Post-Op Instructions
Postoperative Care
After your surgery, you will remain in the Recovery Room for up to two hours before going back to your room. Nurses will be monitoring your breathing, blood pressure, and heart rate closely. You will be asked to rate your pain a scale of 0-10 with a “0” representing no pain and “10” representing severe pain. It is important for you to communicate this information to your nurse. You will become aware of monitors and tubes such as intravenous (IV), oxygen or drainage tubes as you wake up. You may feel somewhat groggy, nauseated, and/or dizzy. Once you have met the discharge criteria, you will be transferred to your room.
The following pages will go over your post-operative surgery procedures. Most metabolic and bariatric patients are brought back to their room on the 2S surgical unit once fully awake. Upon arrival, the staff will be closely monitoring your vital signs and pain level. The staff will provide you with a copy of "Your Daily Recovery Goals" checklist. This will guide you and your family through your hospitalization.
- Intravenous Therapy: You will have an intravenous line for hydration and administration of medication.
- Pain The staff will assess your pain level on a scale of 1-10 with "0" being no pain and "10" being severe pain. Good pain control is important to ensure a quick recovery. It is our goal to keep your pain level less than "3" or at a level that is acceptable to you.
- DVT (Deep Vein Thrombosis) Prevention: You will have compression devices on your lower limbs. These devices are designed to compress the superficial veins in your legs to prevent blood clots from developing in your lower extremities. The compression devices will be removed while you are up and walking. Early ambulation is very important in preventing DVT's. You will also receive daily doses of a blood thinner to help prevent blood clots.
- Activity: Early activity is very important in preventing severe postoperative complications such as DVT's, pneumonia, and pulmonary embolism (a blood clot which develops in your legs and then travels to your lungs). You will be required to walk in the hall the first evening on your day of surgery. You will then be expected to walk in the halls at least 5-7 times daily.
- Respiratory Care: You will have oxygen delivered through a pain of small nasal cannulas placed in your nostrils. The staff will be monitoring your oxygen levels using an oximeter. This is a small clip like device which can be placed on a finger or earlobe. Patients with sleep apnea, you will be instructed on using your CPAP/BIPAP at night. You will also be placed on telemetry monitoring with continuous pulse oximetry. This means that both your heart rhythm and oxygen levels will be continuously monitored by staff in the critical care units. All patients will be expected to take deep breaths and cough every hour. The respiratory therapist or nursing staff will provide you with an incentive spirometer and Vibrapep. This deep breathing device is intended to assist you in your recovery and prevent respiratory complications. You will be expected to use your incentive spirometer and Vibrapep 10x every hour while awake as directed.
- Instructions for using a Spirometer:
Follow these simple instructions:
- Sit up as straight as possible. While in bed, sit up as far as you can.
- Hold the incentive spirometer upright
- Breathe out normally.
- Place mouthpiece in your mouth and tightly seal your lips around it.
- Inhale slowly and deeply to raise the small floating disk as high as you can.
- Hold your breath for 5 seconds. Remove the mouthpiece from your lips and exhale normally.
- Allow the floating disk to fall back to the bottom of the chamber.
- Hold your breath for 5 seconds. Remove the mouth piece and exhale normally
- Allow the floating disk to fall back to the bottom of the chamber. Rest for a few seconds and repeat. Remember this must be done at least 10 times per hour. As you work at it, the distance you move the floating disk will increase. This means you are moving larger volumes of air in and out of your lungs. This is what we want! It is important to continue with your deep breathing and coughing and your incentive spirometer once you are discharged home.
Diet & Discharge
Diet: You will not be able to take anything by mouth for the day of surgery except for ice chips. On Post Op Day 1. You will be advanced to a Clear Bariatric Liquid Diet. You will be given small medicine cups to drink from. These cups are graduated so you can keep track of how much you are drinking. The small cups also ensure that you are sipping small amounts at a time. NO STRAWS ARE ALLOWED. SOME MEDICATIONS WILL BE CUT, CRUSHED, OR IN LIQUID FORM. Let the staff know if you are experiencing any nausea. Your physician will have ordered medication to help alleviate and prevent nausea.
