Nursing care plan obesity bariatric surgery gastric partitioning gastroplasty gastric bypass

I. Indications
a.Weight and health of extremely obese persons can be favorably
changed by bariatric surgery (National Institutes of
Health [NIH], 2008).
b. Improvement in comorbid conditions associated with
morbid obesity—glucose intolerance and diabetes, hypertension,
hyperlipidemia, and sleep apnea

II. Procedures
a. Open approaches with abdominal incisions or by
laparoscopy
b. Extremely obese individuals, or those with previous abdominal
surgery or complicating medical problems, may require
open approach.
c. Three types of surgical procedures are offered.
i. Restrictive
1. 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
lower stomach.
2. Reduces the amount of food the stomach can hold to 15
to 30 mL and slows passage of food through the stomach,
resulting in a feeling of fullness
3. Most common procedures include stapling or banding
of the stomach.
a. Vertical banded gastroplasty (VBG): permits normal
digestion of food, decreasing risk of anemia or
vitamin deficiencies as compared with gastric
bypass
b. Laparoscopic adjustable gastric banding (LAGB):
allows band adjustments depending on client’s
weight loss and appetite; it is considered by some to
be the safest procedure (Salemeh, 2006)
c. Gastric sleeve (GS): restricts food intake without
decreasing absorption of food, with most of the
stomach removed; sensations of hunger may be
reduced through decreased production of the
hormone, ghrelin (Weight-Control Information
Network [WIN], 2008)
ii. Malabsorptive
1. Biliopancreatic diversion (BPD): excludes most of the
small intestine from the digestive tract so that fewer
calories and nutrients are absorbed
2. Produces significant weight loss
iii. Combined restrictive and malabsorptive
1. Roux-en-Y gastric bypass: partial bypass of the small
intestine results in fewer calories being absorbed
2. Greater weight loss is achieved.

III. Complications (Beauchamp-Johnson, 2006; Bouldin et al,
2006; Salemeh, 2006; Trus et al, 2005)
a. Anastomotic leak: occurs at gastrojejunostomy or jejunostomy
site; can result in peritonitis, sepsis, and death
b. Intestinal obstruction: associated with stenosis at
anastomosis sites
c. Wound complications: laparoscopic procedures associated
with higher risk of infection (1.5%) and hernias (1.8%)
than open procedures
d. Nutritional complications: risk for iron, calcium, thiamine,
folate, and vitamin B12 deficiencies can occur early or late
and are long term

IV. Statistics
a. Morbidity: Between 2002 and 2004, frequency of procedure
increased threefold (from previous 3-year period) to
over 106,000 bariatric procedures, with ages ranging from
18 to 64; women outnumbered men 5:1 (U.S. Department
of Health and Human Services [USDHHS], 2006).
b. Mortality: Laparoscopic banding procedures account for
less than 1%; gastric bypass account for 1% to 2%;
mortality rates are higher in the “super obese,” those individuals
who have a body mass index (BMI) greater than 50,
and in those who have undergone BPD due to long-term
complications (Bouldin et al, 2006; NIH, 2008; Salemeh,
2006; Trus et al, 2005).
c. Cost: Average cost is $20,000 to $25,000 per uncomplicated
procedure (NIH, 2008); $948 million in hospital costs for
bariatric surgery in 2002 (Encinosa et al, 2005).

Care Setting
Care is provided in an inpatient acute surgical unit.

Related Concerns
Eating disorders: obesity,
Peritonitis,
Psychosocial aspects of care,
Surgical intervention,
Thrombophlebitis: deep vein thrombosis,

Nursing Priorities
1. Support respiratory function.
2. Prevent or 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 or controlled.
3. Nutritional intake modified for specific procedure.
4. Procedure, prognosis, and therapeutic regimen understood.
5. Plan in place to meet needs after discharge.

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