Roux-en-Y gastric bypass for morbid obesity - Home Study Program

AORN Journal,  Oct, 2002  by Cynthia J. Barrow

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Table 1
PREVALENCE OF OBESITY,
BASED ON BODY MASS INDEX (BMI) (1)

Definitions                     All adults   Women   Men

Overweight                      55%          51%     60%
(BMI 25 to 25.9 kg/[m.sup.2])

Obese                           22%          25%     20%
(BMI > 30 kg/[m.sup.2])

Morbidly obese                   8%           6%      2%
(BMI > 40 kg/[m.sup.2] or
> 35 kg/[m.sup.2] with
comorbidities)

NOTE
(1.) "Statistics related to overweight and obesity,"
National Institute of Diabetes and Digestive and Kidney
Diseases, http://www.niddk.nih.gov/health/nutrit/pubs
/statobes.htm (accessed 11 July 2002); B M Balsiger et
al, "Prospective evaluation of Roux -en-Y gastric bypass
as primary operation for medically complicated obesity,"
Mayo Clinic Proceedings 75 (July 2000) 673.

Table 2
COMORBIDITIES OF OBESITY (1)

Abdominal wall hernias       Osteoarthritis
Asthma                       Panniculitis
Cirrhosis                    Psychological disorders
Complications of pregnancy   Pulmonary emboli
Diabetes                     Reflux esophagitis
Gall bladder disease         Sleep apnea
Gout                         Some forms of cancer
Heart disease                * breast
High cholesterol             * colorectal
Hirsutism                    * gall bladder
Hypertension                 * kidney
Infertility                  * liver
Low back and disc disease    * uterine
Menstrual irregularities     Stress incontinence
                             Stroke
                             Thrombophlebitis

NOTES
(1.) "Statistics related to overweight and obesity," National
Institute of Diabetes and Digestive and Kidney Diseases,
http://www.niddk.nih.gov/health /nutrit/pubs/statobes.htm (accessed
11 July 2002); "Understanding adult obesity," National Institute of
Diabetes and Digestive and Kidney Diseases,
http://www.niddk.nih.gov/health/nutrit/pubs/unders.htm (accessed 11
July 2002); "Surgical management of morbid obesity: Benefits,
techniques, complications, and considerations," Symposium in
Contemporary Surgery 56 (March 2000); P A Choban et al, "A health
status assessment of the impact of weight loss following Roux-en-Y
gastric bypass for clinically severe obesity," Journal of the
American College of Surgeons 188 (May 1999) 491-496; "Recommendations
for facilities performing bariatric surgery," American College of
Surgeons Bulletin 85 (September 2000); B M Balsiger, E Luque-de Leon,
M G Sarr, "Surgical treatment of obesity: Who is an appropriate
candidate?" Mayo Clinic Proceedings 72 (June 1997) 551-557.

Table 3
NURSING CARE PLAN FOR PATIENTS UNDERGOING ROUX-EN-Y GASTRIC BYPASS

Nursing                               Interim           Outcome
diagnosis       Intervention          outcome criteria  statement

Risk of         * Assesses            The patient       The patient's
imbalanced        nutritional         demonstrates      nutritional
nutrition,        habits.             knowledge of      status is
less than body  * Assesses            nutritional       improved or
requirements      psychosocial        requirements      maintained from
                  issues specific     related to the    baseline.
                  to the patient's    surgical
                  nutritional         procedure.
                  status.
                * Provides
                  instruction
                  regarding dietary
                  needs.
                * Evaluates response
                  to nutritional
                  instruction.

Risk for low    * Provides care in a  The patient       The patient's
self-esteem       nondiscriminatory,  receives          right to
                  nonprejudicial      consistent and    privacy is
                  manner, regardless  comparable        maintained.
                  of the setting in   levels of care
                  which care is       from all
                  given.              caregivers
                * Preserves and       regardless of
                  protects the        the situation
                  patient's           throughout the
                  autonomy, dignity,  perioperative
                  and human rights.   period.
                * Acts as a patient
                  advocate by
                  protecting the
                  patient from
                  incompetent,
                  unethical, or
                  illegal practices.

Risk of fluid,  * Identifies factors  The patient's     The patient's
electrolyte,      associated with an  urine output is   fluid,
and acid-base     increased risk      greater than      electrolyte,
imbalances        for hemorrhage or   30 mL per hr,     and acid-base
related to        fluid and           and vital signs   balances are
stress of         electrolyte loss.   are within        consistent
surgery         * Recognizes and      expected range.   with or
                  reports deviation.                    improved from
                * Monitors                              baseline levels
                  physiological                         established
                  parameters.                           preoperatively.
                * Implements
                  hemostasis
                  techniques.
                * Collaborates in
                  fluid and
                  electrolyte
                  management.
                * Collaborates in
                  blood product
                  therapy, as
                  prescribed.
                * Evaluates response
                  to administration
                  of fluids and
                  electrolytes.

Risk for        * Identifies          The patient's     The patient is
injury due to     physical            function and      free from signs
transferring      alterations that    sensation is      and symptoms
and               require additional  maintained or     of injury
positioning       precautions for     improved from     related to
                  procedure-specific  baseline levels   positioning.
                  positioning.        throughout the
                * Verifies presence   perioperative
                  of prosthetics or   period.
                  corrective
                  devices.            The patient's
                * Positions the       pedal pulses
                  patient             are present
                  * neutrally and     and equal
                    anatomically      bilaterally
                    correct,          throughout the
                  * with pressure     perioperative
                    points padded,    period.
                    and
                  * by ensuring that
                    safety
                    restraints are
                    in place.
                * Evaluates for
                  signs and symptoms
                  of injury as a
                  result of
                  positioning.

Table 4

POSTOPERATIVE DIETARY GUIDELINES (1)

* Progress from liquids to purees, then to mechanical soft (ie, foods
  that are chopped or ground, tender, easily chewed) and soft foods,
  and finally to foods of normal consistency.

* Take small bites, and chew food thoroughly.

* Increase the quantity of food as you progress from liquids to solids.
  Stop eating or drinking when you staff to feel full. If you do not
  recognize this feeling, consume only the quantity of food recommended.
  Do not overeat.

* Eat and drink slowly. Initially, eat 1 ounce (ie, 2 tablespoons) of
  food during a 10- to 15-minute period and drink 1 cup liquids during
  a 30- to 60-minute period.

* Plan at least 30 minutes for each meal.

* Slowly sip at least 6 cups of liquids per day between meals. Make
  sure 3 cups are of skim, 1%, or 2% fat milk. If you are unable to
  tolerate milk, commercially prepared nutritional supplements may be
  used. Your dietitian will discuss this with you.

* Try new foods gradually, and try one food at a time

* Choose a nutritionally balanced diet.

* Eat protein-rich foods at each meal.

* Take the recommended vitamin and mineral supplements daily.

* Avoid high-sugar and high-fat foods.

NOTES

(1.) "Nutritional guidelines for surgeries for weight reduction"
(Rochester, Minn: Mayo Press, 1994).