caffeine, administer Beta Blockers, FSBS, high calorie diet, vitamins, mineralsoPrepare client for adrenalectomyPre-opoTreat existing HTN, hyperglycemia, hypokalemiaoMonitor lytesoHigh protein dietoTeach – life-long corticosteroid replacement therapyPost-opoVS – monitor for increased HR and BPoClosely monitoroIV cortisone – high dose to decrease BP and maintain fluid and lyte balances14
Module 2 Study GuideoNG tube may be necessaryoExamine dsg for bleedingoBedrest until VS (BP) are stableoProvide calm, stress free environmentoReinforce teachingoClose follow-upGASTRIC SURGERYSurgery for obesity – bariatric surgery; generally, for the morbidly obese who can’t lose weight through diet and exercise or have obesity-related problems (metabolic syndrome,HTN, heart disease)Must be able to tolerate surgery and be free of drugs and alcoholThorough psych eval is done prior to surgeryBenefits: major weight loss, improved BP, reduced risk of diabetes, sleep apnea, angina, heart failure, blood lipid levels, and venous diseaseRESTRICTIVE/MALABSORPTIVE PROCEDURESMost commonRestrict stomach capacity – limiting food intake and bypass a portion of the small intestine to restrict the absorption of calories and nutrientsoRoux-en-Y gastric bypass – small stomach pouch is created to restrict food intakeY shape section of jejunum is attached to the pouch to allow food to bypass the lower stomach and duodenum= limited calorie and nutrient absorptionoBiliopancreatic diversionHigher risk for nutritional deficiencies – used less frequentlyPortion of stomach is removed to reduce capacityBypass of duodenum and jejunum is created – connecting the ileum to the stomach pouch or distal to the pyloric valveoThese surgeries lead to rapid weight loss that’s maintained over timeMaintain 60-70% weight loss for 10+ years following the Roux-en-Y Help improve obesity-associated health problemsType 2 DMHTNSleep apneaCommon nutrient deficienciesoIronoCalciumoVitamin B12oFat-soluble vitaminsRESTRICTVE PROCEDURESSafer but less effective in the long runAdjustable gastric banding and vertical banded gastroplastyAdjustable gastric banding15
Module 2 Study GuideoHollow band is placed around the upper/proximal portion of the stomachoBand is inflated with saline to create a small stomach pouch with a narrow passage to the rest of the stomachoAmount of inflation can be adjusted with a port implanted under the skinVertical banded gastroplastyoUses a band and staples to create a small stomach pouchBoth can be performed laparoscopically and be reversed if necessaryFew nutritional deficienciesVomiting is common post opBand may slip or break = surgery12-20% of vertical require a 2ndprocedureVertical is performed less frequentlyoClients typically lose up to 50% of excess body weight within 1styro< ¼ maintain that weight loss over a 10 yr periodCOMPLICATIONSPost op complications are high, but mortality rate is low ABD wall herniaGallstonesWound infectionsDVT
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- Fall '16
- Cortisol, Adrenal cortex, Adrenal insufficiency