1	HOSPITAL-BEFORE, DURING, AFTER Ellen Hulme, RD, MPH Coastal Center for Obesity
2	Introduction Discuss what to expect, what might happen, what you can do. Office: 888-527-5222
3	Education Record Support Groups Formal: Western Medical Center, San Pedro, Las Vegas, others. Check www.coastalobesity.com for full schedule Informal: Friends, family, Internet for common problems Follow Up One week, one month nutrition class, three months, etc. Procedures, band adjustments, supplements
4	The Day Before Surgery Normal breakfast and lunch Light dinner (broth, crackers, yogurt) No food after 6:00 PM No fluids after 12:00 midnight
5	Day of Surgery - Medications Take medications per instructions of MD DO take blood pressure medications DO NOT take diabetes medications Bring list of allergies and medications to give to nurse
6	Day of Surgery - Transportation Arrive at hospital 3 hours before surgery –you will start early if the patient ahead is delayed You will need someone to drive you home after discharge
7	Apparel and Accessories RN will start IV & help you change into gown Foley catheter during operation Monitor hydration Collect urine Breathing tube during surgery Drain on left side to silastic bulb in 10-14 days
8	Timing Bypass surgery = One to two hours Lapband= One hour Pre-operative holding = Half hour Post-operative recovery = One hour
9	How to Prevent Complications Infection Pneumonia Blood Clots
10	Breathing Cough- Press pillow or apply pressure to abdomen Deep-breathe Use incentive spirometer Walk a lot If used abdominal binder should be worn around hips
11	Blood Clots/Embolisms Move legs and feet in bed Walk 4-5 times/day Heparin or equivalent Sequential compression stockings at night
12	Infection Keep incisions clean and dry Remove dressing, shower, new dressing afterwards Note appearance and smell of output from J-P drain Red to brownish to clear yellowish, odorless Decreasing output normal Leave drain in 10-14 days IV antibiotics day of surgery
13	Pain Management Intra-operative local anesthesia, patient controlled analgesia (PCA), epidurals, shots, oral medications—liquid Lortab usual Pain Scale: Rate from 1 (mild) to 10 (severe) Gas pain and referred pain Don’t suffer in silence
14	Inpatient Intake Selected liquids 2 oz until gi tract “wakes up” 5-6 HMR shakes/day and selected liquids after gi tract “awakens”
15	Odds and Ends Consider bringing… slip-on shoes bathrobe audio with headphones reading material Leave at home… jewelry, watches, cash, cell phone,weapons
16	Food & Supplements HMR shakes 4 weeks after gastric bypass 2 weeks after Lap-Band Take 1-2 HMR vitamin mineral supplements per day (crushed or blended) Use Micro K (potassium) when on shakes Supplements Gastric Bypass ONLY: sublingual B12 and iron Multiple vitamin chewable or capsule Calcium 1200-1500mg chewable or liquid