Help Educate a Nurse?
 

Afternoon folks!

I'm Susan and I'm a mod over in Weight Loss Support. Leenie and Jiffy will vouch for me. I'm not too much trouble ;)

I'd like to pick your brains, if you don't mind.

I'm a nurse in a small rural hospital in Ontario. In our health care system, we often get folks back from larger centers who need some more recovery time. Bowel resections, joint replacements ... In my opinion, it's only a matter of time until we start seeing WLS's.

In fact in the last couple of months I have had a pt who has had lapband and one who is considering WLS after we resolve some acute healthcare concerns.

While I'm sure we'll receive some kind of direction and inservice info ... I just thought I'd check in with you folks. I like all the info I can get.

To the best of my knowledge lapband is what's 'happening' around here.

My main concerns will be with remobilization, pain control and bowel routine.

I have a couple of specific questions but all info is appreciated.

Did you receive chest physio? Was chest health a priority?

Did you have an evolving pain control plan? For example PCA, then narcotics, then tylenol ...
Are analgesic suppositories ever used?

Was there a bowel care routine? Or were you left to contend with constipation if it occured?

Please feel free to ramble ... I'll read it all and tuck away what I need ;)

Thank you all!

To the best of my knowledge lapband is what's 'happening' around here.... I think there are more GBP than lapband at this site, but I'm not sure.

My main concerns will be with remobilization, pain control and bowel routine.
I have a couple of specific questions but all info is appreciated.

Did you receive chest physio? Was chest health a priority? No because my insurance did not require it. It really depends on the insurance company and the patients stats, because my BMI was lower than most WLS people (37) not much was required from me.

Did you have an evolving pain control plan? For example PCA, then narcotics, then tylenol ... while I was in the hospital I had percocet and also a prescription of it when I got home. I only needed about 5 days worth. After that if I got a headache I used liquid tylenol. Here's a list of meds we can and can not use http://www.3fatchicks.com/forum/showthread.php?t=85115

Are analgesic suppositories ever used? No

Was there a bowel care routine? Or were you left to contend with constipation if it occured? We were left on our own, but I don't remember having a problem since I was on liquids for about 3 weeks, then mushies, then solids. I'm sure there are folks that do have problems afterwards.


Hope this helps ;)

Oh sorry, I was a bit vague there. I meant that lapband is what I see happening around here geographically, as in close to home.

I wondered about chest physio mostly because gall bladder can be a bad one. The pain is close to the ribs and can inhibit deep breathing. I guess I kinda thought ... upper abdomen, ya know?

To the best of my knowledge lapband is what's 'happening' around here.... I had GBP.

My main concerns will be with remobilization, pain control and bowel routine.
I have a couple of specific questions but all info is appreciated.

Did you receive chest physio? Was chest health a priority? No, didn't have any chest issues and I don't have a Gallbadder. (out in 2002)

Did you have an evolving pain control plan? For example PCA, then narcotics, then Tylenol ...in the hospital they tried Morphine and it didn't work for me and switched me to Demoral...then Tylenol codeine (I think, I was still pretty out of it)...then Tylenol. Didn't need the codeine much more then once or twice though, didn't like the narcotic feeling and didn't have much pain.

Are analgesic suppositories ever used? No

Was there a bowel care routine? Or were you left to contend with constipation if it occurred? I was pretty much left on my own, too...but the surgeon recommended oat bran...not much help. I understand that the general anesthesia and messing with the digestive tract can cause the kind of bowel discomfort and gas I had. I resolved it with Benefiber, an enema and time.

To the best of my knowledge lapband is what's 'happening' around here.I had GBP

My main concerns will be with remobilization, pain control and bowel routine.

I have a couple of specific questions but all info is appreciated.

Did you receive chest physio? Was chest health a priority? Not sure what this is? I did have to have an echocardiogram, ekg and a stomach ultrasound. I know they were looking to see if I had any stones. If I did they would remove the gallbladder at the same time. I didn't.....

Did you have an evolving pain control plan? For example PCA, then narcotics, then tylenol ...I think I was on morphine in the hospital. I was released with liquid vicodin which made me sick. Right now I'm just taking tylenol (not liquid) cuz I can't stand the taste of the liquid. It barely takes the edge off the pain but I prefer this to the sick stomach from the liquid vicodin.

Are analgesic suppositories ever used? No

Was there a bowel care routine? Or were you left to contend with constipation if it occured? I sure wish this had been covered more. I have yet to have a BM and I am in quite a bit of pain from a huge gas bubble inside me. I have several books on WLS and they touch on constipation but recommend eating things I'm not allowed to yet (I'm only 6 days post-op) I came here to find out if an enema is ok at this stage. It seems this happens to many patients. I'm really surprised they don't give more information about it.

