© Springer International Publishing Switzerland 2017Andrew Loveitt, Margaret M. Martin and Marc A. Neff (eds.)Passing the Certified Bariatric Nurses Exam10.1007/978-3-319-41703-5_28
28. Complications of Bariatric Surgery: Dehydration
Kennedy University Hospital, 18 East Laurel Road, Stratford, NJ 08084, USA
Lynn J. Stott
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The power of education for the preoperative bariatric patient can never be underestimated and can help prevent complications. With the limited length of the hospital stay, it is critical that all future bariatric patients are thoroughly informed on how to prepare for surgery, their hospital experience, and diet stages, how to recognize the basic needs of their bodies, and how to prevent complications. Nurses as well as medical staff should be sensitive to the potential lack of healthcare literacy and language barriers when educating bariatric patients. Furthermore, the entire clinical staff on the bariatric unit should receive updated bariatric education and continuing education courses annually to assure that they are giving the best possible care to the postoperative patients as well as recognizing complications early .
There are many potential bariatric postoperative complications, but one that is most likely preventable pertains to dehydration. Dehydration occurs when the body loses too much fluid. Signs and symptoms of dehydration include thirst, decrease in skin turgor, dry or cool skin, dry mucous membranes, constipation, low or minimal urine output, muscle cramps, tachycardia, hypotension, light-headedness, feeling dizzy, headache, fever, nausea, malaise, diaphoresis, irritability, confusion, and, in serious cases, delirium or loss of consciousness.
Postoperative monitoring of bariatric patients has revealed a large number of these patients require 1–3 l of intravenous fluid boluses to maintain adequate hydration. Furthermore, patients may have difficulty voiding, or a urine output of <100 mL per void with a foul odor and often a dark amber color. How can we prevent this?
All patients should undergo a bariatric preoperative education class. The topic of dehydration should be emphasized as a preventable complication. Patients may already be in a state of dehydration prior to arriving on their scheduled surgical day; thus, the education should be enhanced to include the following information :
The patient should be instructed to drink plenty of fluids the day before surgery, resulting in increased urination and light yellow to clear appearance of their urine.
A majority of patients have been found to have a lack of healthcare literacy and/or language barriers. The class information should visually reflect what the 64 ounces (almost 2 l) daily fluid requirement looks like by showing eight 8 ounce cups (240 ml) of fluid. Also the presentation should review the signs and symptoms of dehydration in simple terms.
A “urine color chart” should be placed in all the bariatric bathrooms, as well as in their gift bags for home, to remind the patient to drink enough fluids, resulting in urine that will look light yellow to clear in appearance.
It is challenging to reach the goal of 64 ounces of fluid per day due to the small stomach pouch limiting the stomach capacity to accept fluids. Also, patients should be taught the 30/30 rule, meaning they do not ingest fluids 30 min before a meal and wait 30 min after meals to prevent gastrointestinal symptoms and feelings of fullness. Consequently, patients can be instructed to start drinking early in the day, to sip fluids continuously during their waking hours, and to carry a beverage or sports drink with them at all times. They can be taught to be mindful if they are exercising or perspiring during warmer days, because the risk of dehydration quickly increases.
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