Lois Dixon, MSN, RN Clinical Nurse Educator, Genesis Medical Center, Davenport, IA Jan Foster, RN, PhD, MSN, CCRN Asst. Professor for Adult Acute and Critical Care Nursing Houston Baptist University, TX Mikel Gray, PhD, CUNP, CCCN, FAAN Nurse Practitioner and Professor of Urology, School of Nursing, University of Virginia, Charlottesville, VA Tracey Hotta, RN, BScN, CPSN Past-president, American Society of Plastic Surgery Nurses Toronto, Ontario, Canada Victoria-Base Smith, PhD(c), MSN, CRNA, CCRN Clinical Assistant Professor, Nurse Anesthesia, University of Cincinnati, OH Mary Sieggreen, MSN, RN, CS, NP Nurse Practitioner, Vascular Surgery, Harper Hospital, Detroit, MI Advisory Board c o n t i n u i n g e d u c a t i o n f o r n u r s i n g In This Issue Supported by an educational grant from Dale Medical Products Inc. Continued on page 5 Recovery Strategies from the OR to Home Vol. 6 No.4 I n the past decade, bariatric weight loss surgery has increased significantly from ap- proximately 486% from 1998 to 2002. At this rate of increase, by 2007, the number of bariatric surgeries will exceed 300,000 per year. Reasons for the dramatic increase are varied: increased awareness of mortality and morbidity related to obesity, failure of the diet and exercise programs and improvements in the surgical procedures. In this article, Daniel Drake, Maura McAuliffe and their colleagues describe the physiologic and psychosocial chal- lenges of obese patients and essential nursing skills for proper care of these patients in the immediate postoperative period. Tracheomalacia (TM) in an infant occurs when the cartilage in the trachea fails to develop properly. This causes the wall of the trachea to be flaccid, rather than relatively rigid, lead- ing to airway obstruction. The incidence of TM remains unknown, although this condition is more common than previously thought. Con- genital TM is estimated to affect approximately 1 in 1,445 infants. Acquired TM is caused by degeneration of the normal cartilaginous sup- port of the trachea. It occurs for a number of reasons: preterm neonates’ chronic ventilatory needs and traumatized airways due to endo- tracheal intubation. In her article, Dr. Verklan reviews the incidence, pathophysiology, and presenting symptoms of TM, along with man- agement strategies and their outcomes. T he number of bariatric surgeries in this country is increasing, and nurses require new knowledge and skills to care for the unique needs of morbidly obese patients after surgery. Nurses who provide care to bar- iatric-surgery patients must demonstrate clinical skills for safe, efficient, and quality care during the perioperative period. The purpose of this article is to describe the physiologic and psychosocial challenges of obese patients and essential nursing skills for proper care of these patients in the im- mediate postoperative period. The highly publicized obesity epidem- ic among children and adults has raised public awareness and concern about the health of our nation. Body mass index (BMI) is a measure often used to stratify patients based on their height and weight. BMI is calculated by using the following formula: BMI=kg/m 2 . A normal BMI is be- tween 19 and 26. From 1986 to 2000, the number of obese Americans (BMI of 30-39) increased two-fold, and those considered morbidly obese (BMI ≥40) increased more than four-fold. 1 This continued increase in obesity comes with a growing demand for bariatric or weight-reduction surgery. In 2002, Na- tionwide Inpatient Sample (NIS) estimated that 71,733 bariatric surgeries were per- formed in the United States. 2 This statistic represents a 436% rise from 13,386 surger- ies in 1998. If this rate of increase is main- tained, by 2007, the number of bariatric surgeries will exceed 300,000 per year. Bariatric surgeries All bariatric surgeries are conducted in one of two ways: non-laparoscopic Postoperative Nursing Care of Patients after Bariatric Surgery By Daniel J. Drake, RN, BSN, Maura S. McAuliffe, CRNA, PhD, FAAN, Melydia J. Edge CRNA, MSN, Christy C. Lopez, MS (open) method or laparoscopic (closed) method. The main difference between the two is the method of gaining access to the abdomen. The laparoscopic technique is be- coming popular, but variables in higher risk patients may lead surgeons to select the more traditional open technique. 3 This ap- proach is performed by making one long (8- to 12-inch) abdominal incision, so surgeons can access the stomach and intestines. The surgeon completes the procedure by closing the wound with sutures and staple closures. The laparoscopic or minimally inva- sive approach consists of making 5 to 6 small (1/4- to ½-inch) incisions in the abdo- men, through which the laparoscope and other instruments are inserted to carry out the operation. The laparoscopic procedure is performed inside the body after gas has been inserted to expand the abdomen. The incisions are closed with dissolvable inter- nal stitches and sterile strips on the skin. 4 The ability to perform surgery through the laparoscopic approach is a major contribut- ing factor to the increase in bariatric sur- gery. Obesity pathophysiology Bariatric surgery is performed on obese patients who usually have obesity-re- lated comorbidities, such as diabetes, hy- pertension, and sleep apnea. These patients are at higher risk for perioperative com- plications. Bariatric surgeons effectively minimize risks through surgical expertise, appropriate preoperative patient selection, and identification and management of pre- operative conditions that might otherwise contribute to poor outcomes. Knowledge of the surgical procedure