Bariatric Pre Op Class Your Jefferson Team Surgeons

Bariatric Pre Op Class Your Jefferson Team  Surgeons

Bariatric Pre Op Class Your Jefferson Team Surgeons Bariatric Coordinator Nurses (navy) Nursing Techs(gray) Dietitians Respiratory Therapists Physical Therapists Pre-op Diet

Start 2 weeks prior to surgery Continue to take your regular multivitamin until the day before surgery. STOP any fish oil and or herbal supplements. Goal: get 64oz of hydration liquids in. 3 protein drinks a day- get your product approved by RD or RN One modest meal a day - 4 oz. lean protein - cup starch - 1 cup veggies

Day before surgery: Drink plenty of Clear and Full liquids : This will help with IV start in the morning Pre-op Medications Please discuss all of your medications with your physician Surgery can affect the action of certain medications: diuretics, blood pressure and diabetic meds You may need a sliding scale (an adjusting schedule)

Some patients will take medications with a sip of water the day of your surgery Ready, Set, Go!!! Preparation for your Stay at Jefferson What to Expect Day of Surgery? Admissions (1st floor) to check in two hours before your scheduled surgery time call the hospital (SDS) day before your surgery to get your arrival

time 856-346-7908 Go to Same Day Surgery Department (2nd floor) This is a semi private holding area for the OR, your room on the 4 th floor will be private You will change into hospital gown Complete paperwork, check your vitals (BP, Pulse and Resp.) RN or anesthesia team will insert an IV Heparin injection to protect against a blood clot No dark nail polish! Save the Mani-Pedi for post op! What to Expect Day of Surgery?

When the staff and OR and Anesthesia have prepared everything, you will go to the operating room. Approximate time in operating room times: Band*** one hour Sleeve*** one and one half hours Roux-en- y*** two to three hours Time in recovery room varies patient to patient What to Expect Day of Surgery? After surgery, you will awaken from anesthesia in

PACU-post anesthesia care unit. Your mouth and throat may feel dry and tight, its normal You may have sensation of pressure at your lower chest You may feel nausea. Vomiting in this early period is very rare, but we will start meds to help keep you comfortable as you come out of anesthesia Your vital signs, temp, respirations, heart rate and blood pressure will be checked frequently What to Expect Day of Surgery? Recovery room PACU-you will be there until you are stable enough to be admitted to the medical/surgical unit 4 East.

**after this class, we will tour the 4 East Unit If your surgeon feels you require closer monitoring of your vital signs and oxygenation, you MAY be admitted to the Intensive Care Unit overnight. In this unit, we can monitor you continuously. Regarding Family Members During your surgery, they can wait in the surgical waiting room, where the surgeon will talk to them after your surgerysnacks are available and the cafeteria is on the ground floor

While in your room on 4 East- After surgery it is typical to have some discomfort and nausea. We ask that family do not bring food into the patient rooms. Eating can be done in the cafeteria or the 4th floor family room near the elevators What to Bring Day of Surgery? Many patients have diagnosed Sleep Apnea. Your own CPAP machine is a must! Bring it with you. Personal Hygiene items IPod/headphones/cell phones

Pillow Footwear to be comfortable walking the hallways **PLEASE DO NOT Bring Valuables You are responsible for your valuables Obstructive Sleep Apnea Syndrome snoring, daytime sleepiness, hypertension, night time low oxygen levels, stop breathing during sleep Sleep apnea needs to be treated before surgery!

If you have a CPAP machine you must bring it with you to the hospital. Know your settings! Its helpful if your support person knows how to set it up. We have sterile water on 4East What to Bring Day of Surgery? Pajamas/Robe for your shoulders or comfortable clothing. Nurses will help you change into pajama pants shorts/shirt. You do not need to stay in the hospital gown

For walking laps around the nurses station Supportive footwear: slip on shoes or slippers to walk in halls Laps Walked REMEMBER TO KEEP WALKING WHEN YOU GET HOME Early complications can be avoided by walking and sipping liquids Overall: Healthy eating and exercise will work for you and improve your results! A CERTIFICATE WILL BE IN YOUR DISCHARGE BAG TO RECOGNIZE YOUR

ACHIEVEMENT IN WALKING Managing Pain Post op pain is typically from incisions and CO2 insufflation Pain control options: PCA (Patient Controlled Analgesia) The PCA uses IV morphine (a small machine on your IV pole) There is a button on a timer you can push to provide relief You can dose yourself if you need pain medication The PCA has a lockout feature so you cannot over medicate. If you cant have morphine, a different medicine will be given OR

