Impact of Nursing Care on Bariatric Surgery Outcomes, The

Arizona Nurse,  May 2006  by Irvin, Judy

• E-mail
• Print
• Link

As the problem of adult and childhood obesity continues to grow, so does the popularity of bariatric surgery. Most bariatric procedures can now be done laparoscopically which means a shorter recuperation period than earlier open procedures. Patients immediately begin to see and feel the results of their surgery (i.e., lost pounds, increased energy, diminished blood pressure and lower blood sugars). However, like any other surgery, there are associated risks which cannot be overlooked. These risks often present challenges for bariatric nurses who play an important role in the outcome of these patients.

Obesity carries a societal stigma indicating such qualities as laziness, lack of willpower and failure. One important aspect of bariatric nursing is your ability to genuinely convey to the patient that you support their decision to start a whole new life, that you believe in them and know that they will succeed. They may have had all of the commitment in the world prior to surgery, but once they have the surgery and are in pain trying to fight the lingering effects of anesthesia, that commitment may start to decline. They may start to doubt their commitment and see themselves heading for yet another failure. That's where the nurse steps in. pointing out that what they are feeling is perfectly normal and reminding them that they will succeed.

Bariatric surgery patients are certainly at risk for blood clots and are expected to ambulate frequently after surgery. Most of these patients were relatively inactive prior to surgery due to the many complications of their obesity. Bariatric patients are required to ambulate every hour post-operatively, and this can be difficult for even the most motivated patient. Bariatric nurses must be committed to their patients' outcomes and make sure that their patients walk as scheduled. It is sometimes easy to get sidetracked with other duties for other patients or to give a patient who asks you to come back later to get them up. The nurse needs to help set a pattern for when the patient goes home, reinforcing the importance of staying on track. It often helps to include family members that may be in the room since they will be the patient's most significant support system at home. Positive feedback to family members helps to assure compliance when the patient goes home because it is essential that the patient be reminded to stay active.

It is also imperative that bariatric patients remain well-hydrated after discharge. This requires that they continually sip on water throughout the day. Some patients have an aversion to food or liquids initially after surgery. Others are afraid to put "too much" into their stomachs at any one time and as a result don't drink enough fluids. It is important that the bariatric nurse recognize these behaviors when they exist and to then teach the patient about the importance of adequate intake, how to find a comfortable level of fullness as well as some of the tricks other patients have used to help with similar problems.

Bariatic patients require a specific set of nursing assessment skills because subtle changes in a patient's status can represent dangerous complications such as leaks or blood clots. Bowel and lung sounds are often more difficult to assess in morbidly obese patients, and adaptations must be made in the use of a stethoscope. Correctly sized blood pressure cuffs and closely monitored peripheral IV sites are important in the prevention of upper extremity DVTs. Thorough skin inspection is crucial since many of these patients have skin folds requiring special attention. It is difficult to monitor urine output once a foley has been discontinued because many obese female patients have difficulty voiding in a urinary hat, and many male patients have difficulty using a urinal. Bladder scanners are often unreliable in this patient population due to the distribution of fat cells in that area, and edema is difficult to easily detect.

Bariatric nursing is an extremely rewarding field. Morbidly obese patients come in for surgery as their last hope of a cure for a lifelong problem. By demonstrating a high level of professional competency and a genuine commitment to a patient's success, bariatric nurses have a huge impact on that patient's chance at a new life.

Judy Irvin, RN, JD, Staff Registered Nurse

Bariatric Unit, Scottsdale Healthcare

Copyright Arizona State Nurses Association May 2006
Provided by ProQuest Information and Learning Company. All rights Reserved