Prior to your discharge from the hospital, the nursing staff will provide you with specific discharge instructions. They will review this information with you and answer any questions. You will received specific instructions regarding activity, diet, incision care, medications, and respiratory care. You will instructed when your follow up appointment is set with your surgeon. This follow up appointment is usually made during your pre-op visit.
Dietary plan after the Orbera™ intragastric balloon placement
During the first week after placement, you may feel gastric discomfort. Your doctor may prescribe you with oral medication to help you with your symptoms. Reduce your chances of complications by following your doctor's instructions carefully. Complications may include nausea, vomiting, gastric perforation, bowel obstruction, and premature balloon deflation.
Let your stomach rest and adjust to the gastric balloon. Follow your doctor's instructions and stay hydrated throughout the day. For the first two to three days, you are recommended to drink clear liquids only. When your stomach adjusts to the balloon, you can intake more varieties of liquids. Some examples of clear liquids are water, ice chips, sugar-free popsicles, crystal light, and strained clear broth (i.e. chicken, beef, and vegetables stock).
- Drink 64 oz. (about 8 cups) of fluid, including water
- Follow your doctor's instructions
- Take vitamins and supplements as directed
- Focus on low calorie beverages such as water, nonfat milk, no-calorie flavored water, no-sugar added apple juice
- Avoid sodas and alcoholic beverages
- Avoid caffeinated coffee and caffeinated tea as it may lead to dehydration.
- Schedule a follow up visit with your doctor
- Water: Bottled, tap, spring, no-calorie vitamin-enrich water
- Light Tea
- Sugar-free Jello
- Clear chicken, beef, and vegetable stock
Full Liquid Diet: Day 2-7
At this point your body is adjusting to the balloon and after about two days you will be able to enjoy full liquids. Examples of full liquids include protein shakes and strained soup. Remember to take small sips and drink liquids slowly. Wait about one to two minutes between sips. Some individuals may have to wait as long as 10 minutes between drinks. It is important to have at least 8 cups of liquid intake per day to stay hydrated. If you are taking medications, please contact your medical staff to see they may have liquid or other alternatives. Clear liquids are also acceptable in this stage.
Follow your doctor's instructions and stay hydrated throughout the day. For the first three days, you are recommended to drink clear liquids only. When your stomach adjusts to the balloon, you can intake more varieties of liquids. Some examples of clear liquids are water, ice chips, sugar-free popsicles, crystal light, and strained clear broth (i.e. chicken, beef, and vegetables stock).
- Take your time between sips
- ake smaller sips to help your stomach adjust
- Fluid intake should not be less than 8 cups per day
- Meal replacement shakes can help meet your calorie intake (Contact your dietician or staff for more information)
Examples of a full liquid diet
- Everything in the Clear Liquid Diet Above
- Nonfat/Skim milk
- Low-calorie soy milk
- Weak coffee
- Vegetable soup without the chunks such as tomato, cauliflower, and pumpkin soup(strained)
- Low-Fat Yogurt
- Sugar-free popsicle
- Protein shake
Pureed Food: Week 2
During the transition from full liquid diet to a pureed food diet it is important to listen to your body to see if you will be able to tolerate puree foods comfortably. In about a week, you will be able to transition to the next consistency, which are soft foods. Make sure to only continue if you are able to tolerate foods in the previous step comfortably. It is not a race to get to the next step, take your time until you are comfortable to reach the next consistency stage. Remember to stop eating if you feel discomfort or pressure.
How to make a simple puree:
- Step 1: Cut food in to small pieces and place in to a food processor or blender
- Step 2: Add liquid (such as water, low fat chicken broth or apple juice) to cover the blades
- Step 3: Blend until smooth apple sauce like consistency
- Step 4: Strain out any pieces of food, seeds or lumps
- Step 5: Add spices to flavor the puree. Avoid hot spices such as hot sauce, cayenne, and jalapeno peppers)
- Cottage Cheese
- Pureed Soup
- Pureed Fruit
- Pureed Vegetables
- Baby Food
- Protein Smoothies
Soft Food: Week 3
In this stage, the transition is from puree to soft foods, is designed to prepare you to return to solid foods. Select soft foods that are low in calories, fats and carbs. Always listen to your body to see how well you are adapting to the current transition. Notice any feeling of discomfort, fullness or pressure. These may be signs to slow down or to stop eating completely.