IV meds every 4 hours Injected into your IV line You may have shoulder pain (gas) Referred Co2 dissipates through back, shoulders. You will notice it when you try to roll over Movement and getting up to walk will help make this better. You will not be pain free, but the pain will be more of a strong ache than a stabbing pain. Help us manage your pain by using this scale Post-operative Complications The Jefferson staff will be monitoring you for

any signs of complications, Bleeding or Leaks. These are rare but treatable when they happen. There are complications YOU can help prevent: Dehydration Blood Clots

Pneumonia Infection The following slides will teach you how to prevent post operative complications in the hospital and at home YOU Prevent Dehydration The number ONE reason for readmission back to the hospital is Dehydration. Once the IV is discontinued, you will need to pay close attention to fluid intake and it will be challenging!

Your throat may be sore and you may have sense of tightness when you swallow, even small amounts, so getting enough liquid is critical. Your skin may feel dry and because you have had little to no carbohydrates, so you may be urinating quite a lot Signs and symptoms of Dehydration Progressive weakness and profound fatigue

Muscle cramps Dizziness upon standing Nausea/Vomiting or dry retching Low urine output and very dark in color Headaches YOU Prevent Blood Clots Wear your compression boots while in the hospital. Keep on at all times

while in the bed or chair. You will be out of bed to chair the night of surgery and WALKING, WALKING, WALKING remember the record is over 150 laps *DO YOUR PERSONAL BEST. Do move your legs around if you are lying in bed *demonstrate Post Op Walking! LOVENOX INJECTION Be sure to take your Lovenox shot at the same time every day for 14 days

This is very important so that you dont have peaks and valleys of coverage vs. non coverage of protection from blood clots You will be given a Heparin shot in hospital before surgery and daily in the hospital The medicine will change to a Lovenox shot at home Do not push out the air bubble Do not rub after injection Demonstration of Lovenox administration and placement and offer syringe for a closer look YOU Prevent Pneumonia

Use your incentive spirometer 10 times per hour. (approx. every 6 minutes or 2 times at each TV commercial) demonstrate Cough and deep breath every 30 minutes with Bari Bear pillow Out of bed to the chair the night of surgery and walking, walking walking! Ambulate in hallways and continue walking at home, use your Bari Bear to splint your belly and use your incentive spirometer when at home.

YOU Prevent Infection Wash your hands frequently. Keep incisions clean and dry. You can shower, pat dry. No Tub baths or swimming until incisions heal Stay away from others that may be ill! A cold can delay your surgery! What to Expect the Morning After Surgery? A visit from your surgeon A visit from a medical doctor, if needed An upper GI, taken by wheelchair (explained)* not everyone needs

this test and not all doctors order this test After those results reviewed, first clear meal tray comes to patient Bloodwork A visit from Physical Therapy if needed A visit from the hospital dietitian First Hospital Liquids Goal: Start with 1-30cc (1 oz.) per 30 minutes and increase gradually to*2-3 (1 oz. cups) as tolerated You need sodium and potassiumjust like in your IV solution *This may happen when home, progress slowly You may like warm or coldno harm in either

Things to try: Broth, any flavor, not low sodium Sugar-free gelatin, G2, Crystal light, Power Aid Zero Juice (cranberry or apple diluted by half with water) Decaffeinated coffee/tea (decaffeinated still contains caffeine, but typically it is 97/98% caffeine free-caffeine is a diuretic) Caffeine is a cause of dehydration NO soda = pain from bubbles NO straw = fullness from air Stages of Diet Stage 1: Clear liquids

Stage 2: Full liquids Stage 3: Soft diet Stage 4: Regular diet Details of the Stages 3 and 4 diet are explained in depth during post op appointments with the Registered Dietitians. Stage 1: Clear Liquids Patients are not usually on clear liquids for more than a week. Patients may advance to stage 2 on post op day 4-5 if feeling well and hydrating well. 64 oz. is the goal but it will be very difficult to get it all

in early post op Please call your surgeons office, speak with a member of your bariatric team for any questions. CLEAR Protein Drinks You will need clear liquid protein drinks or powder mixed with water after surgery It is recommended that you trial some during your two-week pre-surgery diet. There

