Nursing Care Plan | NCP Bariatric Surgery

Nursing diagnosis: ineffective Breathing Pattern related to Decreased lung expansion, Pain, anxiety, Decreased energy, fatigue, Tracheobronchial obstruction

Possibly evidenced by
Shortness of breath, dyspnea
Tachypnea, respiratory depth changes, reduced vital capacity
Wheezes, rhonchi
Abnormal arterial blood gases (ABGs)

Desired Outcomes/Evaluation Criteria—Client Will
Respiratory Status: Ventilation
Maintain adequate ventilation.
Experience no cyanosis or other signs of hypoxia, with ABGs within acceptable range.

Nursing intervention with rationale:
1. Monitor respiratory rate and depth. Auscultate breath sounds. Investigate presence of pallor and cyanosis, increased restlessness, or confusion.
Rationale: Respirations may be shallow because of incisional pain, analgesia, immobility, and obesity itself, causing hypoventilation and potentiating risk of atelectasis and hypoxia. Note: Many anesthetic agents are fat soluble, so the postoperative “resedation” and the potential for respiratory complications are increased.

2. Elevate head of bed 30 to 45 degrees.
Rationale: Encourages optimal diaphragmatic excursion and lung expansion and minimizes pressure of abdominal contents on the thoracic cavity. Note: When kept recumbent, obese clients
re at high risk for severe hypoventilation postoperatively.

3. Encourage deep-breathing exercises. Assist with coughing and splint incision.
Rationale: Promotes maximal lung expansion and aids in clearing airways, thus reducing risk of atelectasis and pneumonia. Note: Use of abdominal binder—properly fitted and placed at least 2 inches below the xiphoid process—can encourage deep breathing.

4. Turn periodically and ambulate as early as possible.
Rationale: Promotes aeration of all segments of the lung, mobilizing and aiding movement of secretions. Note: If client was a good candidate for bariatric surgery, she or he was probably relatively healthy before operation and is usually able to turn self, walk, and transfer to chair within 8 hours of surgery.

5. Pad side rails and teach client to use them as armrests.
Rationale: Using the side rail as an armrest allows for greater chest expansion.

6. Use small pillow under head, when indicated.
Rationale: Many obese clients have large, thick necks, and use of large, fluffy pillows may obstruct the airway.

7. Administer supplemental oxygen.
Rationale: Maximizes available O2 for exchange and reduces work of breathing.

8. Assist in use of blow bottle or incentive spirometer.
Rationale: Enhances lung expansion; reduces potential for atelectasis.

9. Monitor ABGs or pulse oximetry, as indicated.
Rationale: Reflects ventilation, oxygenation, and acid-base status. Used as a basis for evaluating need for and effectiveness of respiratory therapies.

10. Monitor patient-controlled analgesia (PCA) and administer analgesics, as appropriate.
Rationale: Maintenance of comfort level enhances participation in respiratory therapy and promotes increased lung expansion. Note: For the first 48 hours after the procedure, intravenous (IV) PCA is the method of choice. Oral medications are usually the next level of pain management.