Clinical profile, nursing diagnoses and nursing care for postoperative bariatric surgery patients

Steyer, Nathalia Helene; Oliveira, Magáli Costa; Gouvêa, Mara Regina Ferreira; Echer, Isabel Cristina; Lucena, Amália de Fátima

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Brasil

Revista Gaúcha de Enfermagem

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Brasil

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Sumário

Original Article • Rev. Gaúcha Enferm. 37 (1) • 2016 • https://doi.org/10.1590/1983-1447.2016.01.50170 copy

Clinical profile, nursing diagnoses and nursing care for postoperative bariatric surgery patients

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To analyze the clinical profile, nursing diagnoses, and nursing care established for postoperative bariatric surgery patients.

Method

Cross-sectional study carried out in a hospital in southern Brazil with a sample of 143 patients. Data were collected retrospectively from electronic medical records between 2011 and 2012 and analyzed statistically.

Results

We found a predominance of adult female patients (84%) with class III obesity (59.4%) and hypertension (72%). Thirty-five nursing diagnoses were reported, among which the most frequent were: Acute Pain (99.3%), Risk for perioperative positioning injury (98.6%), and Impaired tissue integrity (93%). The most frequently prescribed nursing care were: to use protection mechanisms in the surgical patient positioning, to record pain as 5th vital sign, and to take vital signs. There was an association between age and comorbidities.

Conclusion

The nursing diagnoses supported the nursing care prescription, which enables the qualification of nursing assistance.

Bariatric surgery; Nursing diagnosis; Nursing care

Characteristics	F (%) n (143)
Age (years) *	39.9 ± 10.1
Gender (female)	120 (84)
Length of stay (pre- and postoperative period in days) *	6.3 ± 1.6
Body mass index (Kg/m²)
Class III obesity (> 40)	85 (59.4)
Class I and II obesity (30-39.9)	45 (31.5)
Overweight (25-29.9)	6 (4.2)
Normal weight (< 24.9)	7 (4.9)
Smoking status
Non-smoker	119 (83.2)
Smoker	13 (9.1)
Abstinent smoker	11 (7.7)
Comorbidities
Hypertension	103 (72)
Osteoarticular disorders	43 (30)
Anxiety and/or depression	38 (26.5)
Diabetes mellitus	34 (23.7)
Ventilatory disorders	33 (23)
Dyslipidemia	26 (18.1)
Biliary lithiasis	22 (15)

Nursing Diagnoses	F	%	Related Factor / Risk Factor	F	%
Acute pain	142	99.3	Trauma*	142	100

Risk for perioperative positioning injury	141	98.6	Situational vulnerability*	141	100

Impaired tissue integrity	133	93	Mechanical trauma*	133	100

Risk for infection	127	88.8	Invasive procedure	127	100

Imbalanced nutrition: more than body requirements	87	60.8	Emotional and/or psychiatric changes	85	97.7
Imbalanced nutrition: more than body requirements	87	60.8	Deficient knowledge	2	2.3

Risk for imbalanced nutrition: more than body requirements	85	59.4	Dietary habits	85	100

Impaired physical mobility	82	58	Obesity	47	56.6
			Trauma	25	30.1
			Pain	8	9.6
			Neuromuscular/musculoskeletal impairment	2	2.4

Impaired comfort	75	52.4	Postoperative period	48	64
			Decreased peristalsis	26	34.7
			Aerophagy	1	1.3

Risk for imbalanced fluid volume	25	17.5	Drug therapy Changes in the gastrointestinal tract	24 1	96 4


Bathing/hygiene self-care deficit**	20	14	Wound pain	11	55
			Trauma	6	30
			Restrictive therapies	2	10
			Neuromuscular/musculoskeletal impairment	1	5

Actual NDs	Nursing care	F	%
Acute pain (n=142)	To record pain as the 5th vital sign	83	58.5
	To request assessment	26	18.3
	To calm down the patient	20	14.1
	To take vital signs	10	7
	To request the presence of a family member	2	1.4
	To assess pain using the intensity scale	1	0.7

Impaired tissue integrity (n=133)	To rotate the site of subcutaneous injections	65	48.9
	To perform dressings	22	16.5
	To sit patients on the chair	13	9.8
	To protect the skin of bony prominences	7	5.3
	To rotate the site of capillary glucose monitoring	7	5.3
	To monitor bleeding	6	4.5
	To observe puncture site and sites of catheter insertion	3	2.3
	To maintain specialty mattress, as appropriate	2	1.5
	To observe signs of infection	2	1.5
	To perform a compressive dressing	2	1.5