Are a few choices at the GNC and Walmart. Your individual protein needs will be discussed with you at your post-op visit with dietitian or bariatric nurse once you are given permission to advance to the next stages. Broth Crystal light Sugar free popsicles, Gelatein Any sugar free, calorie- Clear

Liquids free, caffeine free beverage Fruit juice No caffeine Sugar substitutes: Splenda, Equal Clear protein drinks Powder protein drinks Stage 2: Full Liquids 1 Week Sleeve Meals should be a TOTAL of cup 3-4

times per day Striving for 80 to 100 grams/day. Your Personal goal set by your dietitian Bypass 64 oz. fluid a day Sugar free Yogurt- Greek or plain- No lumps of fruit Meals should be a TOTAL of cup 3 4 times per day

Cream of wheat or plain oatmeal (not flavored oatmeal), grits, Make protein Wet Dilute it with water or milk to make it thin.thick may be difficult to swallow Strained/pureed/low fat soups (no pieces or chunks). Soups should be broth based or a low fat cream soup. Use skim milk, skim milk plus, 1% milk or unsweetened non dairy beverages,

Unsweetened applesauce and fat free or low fat whipped cottage cheese. Scrambled EggBeaters are permitted and may also be added to boiling broth for a higher protein soup Vitamins Your surgeons office will recommend when you should start taking your chewable vitamins usually after post op dietitian visit You will have brochures from vitamin companies in your discharge folderCall them and ask for free samples

Nausea/Vomiting Possible causes and what to do. Remember, the area under the diaphragm is tight and swollen for 2-3 weeks after surgery Eating too fast Start drinking slowly: one ounce per 30 minutes and progress to 3 ounces per 30 min as tolerated Not chewing well Eating too mucheyes bigger than your new stomach Drinking with meals Advancing diet too quickly

Medications to Avoid After Surgery For Sleeve patients there are not as many restrictions regarding NSAIDSCheck with your doctor

BUT for RNY Gastric Bypass, NSAIDS should be avoided NSAIDS- Non Steroidal Anti-Inflammatories- this category of drug is known to cause GI upset and to some extent the cause of ulcers Celebrex (celecoxib) Motrin, Advil (ibuprofen) Aspirin containing products Pepto-Bismol, Excedrin, Alka-Seltzer Aleve (naproxen) Tylenol Tylenol (acetaminophen) is safest

Headache Fever Pain WHEN IN DOUBT ASK YOUR DOCTOR OR A PHARMACIST! What to Expect Upon Discharge? You will go home with a script for pain and nausea meds OR the office will call in to your pharmacy You will continue to walk and sip, with rest episodes in between. Slow down, sip and advance the food and the amount carefully. The

post op period is about healing inside the new stomach Listen to your bodyit is ok if it takes 15 minutes in between bites. Call Dr Balsamas office for Chris 856-589-0600 [email protected] Call Dr.Neff, Fakulujo, Goldstein for Joann 856-665- 2017 [email protected] FILL OUT YOUR POST OP SURVEY.Send us your comments! We use this feedback for improvement!! At Home: Notify Your Surgeon IF:

If you have a temp >101.0 You will be given a digital thermometer in your discharge bag. Heart rate >100-120 beats per minute- Listen to teaching on finding a Radial Pulse elevated for more than 30 minutes. Increased stomach pain/shoulder pain Increased nausea Persistent vomiting Increased redness and drainage at incision sites If you think you are having a complication Call your surgeon and Come to STRATFORD!! CALL 911

Thoughts on Long Term Follow up Why is it important? Annual lab studies critical to keeping you well. A correlation to f/u for losing the weight and LT for keeping it off. As time goes by, metabolism changes, diets need to change LT issues, pouch stretch, Ulcer, Twists, Reflux We collect data and compare ourselves nationally to determine best practices We want to be sure YOU STAY WELL!

Fitness: Come check it out!! Class schedule and Support group meetings info in your discharge folderIn the Blue bag. RESOURCE PERSONNEL: Kennedy Hospital Program Coordinator: Peg Martin 856-3466470 THANK YOU FOR COMING TO THIS Certified Bariatric RN: Chris Arroliga, RN 856-701-8668 LEARNING EXPERIENCE Bariatric program RN: Joanne Bu RN 856-665- 2017

Lets Test and then go to see 4 East Appendix What questions do you have? What to Expect Day of Surgery? If you are having a Roux-en-Y surgery.. There is a rare possibility that you will wake up with a drain in place. It is usually removed in your

surgeons office during your first post-op visit

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