Question

Crystal Monte, 32 years of age, is a female patient who is admitted to the medical-surgical unit after a laparoscopic Roux-en-Y gastric bypass for weight loss. Prior to choosing the surgery, the patient tried numerousdiets and exercise programs without success and developed metabolic syndrome that led to insulin resistance. The patient’s parents both had complications related to morbid obesity and diabetes, so the patient wanted to have successful long-term weight loss and to decrease the risk factors for developing diabetes. The patient met with the multidisciplinary team before surgery, which consisted of a social worker, nurse counselor, dietitian, psychologist, exercise therapist, and surgeon. The patient received intensive preoperative teaching and followed the diet she would follow after surgery for several weeks before the operation.

a.What nursing management should be provided for the patient postoperatively?

b. What discharged instructions should the nurse provide the patient?

Answer 1

Roex-en-Y gastric bypass refers to dividing stomach into two parts (a smaller and a larger pouch) and then this is connected to the intestine.

a.Nursing management post operatively are

• Monitor the patients vital signs (can provide baseline information when there is a change in the body status)
• Patient has to under go a x Ray abdomen
• Assess for any complications ,dumping syndrome ,rhabdomylosis
• Assess the persistalis to ensure the return of bowel movements which are usually anesthetized and losses its function temporarily
• Keep the patient NBM till order
• When NBM is relieved then the patient can be started with clear fluids
• Maintain air away of the patient ,provide propped up position to enhance lung capacity and elevate the bed to semi propped up position
• Administer medication (antibiotics, analgesics,an to enetivs ,vitamin k,proton pump inhibitors ,etc.,)as per order
• Prevent cross infection by meticulous hand hygiene practices
• Maintain skin care as there are high chance of ulcerations due to restricted mobility

b.The following discharge instruction has to be provided to the patient

• Take medication as per order
• Follow up after two weeks
• Eat small portion of meal
• Avoid alcohol,soft drinks,beverages
• Follow a bland diet,and chew well the foods
• Avoid late night snacks or foods
• Do not take water along with food consume either half hour prior or later
• Continue the coughing and deep breathing exercise
• Avoid strenuous exercises,activity, no continious star is climbing
• Avoid lifting weight more than 10 pounds
• Seek medical help in case of fever, duscharge from surgical site, intolreable to eat, etc.,
• Monitor weight