Background
Diabetes is a common disease that affects metabolism and how the body processes food into energy. In the US, over 100 million individuals are diagnosed with diabetes or pre-diabetes. Out of that number, over 80,000 diabetics die each year from diabetes-related causes. At the same time, the number of new cases of diabetes grows by 1.5 million cases per year. As it is possible to see, diabetes is a significant health hazard that keeps spreading among the population at an incredible rate.
Diabetes is spread into three groups, including type 1, type 2, and gestational diabetes. Type 1 diabetes is thought to be caused by the imperfections and alterations in the autoimmune system. It is not a very common form of diabetes, which comprises only 5-10% of the entire diabetic population. Type 2 diabetes is much more common, comprising roughly 90% of patients. It affects the capacity of the individual to produce insulin, which is necessary to maintain blood sugar balance. Finally, gestational diabetes is a kind of affliction that occurs in pregnant women, for the duration of their pregnancy.
Bariatric surgery is one of the primary surgical means of dealing with the symptoms of type 1 and type 2 diabetes. It is a type of surgery that helps individuals reduce their weight (one of the primary symptoms of diabetes) by inserting a foreign object into the stomach that fills out the cavity, effectively reducing the individual’s capacity to eat too much. It is also associated with numerous post-operational complications that could be dealt with at the nursing care level.
Literature Review
Bariatric surgery is one of the primary means of weight reduction in type 1 diabetes patients diagnosed with obesity. Kirwan et al. (2016) reports that the surgery, involving gastric bypass in 70-80% of all cases, managed to successfully reduce the weight of the patient in the scope of the next 6 months and up to a year. The adverse negative effects as reported by Kirwan et al. (2016) may involve bleeding, gastrointestinal leaks, marginal ulcers, and hypoglycemia. The research reports that sleeve gastrectomy is a recommended way of ensuring post-operational feeding in patients, as it results in better absorption of carbohydrates and fat-soluble nutrients, thus reducing the risks of hypoglycemia (Kirwan et al., 2016).
For type 2 diabetes, bariatric surgery is typically used when their BMI is at 35 kg/m2 or higher (Kashyap, Gatmaitan, Brethauer, & Schauer, 2010). The research by Kashyap et al. (2010) indicates that different approaches to bariatric surgery have different outcomes on diabetes, as one method involves gastric restrictive procedures, while the other relies on malabsorption in order to achieve a diabetic remission.
Patients that have underwent bariatric treatment are primary candidates for being treated in the ICU (O’Donnel & Nacul, 2016). The operation places additional stress on all bodily systems, but namely the gastrointestinal tract, lungs, and heart (O’Donnel & Nacul, 2016). Little information is available on the existing practices, but the majority of ICU treatments seem to be aimed at predicting and eliminating the chances of adverse effects happening (O’Donnel & Nacul, 2016).
Thorell et al. (2016) elaborates on the points touched by O’Donnel and Nacul (2016) by providing a framework for post-operative and perioperative care nurses that have to treat bariatric patients. The primary actions to prevent adverse effects involve consultations, rehabilitation and exercise, cessation of smoking and alcohol, postoperative analgesia, dieting, oxygenation, the use of and noninvasive ventilatory systems. These actions help alleviate the impact on the hormonal and gastrointestinal systems, as well as lungs (Thorell et al., 2016).
The primary requirements for modern bariatric postoperative care are its continuousness and adherence to the potential problems a patient may experience. Juo, Khrucharoen, Sanaiha, Chen, and Dutson (2018) report that fragmentation of care results in the higher rates of mortality during the first 30 days of post operational care. Reavis, Barett, and Kroh (2018) also state that the incorrect estimation of patient risks is directly linked to poor performance (placing an unstable patient in a non-ICU unit).
Rationale
Obesity is one of the major risk factors that promotes the progression of diabetes. Weight loss control is one of the primary tools in alleviating the symptoms and enjoy a better standard of living. In some individuals that have physical and psychological inclination for overconsumption, bariatric surgery is the primary means of weight loss. It also helps deal with the remission of diabetes in most patients, restores glycemic control, and increases insulin secretion. The effectiveness of bariatric surgery is directly connected to post-treatment care and regimen.
Research Objectives
- Assess the knowledge of post-operational care in diabetic bariatric surgery;
- Identify gaps in the existing research;
- Propose alterations to the existing guidelines on post-operational nursing care.
Research Questions
- What are the existing practices utilized in post-surgery bariatric care?
- What barriers exist to these practices and how could they be overcome?
- What potential improvements could be suggested to inform the existing practice?
Method
The proposed research method for this paper is a substantive literature review. Qualitative and quantitative information will be extracted from peer-reviewed academic journal articles dedicated to the subject. The materials for research will be taken from various electronic databases, such as PubMed, CINAHL, and Cochrane library. All articles would have to be recent, published within the last 10 years. Older articles would be permissible for areas that do not require recently-acquired data. The articles would then be manually syphoned through in order to reduce the total amount of material, after which it would be processed and coded.
References
CDC. (n.d.). About diabetes. Web.
CDC. (2017). New CDC report: More than 100 million Americans have diabetes or prediabetes. Web.
Juo, Y. Y., Khrucharoen, U., Sanaiha, Y., Chen, Y., & Dutson, E. (2018). Postoperative care fragmentation is associated with increased 30-day mortality after bariatric surgery. Obesity Surgery, 28(12), 3795-3800.
Kashyap, S. R., Gatmaitan, P., Brethauer, S., & Schauer, P. (2010). Bariatric surgery for type 2 diabetes: weighing the impact for obese patients. Cleveland Clinic Journal of Medicine, 77(7), 468-476.
Kirwan, J. P., Aminian, A., Kashyap, S. R., Burguera, B., Brethauer, S. A., & Schauer, P. R. (2016). Bariatric surgery in obese patients with type 1 diabetes. Diabetes Care, 39(6), 941-948.
O’Donnell, J. M., & Nácul, F. E. (Eds.). (2016). Surgical intensive care medicine. New York, NY: Springer.
Reavis, K. M., Barett, A. M., & Kroh, M. D. (2018). The SAGES manual of bariatric surgery. New York, NY: Springer.
Thorell, A., MacCormick, A. D., Awad, S., Reynolds, N., Roulin, D., Demartines, N., … & Lobo, D. N. (2016). Guidelines for perioperative care in bariatric surgery: enhanced recovery after surgery (ERAS) society recommendations. World Journal of Surgery, 40(9), 2065-2083.