Question

EJ is a 28-year-old female. She is being admitted for Gastric Bypass Surgery. She is 5'6'' and 265 pounds. She has a history of Diabetes and hypertension, she is not on medications at the time.

What client education topics are important to reinforce for this client?

How will this client's diet be advanced?

What complications can occur after this surgery?

What is Dumping Syndrome and what are some interventions to help prevent its development?

Answer 1

BMI = weight in kg/ height in meter square = 42.77 and patient is in an Obese category as the BMI of 30 or greater come under this category.

Gastric bypass surgery can be used to manage the extreme obesity and the in it the stomach size is reduced and the intestines are rerouted. Client education and preparation is very important to manage the outcome of the surgery.   

The client education topics must include the following:

Lifestyle changes: include proper diet and exercise

Importance of maintaining adequate protein intake and micronutrients like vitamins & minerals supplements

Effect of surgery to reduce nutritional absorption

Signs of dehydration and its management

Avoidance of alcohol, fatty foods or foods high in sugar

Importance of avoiding carbonated beverages and junk foods

The signs and symptoms of dumping syndrome and preventive measures with management.

Importance of taking small and frequent meals within the required calories.

Maintaining normal blood sugar levels and BP

Chances of side effects like abdominal pain, bloating and diarrhoea

Support measures like a counsellor for emotional support before and after surgery.

Importance of the surgery as a major life changing point.

Follow up and prognosis

Or

About weight loss surgery and treatments

The concept of overweight and health risks of obesity

Care after weight loss surgery

Losing weight and sleep apnea in adults.

Other bariatric surgery risks include:

Acid reflux

Anaesthesia-related risks

Chronic nausea and vomiting

Dilation of oesophagus

Inability to eat certain foods

Infection

Obstruction of stomach

Weight gain or failure to lose weight

Bariatric Surgery Long-Term Risks

Long-term risks for patients:

Dumping syndrome, a condition that can lead to symptoms like nausea and dizziness

Low blood sugar

Malnutrition

Vomiting

Ulcers

Bowel obstruction

Hernias

Dumping syndrome

Dumping syndrome after gastric bypass surgery occurs when food gets “dumped” directly from the stomach pouch into the small intestine without being digested. There are 2 forms occurs: early and late. Early dumping occurs 10 to 30 minutes after a meal. Late dumping occurs 1 to 3 hours after eating.

The early dumping syndrome occurs due to the dense mass of food that gets dumped into the small intestine at an earlier stage of digestion. As it the food mass is too concentrated the intestines sense release gut hormones. As a result, the body reacts by shifting fluid circulating in the bloodstream to the inside of the intestine. So the intestines become fuller and bloated. 30 to 60 minutes later diarrhoea often occurs. In addition to that certain chemical substances are released by the intestine that affects heart rate and often blood pressure, causing many of the symptoms of early dumping. The main manifestations are lightheadedness or even fainting.

Symptoms of late dumping occur due to a decrease in blood sugar level (reactive hypoglycemia), 1 to 3 hours after a large surge of insulin. Occurs by eating a meal heavy in starches or sugars. As a result, insulin levels can increase to high levels, then lower to an extreme level.

Typical early dumping symptoms are :

Bloating

Sweating

Abdominal cramps and pain

Nausea

Facial flushing

Stomach growling or rumbling

An urge to lie down after the meal

Heart palpitations and fast heartbeat

Dizziness or fainting

Diarrhoea

The symptoms of late dumping syndrome are:

Heart palpitations

Sweating

Hunger

Confusion

Fatigue

Aggression

Tremors

Fainting

Prevention:

The main management of dumping syndrome is changing in the dietary instructions like :

At every stage of the gastric bypass diet, the client must be careful to:

Avoid dehydration by drinking at least 64 ounces of fluid a day.

Take liquids between meals and not with meals. It is better to wait about 30 minutes after a meal to drink anything and avoid drinking 30 minutes before a meal.

Eat and drink slowly, with adequate chewing to avoid dumping syndrome.

Consume lean, protein-rich foods daily.

Use foods and drinks that are low in fats and sugar.

Avoid alcohol consumption.

Minimize the intake of caffeine, which can cause dehydration.

Take vitamin and mineral supplements daily as directed by your health provider.

Chew foods thoroughly to a pureed consistency before swallowing, once you progress beyond liquids only.