Anyone work on a med/surg floor that cares for post op bariatric surgical pts?

tokmom, BSN, RN · Jul 6, 2012

are these people coming in for gastric bypass type surgeries for weight loss?

I worked at a hospital that did a lot of them. They were not difficult surgeries to take care of. Most were young and pretty mobile. They were also very motivated to lose their weight. The only 'bad' thing I can think of, was the fact they do have a lot of co morbidities. Many were diabetic or had respiratory issues post op. Overall though, they were a pretty benign population to take care of.

As for the lifting, the hospital should supply you with lifts, etc..so you don't have to kill your back!

cjcsoon2bnp, MSN, RN, NP · Jul 12, 2012

Having taken care of a few Bariatric Surgery patients post-op and being a post-op Bariatric Surgery patient myself here is what I can offer.

Like tokmom said most of us Bariatric Surg. post-ops are fairly young and mobile and because this is an elective surgery we are highly motivated to be compliant with what is asked of us. Keep in mind that most of your patients have probably been waiting for this for at least 6 months, have gone through a rigorous insurance approval process and have turned to this as a last resort to saving their lives. They want this surgery more than you can even imagine.

Your patient will also have been prepped extensively before the surgery by the surgery team about the importance of ambulating, deep breathing with the incentive spirometer, sipping fluids and resting in the post-op period (but they will need reminders from nursing). As the nurse you will have to watch out for the comorbidities such as: IDDM/NIDDM, HTN, Sleep Apnea, OHS, Asthma etc. You will also have to remember that obesity affects how you respond to anesthesia and puts these patients at a higher risk for surgical complications (DVT and PE among others). Encouraging the patient to ambulate (if they are able to and the surgery team allows it) will be crucial for you as the nurse. I was lucky to have my family and friends come to visit me a lot so they would often take me to do laps around the unit (at the nurse's encouragement) and not only did it help to prevent DVT/PE but it also helped to diminish the post-op gas pain (a major selling point that you can emphasize).

When monitoring these patients for complications use your best judgement and nursing instinct to advocate for your patient. On my third post-op day (and anticipated date of D/C) I woke up feeling short of breath, febrile, tachycardic and had increased acute abdominal pain. I called for my nurse and she noted that my temperature was 101.4 and I didn't seem "just right" to her so she paged the surgeon. The Bariatric Fellow (the second surgeon who was training with my Attending Surgeon) came to check on me and said that he thought I was ok and that my temp. wasn't really considered a fever unless it was 101.5. I told him that I didn't feel right and something must be wrong. I asked the nurse to please rechecked my temp and it was 101.6 and at this point I started vomiting. After the nurse spoke with the Fellow and told him that she agreed that my condition had changed drastically from the previous shifts he decided to spend me off to CT for a scan "just in case" something might be wrong. Needless to say, I ended up having a surgical complication called GRD (Gastric Remnant Dilatation) which required me to have a CT guided decompression of my remnant stomach with a drain attached. Basically my stomach wasn't draining fluid into my intestines correctly and so the stomach was filling with fluid and expanding. The pressure from my stomach expanding was making it difficult for me to breath which caused my fever and tachycardia and then led to the vomiting. Once I had the drain placed I was fine and I was D/C the next day but the moral of the story is that as the nurse you need to listen to your patient and advocate for them (like my nurse Maureen [the night nurse BTW] did for me).

Lastly, if you are working with this patient population you need to really think carefully about how you feel about people who are overweight. If you have an underlying prejudice against overweight people and think that these patients are just taking the "easy way out" or are "being lazy" then do yourself (and your patients) a favor by not working on a unit that cares for these patients. I can tell you that when I was a patient I was very happy with the nurses that cared for me but I could tell immediately if someone had an underlying prejudice against me because of my weight or because I did this surgery. This prejudice only causes shame for your patients, creates distrust on the part of the patient and destroys any sort of therapeutic relationship that may have been created. Many nurses find working with these patients rewarding as they are usually highly motivated, very appreciative and caring for them is fairly easy.

Sorry for the long post but I hope it helps!

!Chris :specs:

ashleyisawesome, BSN, RN · Jul 19, 2012

cjcsoon2brn, that was great! thanks! i absolutely dont have a prejudice, and think very highly of people who are motivated enough to jump through all the hoops they have to go though to even get this surgery. the thing i like about my ortho job is that it is elective surgery and the pts are usually very motivated to get better, as it seems the bariatric pts will be. im sorry about your complications, and glad everything turned out okay! looks like i will have great opportunities to exercise my pt advocacy skills in this specialty if i get this job!

ExpatHopeful, LPN, LVN · Jul 28, 2012

Hey ashley, I don't know if you were offered the position or not, but I work on a colo-rectal floor that also takes elective bariatric patients. About 1/4 of our patients are post-op gastric bypass/gastric band/ or occasionally post-bypass fistulas. In general I find it a good group to work with. As a previous poster said they are generally very well educated in advance of the surgery about what happens when and although they certainly need monitoring, most do well and are able to be discharged as planned. They are very 'routine' patients in the sense that there is a regular protocol that they all follow (ie, NPO until swallow study on the first post-op day, ambulate q6hr, PCA until on clears then switch to crushed percocets, etc). I think a previous poster did a good job of describing the co-morbidities you see and need to manage. You will definitely do a lot of discharge teaching with this group and reinforcement of what they were told pre-op, which I find rewarding. Many of them are just beginning to realize what a major change this is. It's one thing to be told you can only drink or eat 2-3 tablespoons at a time and another thing to automatically take a big swig of water only to vomit (which is why dixie cups are great). We actually see a fair number of 'young' patients, 18-30 year olds, and they especially can be a little slow in coming to terms with the actual surgery. 'Yes, you are going to be sore after surgery, no, you haven't lost any weight yet.' There's a lot of reassurance, but as you said, it's elective and planned so it's great to see them get better quickly and head home.

As for lifting, you may find you do less than with ortho patients! In my hospital all the bariatric patients arrive on our floor from recovery in special bariatric beds that turn into a chair. 6 hours post op you just push a button, the bed goes into chair mode, they stand up under their own steam and walk. There's no lifting or rolling involved. We have yet to have a patient fall or collapse, although we do have an emergency hoist of course.