Perspectives is committed to providing timely and relevant information on postoperative recovery strategies. Our articles focus on the continuum of care from operating room to recovery room, ward, or home. Perspectives strives to provide pertinent, pragmatic information, continuing education, and gudelines to maximize nurses' ability to enhance patient outcomes and minimize secondary (iatrogenic) problems. Our articles are authored by nurses, who have in depth knowledge and experience in a broad range of clinical specialties, and are reviewed by our advisory board. We welcome opinions and suggestions from our readers. In each issue, we will provide our readers with an opportunity to earn continuing education credits.

Tracheostomy in the Mechanically Ventilated Patient
by Tim Op’t Holt EdD, RRT, AE-C, FAARC

Tracheostomy is a common procedure in the intensive care unit (ICU), often performed to facilitate long-term mechanical ventilation and tracheobronchial hygiene. There has been much discussion about the type of tracheostomy procedure (percutaneous dilational versus open surgical), the effect of timing of tracheostomy on length of stay, weaning from ventilation, cost of care, and the incidence of nosocomial pneumonia related to tracheostomy.

Body contouring after massive weight loss
By Susan Gallagher Camden RN, CWOCN, PhD

Increasingly, people having bariatric surgery are requiring some type of reconstructive procedure to manage redundant skin that often remains after massive weight loss. Although the term bariatrics has recently become strongly associated with weight loss surgery, it holds a much broader meaning.1 Bariatrics is derived from the Greek word baros and refers to the treatment of obesity and its associated conditions.2 Therefore, the specialty of bariatrics includes weight loss surgery, medical weight loss programs, reconstructive surgery and more. The thread tying each of these specialties together is the uniqueness of this patient population. Many bariatric patients are embarrassed by their physical appearance and are often reluctant to accept care for a variety of reasons. Physical assessment, for instance, can be challenging. Equipment as common as a blood pressure cuff that is poorly fitted will affect accurate assessment.3 Many individuals report emotional concerns related to past health care experiences. Categories of obesity are described along with commonly recognized etiologies. Documentation for reimbursement, surgical options and informed consent are reviewed. Clinical care is presented along with ideas for tools and resources, including preplanning for unexpected outcomes.

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