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OBESITY: SURGICAL INTERVENTIONS (GASTRIC PARTITIONING/ GASTROPLASTY, GASTRIC BYPASS) Weight reduction surgery has been reported to improve several comorbid conditions such as sleep apnea, glucose intolerance and frank diabetes, hypertension, and hyperlipidemia. A number of surgical treatments for morbid obesity have been tried and discarded because of ineffectiveness or complications. The procedure of choice is vertical-banded gastroplasty, although the Roux-en-Y gastric bypass is also performed. Procedure may be performed via open abdominal incision or laparoscopy. Gastroplasty ( gastric stapling/banding ) : A small pouch with a restricted outlet is created across the stomach just distal to the gastroesophageal junction. A small opening remains, through which food passes into stomach. Vertical banded gastroplasty (VBG) is accomplished by placing rows of staples vertically in the strongest sidewall of the stomach and insertion of polypropyline band around the outlet of the resulting pouch. Gastric bypass ( Roux-en-Y ) : Anastomosis of a segment of the small intestine to upper portion of stomach that has been partitioned by a horizontal staple line or banding. CARE SETTING Inpatient acute surgical unit RELATED CONCERNS Eating disorders: obesity Peritonitis Psychosocial aspects of care Surgical intervention Thrombophlebitis: deep vein thrombosis Patient Assessment Database ACTIVITY/REST May report: Difficulty sleeping Exertional discomfort, inability to participate in desired activity/sports EGO INTEGRITY May report: Motivated to lose weight for oneself (or for gratification of others) Repressed feelings of hostility toward authority figures History of psychiatric illness/treatment May exhibit: Anxiety, depression ELIMINATION May report: Urinary stress incontinence FOOD/FLUID May report: “Yo-yo” dieting Weight fluctuations Dysfunctional eating patterns May exhibit: Weight exceeding ideal body weight by 100 lb or more or a body mass index (BMI) of more than 40 (morbid obesity) HYGIENE May report: Difficulty dressing, bathing TEACHING/LEARNING May report: Presence of chronic conditions (hypertension, diabetes, heart failure, arthritis, sleep apnea, Pickwickian syndrome, infertility) Adequate trials and failure of other treatment approaches
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Desire to lose weight Discharge plan DRG projected mean length of inpatient stay: 7.4 days (2–4 days for laparoscopic procedures) considerations: May require support with therapeutic regimen/weight loss, assistance with self-care, homemaker/maintenance tasks Refer to section at end of plan for postdischarge considerations. DIAGNOSTIC STUDIES Studies depend on individual situation and are used to rule out underlying disease and provide a preoperative workup, including psychiatric evaluation.
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This note was uploaded on 02/01/2011 for the course PNR 182 taught by Professor Toole during the Spring '10 term at Orangeburg-Calhoun Technical College.

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