Bariyatrik Cerrahi Sonrası Hemşirelik Bakımı

Abstract

Morbid obezite; beden kitle indeksinin (BKI) 40'ın üzerinde veya BKI 35 olup obeziteye eşlik eden hastalık bulunması olarak tanımlanmaktadır. Obezite ameliyatları üç gruba ayrılmaktadır. Bunlar kısıtlayıcı ameliyatlar, malabsorbsiyon (emilimi bozan) ameliyatları ve hem kısıtlayıcı hem de malabsorbsiyon ameliyatlarıdır. Obezite cerrahisinde dikey bant gastroplasti (VGB), ayarlanabilir mide bandı (AGB) ameliyatları gibi kısıtlayıcı ameliyatlar, Biliopankreatik Diversiyon (BPD)/duodenal switch (DS) ameliyatları gibi malabsorbsiyon ameliyatları ve Roux-en-Y gastrik bypass (RYGB) ameliyatları gibi hem kısıtlayıcı hem de malabsorbsiyon ameliyatları yaygın olarak yapılmaktadır. Bariyatrik cerrahi ameliyatları sonrası bakım, bir cerrah, bir endokrinolog, bir psikiyatrist, bir diyetisyen ve bir bariyatrik cerrahi tedavisinde uzmanlaşmış bir hemşireden oluşan multidisipliner bir ekibi içermelidir. Obezite cerrahisi sonrası hemşirelik bakımı, ameliyat sonrası erken bakım (1-3 gün) ve ameliyat sonrası geç bakım olarak değerlendirilmektedir. Bariyatrik cerrahi hastalarının uzman hemşirelik bakımında yakından gözlem, dikkatli ve tam değerlendirme önemlidir. Bariyatrik cerrahide hastalara oksijen ve hemodinamik monitarizasyon, ağrı yönetimi, mobilizasyon, yara bakımı, derin ven trombozu profilaksisi, erken ve sık ambulasyon, dren bakımı, sıvı dengesi beslenme, eğitim ve emosyonel destek gibi rutin ameliyat sonrası hemşirelik bakımı yapılır.

Keywords

• Obezite
• bariyatrik cerrahi
• hemşirelik bakımı

Post Bariatric Surgery Nursing Care

Abstract

Morbid obesity is defined as having a body mass index (BMI) above 40 or having a BMI of 35 and comorbidities along with obesity. Bariatric surgeries can be grouped into three. These are restrictive surgeries, malabsorption (impairing absorption) surgeries, and both restrictive and malabsorption surgeries. In bariatric surgery, restrictive surgeries such as vertical band gastroplasty (VGB), adjustable gastric banding (AGB) surgeries, malabsorption surgeries such as biliopancreatic diversion (BPD)/duodenal switch (DS) surgeries, and both restrictive and malabsorption surgeries such as Roux-en-Y gastric bypass (RYGB) surgeries, are commonly performed. Post-bariatric surgery care should include a multidisciplinary team consisting of a surgeon, an endocrinologist, a psychiatrist, a dietitian, and a nurse specializing in bariatric surgery. Nursing care after obesity surgery is evaluated as early postoperative care (1-3 days) and late postoperative care. Close observation, careful and complete evaluation are important in the specialist nursing care of bariatric surgery patients. In bariatric surgery, patients are provided with routine post-operative nursing care such as oxygen and hemodynamic monitoring, pain management, mobilization, wound care, deep vein thrombosis prophylaxis, early and frequent ambulation, drain care, fluid balance nutrition, training, and emotional support.

Keywords

• Obesity
• bariatric surgery
• nursing care

References

1. T. C. Sağlık Bakanlığı Sağlık Hizmetleri Genel Müdürlüğü. Obezite ve Metabolik Cerrahi Klinik Protokolü. Ankara; 2021. Available from: https://dosyamerkez.saglik.gov.tr/Eklenti/41294/0/obeziteklinikprotokolu13082021pdf.pdf
2. data.tuik.gov.tr [Internet]. Türkiye Sağlık Araştırması; 2019 [cited 2022 Jan 15 ]. Available from: https://data.tuik.gov.tr/Bulten/Index?p=Turkey- Health-Survey-2019 33661
3. Barth MM, Jenson CE. Postoperative nursing care of gastric bypass patients. Am J Crit Care. 2006 Jul;15(4):378-87.
4. Chebli JE. The current state of obesity, metabolism, and bariatric surgery. Bariatric Nursing and Surgical Patient Care. 2009;4(4):295-7.
5. Association of periOperative Registered Nurses. AORN Bariatric Surgery Guideline. AORN J. 2004;75(5):1026-52.
6. Harrington L. Postoperative care of patients undergoing bariatric surgery. Medsurg Nurs. 2006;15(6):357-63.
7. Ide P, Farber E, Lautz D. Perioperative nursing care of the bariatric surgical patient. AORN J. 2008 Jul;88(1):30-54.
8. Aygin D, Açıl H. Early stage nursing care in morbid obesity after bariatric surgery, Gümüşhane University Journal of Health Sciences. 2015;4(4):604-13.

9. Mulligan AT, McNamara AM, Boulton HW, Trainor LS, Raiano C, Mullen A. Best practice updates for nursing care in weight loss surgery. Obesity. 2009;17(5):895-900.
10. Elrazek AEMA, Elbanna AEM, Bilasy SE. Medical management of patients after bariatric surgery: Principles and guidelines. World J Gastrointest Surg. 2014 Nov;6(11):220-8.
11. Kaser NJ, Kukla A. Weight-Loss Surgery. Online J Issues Nurs. 2009;14(1):4.
12. Gallagher S. Taking the weight off with bariatric surgery. Nursing. 2004;34(3):58-63.
13. Sabuncu T, Kiyici S, Eren MA, Sancak S, Sönmez A, Güldiken S, et al. Summary of Bariatric Surgery Guideline of the Society of Endocrinology and Metabolism of Turkey. Turk J Endocrinol Metab. 2017;21:140-7.
14. Grindel ME, Grindel CG. Nursing care of the person having bariatric surgery. Medsurg Nurs. 2006;15(3):129-45.
15. Canadian adult obesity clinical practice guidelines: bariatric surgery: Postoperative Management. 2020;1-15. Available from: http://www.ihsm.gov.tr/indir/mevzuat/genelgeler/G_13082007_1.pdf
16. Virji A, Murr MM. Caring for patients after bariatric surgery. Am Fam Physician. 2006 Apr 15;73(8):1403-8.
17. Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Spitz AF, et al. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient. Obesity (Silver Spring). 2008;4(5):109-84.
18. Levi D, Goodman E, Patel M, Savransky Y. Critical care of the obese and bariatric surgical patient. Crit Care Clin. 2003;19(1):11–32.
19. Pieracci FM, Barie PS, Pomp A. Critical care of the bariatric patient. Crit Care Med. 2006;34(6):1796-804.