- Use 20/20 rule: Chew food at least 20 times + a meal should take about 20 minutes to finish
- Eat Slowly
- Slow down or Stop eating if discomfort occurs
- Only progress to the next stage if you are comfortable with the current consistency stage
- Soft veggies (over cooked)
- Oatmeal
- Tofu
- Hummus
- Boiled Eggs
- Canned Chicken, Tuna, or Salmon
Solid Food: Week 4
The fourth week is the final dietary transition, which introduces solid foods in to the diet. This is the consistency of food that you will be able to eat from this point forward. The gastric balloon is designed to be a tool to re-train your appetite to help you with your weightless goals. Contact your dietician or clinical staff member if you have any problems, questions or concerns regarding diet and food intake.
- Introduce one solid food at a time and see how it makes you feel. Start with cooked foods before going to raw or hard foods
- Limit starches such as rice, bread and pasta as these foods can cause bad breath by sticking to the balloon
- Drink a glass of water 30 minutes before every meal
- Drink two glasses of water 30 minutes after each meal to rinse the balloon
- Refrain from drinking water during the meal
- Take a multivitamin as directed by your medical practice
- Avoid fried foods, instead bake, boil, barbecue or broil foods
- Limit use of oil, butter, cream, sugar, mayonnaise, jelly, jam, and margarine as they may be high in fat or sugar content.
- Fresh apples
- Fresh cucumbers
- Lean beef steak
- Grilled chicken breast
- Grilled salmon
- Steamed tilapia or halibut
- Salad with light vinaigrette
- Mini turkey meatballs
- Soft or hard boiled egg
- Spinach Frittata
- Cooked Carrots
- Chicken Sandwich
- Boiled Shrimp
Sample Food Guidelines For Orbera
- Food Types
- What is Allowed to Eat/Drink
- What to Avoid
Beverages-
- Water
- No calorie flavored water
- Decaffeinated teas & coffes
- Vitamin enriched water(sugar free)
- No sugar added coconut water
-
- Sodas
- Sugary beverages
- Sweetened juices
- Caffeinated beverages
- Alcoholic beverages
Dairy Products-
- Non fat milk
- Non fat yogurt
- Non fat dry milk powder
- Low-fat cheese
-
- Whole milk
- Sweetened & flavored milk
- High-calorie yogurt
- Full cream
- Whole milk cheese
Meat, Fish, Poultry, Eggs, & Legumes-
- High protein & lean meats, fish & poultry
- Steamed, grilled, or baked chicken/turkey
- Steamed, grilled, or baked fish
- Steamed, grilled, or baked steak
- Whole eggs, egg whites and egg substitutes
- Beans, peas, and lentils
-
- Fried foods
- Hot dogs
- High-fat ground meats
- High- fat Processed foods
- High-calorie fast foods
Fruits & Vegetables-
- All fruits are acceptable. However, limit the calorie intake on high-fat fruit such as avocado.
- All vegetables are acceptable. However, limit the calorie intake on starchy vegetables such as potatoes, yams, and corns
Grains & Starches-
- White rice, wild rice, red rice
- Sprouted grains
- Whole wheat bread
- Quinoa
- Light soup or with nonfat creamer
-
- French fries
- Croissants
- Popcorns
- High- fat soup
Fats-
- Low-fat or nonfat margarine
- Light cooking spray
- Low-fat mayonnaise
- Low-fat salad vinaigrettes
-
- High saturated fats
Sweets & Deserts-
- Sugar free popsicles
- Low-calorie/mini pies and cakes
- Sugar-free pudding
- Sugar substitutes (i.e. stevia/Splenda)
-
- Candy, caramel
- Ice cream
- High sugar and fat baking goods
- High sodium snacks
Dietary plan prior to the removal of Orbera™ intragastric balloon
Follow your doctor's instructions and meet the support team on a regular basis. After about 6 months, your doctor will perform a removal of the gastric balloon. You may be instructed to consume only fluids for 24 hours before the removal procedure.
