### Reflective Journal
**Reflection on Bariatric Surgery Case**
**New Information Learned:**
Completing this assignment provided a comprehensive view of the multidisciplinary approach necessary for preparing a patient for bariatric surgery. I learned about the sequential steps involved, from initial consultations with weight management specialists to visits with dieticians, physician assistants, and bariatric surgeons. The importance of psychological evaluation and anatomical clearance via endoscopy were also highlighted. This detailed process ensures that the patient is thoroughly evaluated and prepared both physically and mentally for the surgery. Additionally, the post-operative care information, including monitoring vital signs, pain management, and assessing for potential complications such as urinary retention, provided insights into the critical aspects of patient management after surgery.
**Impact on Future Behavior as a Healthcare Professional:**
The knowledge gained from this case will significantly impact my future behavior as a healthcare professional. Understanding the comprehensive preparatory requirements for bariatric surgery will enable me to better support patients undergoing this procedure. I will prioritize ensuring that patients are well-informed about each step of the process and the importance of adherence to pre- and post-operative instructions. Recognizing the signs of post-operative complications will also allow me to respond promptly to any issues, ensuring patient safety and promoting recovery. This experience underscores the value of a collaborative, multidisciplinary approach in patient care, emphasizing the need for effective communication and coordination among healthcare providers.
**Reflective Flow and Application:**
Reflecting on this case study highlights the critical role of thorough preparation and comprehensive care in successful surgical outcomes. As a future healthcare professional, I will apply this understanding by advocating for patient education and engagement throughout the surgical process. I will also strive to maintain a high level of vigilance in post-operative care, ensuring that any deviations from expected recovery are addressed promptly. This holistic approach not only enhances patient outcomes but also fosters a supportive and trusting relationship between patients and healthcare providers.
### References
– Mayo Clinic. (2020). Bariatric surgery. Retrieved from https://www.mayoclinic.org/tests-procedures/bariatric-surgery/about/pac-20385189
– Mechanick, J. I., Youdim, A., Jones, D. B., Garvey, W. T., Hurley, D. L., McMahon, M. M., Heinberg, L. J., Kushner, R., Adams, T. D., Shikora, S., Dixon, J. B., & Brethauer, S. (2013). Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. *Obesity (Silver Spring, Md.)*, 21(Suppl 1), S1-S27. https://doi.org/10.1002/oby.20461
Completes reflective journal a. 150 word minimum reflection. b. Summarize new information learned by completing this assignment. c. Reflects on how the new knowledge will impact future behavior as a healthcare professional.
d. Logical reflective flow which follows standard grammatical rules with minimal (1-2) misspellings and APA where applicable.
Patient Information Nursing notes and assessment 5/12 Nursing Note: Client is working toward completing requirements needed for insurance payment for bariatric surgery.
● 12/06- Initial visit with weight management ● 01/06 – Dietician visit ● 02/12 – Visit with physician assistant for weight management ● 03/19 – Appointment with bariatric surgeon ● 04/10 – Appointment with a psychologist for clearance
Today, 05/12, the client is here for an endoscopy for approval of pre-bariatric surgery. The gastrointestinal provider will clear the client anatomically for surgery as well and a biopsy taken to rule out h-pylori.
6/12
The client was admitted this morning for Roux-en-Y gastric bypass surgery. The client has been working with weight management since December and has completed the requirements for insurance authorization. The client has met with the surgeon and signed consent on file. Anesthesia will meet with the client before the procedure. The client reported that she is “ready for the procedure but anxious.” The client has completed two-week liquid diet as prescribed by the surgeon. Has had nothing by mouth since midnight.
Neurologic: Alert, oriented x 4.
Cardiac: Regular, S1&S2 present, +1 edema in bilateral lower extremities, +2 pulses in radial and pedal pulses.
Respiratory: Lungs clear bilaterally, diminished in bases.
Gastrointestinal: positive bowel sounds x4 quadrants. Rounded, soft, non-tender to palpation
Genitourinary: indwelling catheter draining clear yellow urine
Integumentary: Intact, dry, warm, red discoloration to bilateral lower extremities
6/22
: Client post-op day 1. The client’s indwelling urinary catheter was removed at 0500 this morning. The client has not voided on her own. The client has a morse fall risk of 35. Ambulating independently in the room. Upon rising this morning, the client started her oral water intake of 15mL per hour.
Neurologic: Alert, oriented x 4. Drowsy
Cardiac: Apical rate 110, S1&S2 present. +1 edema in bilateral lower extremities, +2 bilateral radial and pedal pulses.
Respiratory: Diminished in bilateral lower lobes. Right upper lobes clear. Left upper lobes with mild wheezing
Gastrointestinal: Abdomen tender in all quadrants. Positive bowel sounds in all 4 quadrants, mild distention, rounded,
Genitourinary: Indwelling urinary catheter removed at 0500. No post-catheter void.
Integumentary: Four surgical incisions on the abdomen closed with surgical glue. Edges well-approximated
Pain: 4/10 in abdomen.
Date & Time Temp HR RR BP SpO2 O2
05/12 0730 98.6°F (37.0°C) 98 24 165/92 95% RA
06/21 0645 97.6°F (36.4°C) 112 20 168/96 96% RA
06/22 1000 99.8°F (37.7°C) 98 12 116/58 92% RA
Date & Time Weight BMI
06/21 0645 380 lbs. (172.4 kg) 58
06/21 1000 381 lbs. (173.2 kg) 58
Date Result
06/21 0645 147
05/12 0730 Client Information:
Medical History:
● Hypertension ● Osteoarthritis in bilateral knees and bilateral hips ● Obstructive Sleep Apnea ● Prediabetes (HA1c of 5.7 or higher) ● Morbid Obesity ● Polycystic Ovarian Syndrome ● Uncomplicated Varicella ● Urinary Tract Infection ● Depression
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