Editor's note: Last issue, we took a look at caring for our aging population. Join us this issue as we look at another special patient population—bariatric patients.
Obesity prevalence in the United States continues to rise each year. The cause of obesity is complex and includes behavior, environment, genetic factors, education, economic situation, and sedentary lifestyle either by choice or due to disability. Treatment options include exercise programs, medically supervised weight-loss programs, and surgery. As a healthcare provider, caring for a bariatric patient may be challenging.
Bariatric patients may be difficult to care for due to their size, as well as co-morbid conditions associated with obesity, including hypertension, diabetes, high cholesterol, obstructive sleep apnea, depression, anxiety, joint pain, and limited mobility—all of which increase the risk of complications and a longer hospital stay.
Special equipment is necessary to care for this patient population. The equipment must not only be appropriate in size, but it must also accommodate the patient's weight. Healthcare providers must know the weight capacity of all equipment, including beds, bedside chairs, scales, wheelchairs, toilets, bedside commodes, carts, OR tables, and radiology equipment. Other things to consider include doorways, elevator openings, BP cuffs, hospital gowns, nonslip socks, bedpans, sequential compression device sleeves, and medication administration (a pharmacist should be contacted for accurate drug dosing).
The most common bariatric surgeries include Roux-en-Y gastric bypass (RNYGB), adjustable gastric banding, and sleeve gastrectomy. The RNYGB procedure reduces the stomach to the size of a small egg by cutting and stapling to create a pouch. The anatomy is adjusted by connecting a limb of intestine to the pouch to bypass the remaining stomach and first segment of the small intestine. The gastric band is an adjustable device placed around the top portion of the stomach to create a small pouch. Sleeve gastrectomy is a procedure that removes approximately two-thirds of the stomach, leaving the remaining portion of the stomach long and slender in the shape of a garden hose.
The immediate post-op care for patients undergoing these surgeries is similar in the fact that they all must decrease food portions. Complications include leaks, bleeding, obstructions, and a slipped band. As you're caring for the post-op bariatric surgery patient, you should notify the surgeon of persistent tachycardia, sudden onset of left shoulder pain, fever, and decreased urine output because these are symptoms of a leak. Severe abdominal pain and nausea with emesis of bile could be symptoms of a bowel obstruction. As with any surgical patient, always pay close attention to clinical changes that deviate from the pathway.
Obesity is a condition that isn't going away and it affects all patient populations, including medical, surgical, cardiovascular, geriatric, and even pediatric areas. You should be aware of specific equipment needs and how to perform diligent monitoring and assessment, ensuring not to exclude skin integrity and the patient's psychosocial needs. And if your hospital offers bariatric sensitivity training, consider taking advantage of it; it can be a positive experience.