Transcript Bariatric Inpatient Preparation Group

Bariatric Inpatient Preparation
Group
Specialist Bariatric Surgery Dietitians:
Laura Carstairs
Cleverly Fong
Bariatric Nurse Specialist:
Tamara Ramkalawan
Cecilia Jones
Bariatric physiotherapist:
Al Myers
Objectives
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Inpatient experience
Length of stay & operation
Medications
Pregnancy
Before surgery and after diets
Breathing & circulation exercises
Importance of early post-op mobility
Introduction to physical activities
The surgery
• Usually done as keyhole surgery
• Quicker recovery time
• Length of stay in hospital
– 1 to 2 days for Gastric Banding, surgery time 12hrs
– 3 to 4 days for the other surgeries, surgery time
1.5 – 4hrs
Day of surgery
• Omit diabetes tablets, blood pressure tablets, insulin,
and other regular tablets morning of surgery unless
instructed specifically to do otherwise
• Warfarin and aspirin – to follow your consultant’s
instruction
• Bring all meds and CPAP
• Bring personal clothing and toiletries for use on ward
• Arrange transport to come into and discharge from
hospital
• Walk to theatre and onto the operating table
Ward experience
• Surgical ward after recovery
• IV Fluids, Flowtron and TEDS, Nursed upright,
Oxygen therapy, Drains
• Regular observations
• Sips of water to clear fluids
• MRSA screening
• Nebulizers, CPAP to start 48hrs post surgery
• Clexane (you may get some bruising) and early
mobilisation
What will you feel like after
surgery?
• Pain ( wind or bloating) – painkiller will be
given
• Nausea and vomiting – anti-sickness will be
given
When to alert staff
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Short of breath, anxiety and chest or calf pain
Severe onset of abdominal pain
Racing heart beat
Vomiting
Wounds bleeding
Discharge
• Medication – Clexane, Fastabs, Multivits, Adcal,
painkillers, laxatives (no whole tablets, liquid, soluble,
chewable or crushed meds using a pill crusher or
spoons for 4 wks post surgery)
• G.P.- get repeat prescriptions & return sharps bin
• Practice nurse – wound dressings, Blood sugar and
BP to be checked regularly
• Appointments with nurse, dietitian and surgeon. Band
fills 4-6 wks post op
• Contact team if any problems
Pregnancy
• Weight loss can increase fertility
• Pregnancy is not advised during the first 18 months after
surgery as it can be very risky for both mother and baby.
- Potential for maternal and fetal malnutrition
- Gestational diabetes
- Preeclampsia ( High blood pressure in pregnancy)
- More likely to need cesarean delivery
- Blood clots after giving birth
- Increased blood loss during delivery
- Increased risk of miscarriage, pre-term birth, stillbirth
- Increased risks of congenital anomalies, growth abnormalities,
etc.
Pre op liver shrinkage diet
• Follow for 2-4 weeks pre surgery
– 4 weeks if BMI over 50
• 3 options
– Food based diet
– Milk diet
– Slimfast diet
• All 1000kcal, low carbohydrate
• Caution with diabetic control
• Follow one diet only- do not mix and
match
Post surgery liquids in hospital
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Water
Tea/coffee
Milk
No added sugar squash
Clear soup
Build up soup tomato flavour (ask the staff!)
• You should not be having yoghurt, jelly, ice
cream or liquids with bits or lumps at this
stage
Post-surgery: Stage Diet
Stage 1:
Liquid Diet
Stage 2:
Puree Diet
Stage 3:
Soft Textured Diet
Stage 4:
Normal Diet
2 weeks
Except after Sleeve Gastrectomy:
3 weeks
2 weeks
2 weeks
Long term
Physiotherapy in the Ward
• You will be seen the day after your surgery.
• Your respiratory system and movement will
be checked.
• You will be advised on breathing and
circulation exercises.
• You will be encouraged to sit out of bed as
much as possible and to walk around the
ward lots.
Why is early mobility
important?
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Early mobility restores normality to your
body’s systems by;
Speeding up your recovery from the
anaesthetic.
Reducing your risk of developing blood
clots.
Making the lungs work more effectively and
reducing the risk of chest infections.
Moves trapped wind from your abdomen.
Can I reduce the risk of blood
clots?
• Early mobility!
• Practice circulatory exercises of your ankles;
point the feet down all the way then pull up
and perform clockwise/anti-clockwise circles.
• Repeat roughly 5 times in each direction
hourly throughout the day.
• Remember spelling the alphabet with your
toes.
Could I get a chest infection
after the operation?
• The anaesthetic used in the operation
reduces lung function.
• You can feel pain in your abdomen - making
deep breathing and coughing painful.
• This can cause mucus/phlegm to gather in
your lungs and can cause a chest infection.
• If you are a smoker, you are already at a
higher risk of chest infections as the lungs
tend to contain more mucus.
How can I reduce the risk of
chest infections?
• Early mobilisation!
• Sitting out of bed (make the lungs more
upright).
• If you smoke, please look to stopping;
contact the NHS Stop Smoking Helpline
on 0800 022 4 332 or access
information online at smokefree.nhs.uk.
How can I reduce the risk of
chest infections? Contd.
• Tell ward staff if your pain stops you
doing breathing exercises, perform an
effective cough or mobilise.
• Support your abdomen with your hands,
a towel or pillow when coughing to
reduce pain.
• Practice breathing exercises twice an
hour to keep the chest as clear as you
can - less phlegm, less risk of infection
Breathing exercises?
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The Active Cycle of Breathing
Technique (ACBT) exercises.
To start-get comfortable; sit up in bed
or sitting upright in a chair.
Breath in through your nose and out
through your mouth if possible.
Lets Practice The Cycle
Breathing
Control
(6-8)
Deep Breaths
(3-4)
Supported
Cough
if required
Breathing Control
(6-8)
Deep Breaths
(3 or 4)
Huff
(1-2)
Breathing
Control
(6-8)
What Breathing Exercises can I
do? Contd.
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Breathing Control – Normal, relaxed breathing as
you would do, do 6-8 breaths.
Deep Breaths – Breathe in slowly and deeply,
breathe out without forcing it, repeat 3 or 4 times.
The Huff – Take a medium sized breath in, breathe
out forcefully for a short time, keep your mouth
open and use your stomach muscles. “Imagine you
are steaming up a mirror with your breath”.
Practice the cycle every hour-stop if you feel your
cough the dry and unproductive.
Physical Activity
• In the ward we will discuss;
*benefits of physical activity
*the government recommendations
*check your current physical activity levels
*help set shared goals
*exercise initiatives local to you
• Regular physical activity is essential to the lifestyle change
required to get the most from this procedure in the long-term
• General rules for activity after surgery - avoid heavy lifting until
you feel comfortable and swimming until your wounds have
healed.
• If you drive, contact your insurance provider to ensure they are
happy with coverage – also make sure you can comfortably
perform an emergency stop.
The PACE Class
• If you can get to the Hospital and commit to the
twelve weekly classes you can join the Physical
Activity Circuit and Education (PACE) class.
• Exclusively for patients who have had bariatric
surgery at the Homerton University Hospital.
• You will take part in education sessions combined
with physical activity circuits.
• Its aim is to introduce, support and motivate for
increasing your physical activity levels.
• Classes run every Tuesday evening from 6.30-8pm
and Wednesday afternoons from 3pm-4.30pm.
• The classes last for 12 weeks.
Questions?
• Thanks for listening and good luck!
• Any questions for the team? 
YOU ALL NEED TO ATTEND PRE
ADMISSION IN THE SURGICAL
CENTRE TODAY