Page 203 - Critical Care Notes

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Management
Surgical Management
Bariatric surgical techniques include those based on gastric restriction and
those combining gastric restriction and malabsorption. They include gastric
bypass (Roux-en-Y), gastric banding, horizontal or vertical-banded gastroplasty
(Mason procedure or stomach stapling), sleeve surgery/gastrectomy, duodenal-
switch procedures, and biliopancreatic diversion (BPD)/bypass.
Postoperative Management
Standard postoperative care should be provided, with the following special
attention:
■ Administer analgesics for pain.
■ Vigilantly assess respiratory status. Patient may need long-term ventilatory
support with use of tracheostomy.
■ Elevate head of bed 30° to reduce weight of adipose tissue on the
diaphragm.
■ Encourage early ambulation; turn and position frequently with use of tra-
peze on the bed.
■ Assess for skin breakdown, especially within skin folds.
■ Slowly advance diet and fluids appropriate to surgical procedure.
■ Provide DVT prophylaxis.
Complications may include:
■ Bleeding from surgical site or internally
■ Thromboembolism and pulmonary embolism
■ Atelectasis and pneumonia
■ Bowel obstruction, incisional or ventral hernias, wound dehiscence, and
slow wound healing
■ Infection: Respiratory, urinary, wound, or sepsis
■ Anastomosis leak → peritonitis
■ ACS
■ Nausea, vomiting, gastric dumping syndrome (↑ HR, nausea, tremor, dizzi-
ness, fatigue, abdominal cramps, and diarrhea), and diarrhea or constipation
■ Fluid and electrolyte imbalances; dehydration
■ Gallstones, nutritional deficiencies, hyperparathyroidism, electrolyte imbal-
ance, anemia, seizures, and weight gain (long-term complications)
Gastrointestinal Surgery
Esophagectomy is the removal of the entire esophagus and part of the stomach
and lymph nodes in the surrounding area.

GI