 
Anxiety, depression

ELIMINATION

May report: 
Urinary stress incontinence

FOOD/FLUID

May report: 

1. “Yo-yo” dieting
2. Weight fluctuations
3. Dysfunctional eating patterns

May exhibit: 
Weight exceeding ideal body weight by 100 lb or more or a body mass index (BMI) of more than 40 (morbid obesity)

HYGIENE

May report: 
Difficulty dressing, bathing

TEACHING/LEARNING

May report: 

1. Presence of chronic conditions (hypertension, diabetes, heart failure, arthritis, sleep apnea, Pickwickian syndrome, infertility)
2. Adequate trials and failure of other treatment approaches
3. Desire to lose weight
4. Discharge plan
5. DRG projected mean length of inpatient stay: 7.4 days (2–4 days for laparoscopic  procedures)
6. May require support with therapeutic regimen/weight loss, assistance with self-care, homemaker/maintenance tasks
7. Refer to section at end of plan for postdischarge considerations.

DIAGNOSTIC STUDIES

Studies depend on individual situation and are used to rule out underlying disease and provide a preoperative workup, including psychiatric evaluation.

NURSING PRIORITIES

1. Support respiratory function.
2. Prevent/minimize complications.
3. Provide appropriate nutritional intake.
4. Provide information regarding surgical procedure, postoperative expectations, and treatment needs.

DISCHARGE GOALS

1. Ventilation and oxygenation adequate for individual needs.
2. Complications prevented/controlled.
3. Nutritional intake modified for specific procedure.
4. Procedure, prognosis, and therapeutic regimen understood.
5. Plan in place to meet needs after discharge.