Impaired tissue integrity (n=133)	To implement care with venipuncture	1	0.8
	To observe perineal status	1	0.8
	To change patient’s position in bed	1	0.8
	To take vital signs	1	0.8

Imbalanced nutrition: more than body requirements (n=87)	To take vital signs	75	86.2
	To take patient’s weight	9	10.3
	To stimulate the patient to walk	1	1.1
	To guide the patient	1	1.1
	To provide health education and performing referrals	1	1.1

Impaired physical mobility (n=83)	To sit patients on the chair	20	24.1
	To stimulate the patient to walk	18	21.7
	To maintain specialty mattress, as appropriate	8	9.6
	To take vital signs	7	8.4
	To stimulate the patient to leave the bed	5	6
	To keep the bell within reach of patients	5	6
	To keep the head of the bed elevated	3	3.6
	To keep the bed rails	3	3.6
	To hydrate patient’s skin	2	2.4
	To provide a comfortable position to the patient	2	2.4
	To change patient’s position in bed	2	2.4
	To evaluate circulatory status	1	1.2
	To report changes in limbs	1	1.2
	To stimulate active movements	1	1.2
	To give pain medication before the procedures	1	1.2
	To guide patients and family members on changes in lifestyle	1	1.2
	To make patient’s body hygiene in the shower	1	1.2
	To record pain as the 5th vital sign	1	1.2
	To calm down the patient	1	1.2

Impaired comfort (n=73)	To measure waist circumference	23	30.7
	To provide safety and comfort	18	24
	To report abdominal distension	17	22.7
	To keep the bell within reach of patients	10	13.3
	To provide a comfortable position to the patient	3	4
	To stimulate respiratory exercises	2	2.7

Bathing/hygiene self-care deficit (n=20)	To stimulate oral hygiene	4	20
	To make patient’s bodily hygiene in the shower	3	15
	To take the patient to the shower	2	10
	To give pain medication before the procedures	2	10
	To perform oral hygiene	2	10
	To assist in showering	1	5
	To assist the patient in performing oral hygiene	1	5
	To stimulate self-care	1	5
	To keep the perineum clean and dry	1	5
	To comb patient’s hair	1	5
	To perform a bed bath	1	5
	To take vital signs	1	5

Risk NDs	Nursing care	F	%
Risk for perioperative positioning injury (n=141)	To use protective mechanisms in the surgical patient positioning	115	81.5
	To use protective boots for malleolus and calcaneus	19	13.5
	To use safety cushions and protective strips in surgical positioning	6	4.2
	To remove excess detergent fluid	1	0.7

Risk for infection (n=127)	To take vital signs	28	22
	To perform dressings	21	16.5
	To observe signs of infection	17	13.3
	To implement care with venipuncture	16	12.6
	To implement care for the prevention of infection according to CCIH** guidelines	15	11.8
	To implement care with serotherapy	8	6.3
	To instruct the patient on the importance of body hygiene	5	3.9
	To guide the patient on self-care	3	2.4
	To implement care with delayed vesical probe	2	1.6
	To observe puncture site and sites of catheter insertion	2	1.6
	To record the appearance of the lesion	2	1.6
	To implement care by administering medication	1	0.8
	To implement care with serotherapy	1	0.8
	To implement care in changing dressings of central venous catheter	1	0.8
	To implement care in the handling of central venous catheter	1	0.8
	To observe suture status	1	0.8
	To guide patient / family members	1	0.8
	To perform a medium dressing	1	0.8
	To calm down the patient	1	0.8

Risk for imbalanced nutrition: more than body requirements (n=85)	To take vital signs	75	88.2
	To take patient’s weight	9	10.6
	To stimulate the patient to walk	1	1.2
	To guide the patient	1	1.2
	To provide health education and perform referrals	1	1.2

Risk for imbalanced fluid volume (n=25)	To measure urine output	7	28
	To take vital signs	5	20
	To implement care with serotherapy	4	16
	To control the drip of intravenous infusions in the infusion pump	3	12
	To perform total water balance	3	12
	To monitor bleeding	2	8
	To take patient’s weight	1	4

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[1] Corresponding author
: Amália de Fátima Lucena E-mail: afatimalucena@gmail.com