HI SUSAN!!! we're always happy to help you... and i've been spending the past couple of weeks on a freelance project - nasal carriers of staph and the implications for postop infections.

here's my two cents!!!

Did you receive chest physio? Was chest health a priority? here's the deal - no decent surgeon would put anyone through this if the patient hadn't passed a cardiothoracic check - and if there's been any doubt, that also includes respiratory function testing, ECG, echos. that doesn't mean that there wouldn't be problems, often due to the gas injection. BUT, some VERY serious chest complications [like emboli and pneumonia] can crop up LATER post-op, so everyone should be up and out of bed and moving, and speak up if they have ANY pain or chest discomfort later on. if someone has their gallbladder out, they'd pretty darn well be up and breathing while in the hospital as a condition of discharge. if you're seeing someone a few weeks postop with a fair amount of chest pain and difficulty breathing, it'll probably be something far more interesting and challenging!

Did you have an evolving pain control plan? For example PCA, then narcotics, then tylenol ...if you're expecting to get patients a few weeks after surgery, you won't have this to contend with. however, the other ladies are right. we often started with the morphine pump [that was WONDERFUL!!!!!], and then we're discharged on oral morphine derivatives - i thoroughly enjoyed the oxycontin. the good docs monitor our use, and really limit it. we then move on to acetominophen - NO NSAIDS!!! if someone has signs of bleeding and reports taking aspirin or ibuprofen, you have my permission to smack them upside the head!

Are analgesic suppositories ever used? I've heard of one or two people who've had them, but it's not very common

Was there a bowel care routine? Or were you left to contend with constipation if it occured? darlin - it's not just constipation!!!! some of us had frightful diarrhea. the key issues, assuming that the anastamosis hasn't come apart, include NOT ENOUGH WATER, NOT ENOUGH FIBER [even fiber supplements help] NOT ENOUGH EXERCISE. but it's also important to remember that the bowel may need a few days to sort of 'wake up,' but that's generally a requirement for discharge, at least with the bypass. it's not as big a problem with the lapband. so, my two cents for the wonderful nurses around here would be to make sure that patients understand basic bowel care. sounds gross to everyone else, but sometimes we forget the basics that our moms and grandmoms taught us!

Hi, Susan! Long time, no see! :hug:

I'm working my toward WLS, but not the band nor the RNY gastric bypass. I am having a Duodenal Switch (DS). I know it is less common, but I do know some people in Ontario are having it done (I've spoken with some Canadian folks online about it).

With the RNY gastric bypass, patients are not supposed to have NSAIDS after surgery since they have a blind stomach, and ulcers are a large concern. This is not a restriction for the other procedures (banding, DS, and vertical sleeve gastrectomy).

For all WLS procedures, I've been told that patients need to be up and walking the same day they get out of surgery.

I've heard most patients have the morphine pump when they come out of surgery, but most people I've spoken to haven't needed anything major once they leave the hospital (folks I've spoken to who have lad the surgery laparoscopically typically stay over 2 nights after surgery, 3 nights for open surgery, assuming there are no immediate complications).

I haven't had my surgery yet, but I have previously had open abdominal surgery, and my father recently had an open abdominal surgery as well. I think the majority of the issues are the same for almost any abdominal surgery--walking asap (and likely the cuffs on the legs that inflate to apply pressure when laying in bed), morphine pump initially, some may come out of surgery with a drain or 2, BM before being released (possibly bad diarrhea)...

I'm not sure what a chest physio is, but as others have mentioned, I think most have EKC/ECG prior to surgery as part of pre-op testing. I know I will (I'm participating in a study, so I'll have all kinds of tests done before and after surgery).

Chest physio? exercises especially for deep breathing and preventing pneumonia.

Early ambulation is the most common however deep breathing, coughing, postural drainage and incentive spirometry are more agressive.
I'd expect to use those for someone who's compromised by congestive heart failure, recurrent chest infections, smokers, supplemental oxygen dependent ...

Perhaps in bigger centres the respiratory team does this. We just have a physiotherapist ... and us nurses.

Yup, that may definitely be a factor in different experiences.

OHHHHH right! Yes, they had me cough and do the beathing exercises. Silly me. LOL

Angela

I have a spirometer, and was told to use it 10 times per hour. I think it really helped -- I had a lot of phlegm and congestion post-op.