nursing care plan for an obese patient

  1. 0
    I need help with my nursing diagnosis. I have a 42 yr old pt, that has just had a Gastric Bypass. She has a hx of depression and weighs 344.8 (morbid obesity) pounds and BMI of 56.6. She doesn't make good eye good contact.

    I think of the diagnosis of
    Chronic Low Self*Esteem r/t body image

    Does this sound right? This is my first time. I will take any suggestions
    Also can I use, pt doesn't make good eye contact as an objective data?

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  2. 2 Comments...

  3. 0
    hi,tan01!

    i think you're missing the boat here and missing some even more important nursing care that needs to be done. i've had family that went through this procedure. was it a closed (laparoscopic) or open (an incision into the abdomen) procedure? the reason i ask is because your nursing diagnosis is always based on assessment data and symptoms that the patient has. now, i know that you want to go with depression because that is the most prominent diagnosis you see and may be the biggest reason for the surgery, but there are some very real physical post-op problems and concerns that go with this surgery that you may have missed that are of bigger concern and priority here right now.

    if she had a laparoscopic approach, air was pumped into her abdomen and she is likely to be having gas and/or crampy pain. if she had an open procedure she needs to be care planned like any other post-op patient with an incision. not only that, but these patients have to learn to re-eat. that is a big factor in their post-op care. risk for fluid volume deficit is a real danger for them because their stomachs are now only able to hold about 1 ounce (30cc) maximum at one time. the surgeons who do this surgery usually have a team of people who are educating these patients about what they can and can't eat immediately after surgery. law #1 is they have to get at least 6 to 8 ounces of fluid in them a day. law #2 is they have to get at least 30 grams or so of protein in them as well. not only this, but if this patient is on any regular medications, she cannot take them the same way she did before surgery. they need to be crushed, so instruction in how to crush and take pills (some of them may be pretty bitter) may also be in order here.

    my sister had this done a few months ago and these were absolute laws that were constantly reinforced with her by everyone on the staff before she was discharged. first foods were clear liquids. progression to soft foods usually carries the risk of potential vomiting as they learn (it's all a brand new process for them) what foods they are going to be able to tolerate and those they won't. prior to discharge my sister had a swallowing esophogram done to confirm that the anastomosis (where the intestine is joined to the top section of what is left of the stomach) was patent and functional. my sister was sent home with prescriptions for zantac for a month and pain medication. the zantac was to keep the remainder of the stomach which was now bypassed from flaring up from the stress and developing gastritis. her biggest fear now is the potential development of hair loss. any depression she had before the surgery has been partially replaced with this hair loss fear and the fact that she has now dropped off 50 pounds.

    http://www.fpnotebook.com/end218.htm - here is information on medical management of gastric bypass surgery that includes information on diet management concepts
    http://www.obesityhelp.com/ - this is one of the big public websites recommended by many patients of bypass surgery for people to go for information about this surgery and aftercare.
    http://www.obesityhelp.com/content/lifeafter.html - life after weight loss surgery

    my recommendation is that you consider these nursing diagnoses for this patient:
    • risk for fluid volume deficit
    • readiness for enhanced nutrition
    • acute pain
    • risk for infection [if the patient had open procedure]
    since you are new to allnurses, let me point out that there are a number of sticky threads to help you with care planning and collecting assessment data. if you have not already read through them, here are links to them:

    see you on the forums! welcome to allnurses!
  4. 0
    Have you asked her how she is feeling about herself?


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