PERIOPERATIVE NURSING CARE OF THE MORBIDLY OBESE PATIENT

The Obesity Epidemic 67% are overweight or obese $117 billion spent in 2000 to treat the medical consequences of overweight and obesity 112,000 deaths/year attributed to obesity* Mokdad, A. H., Marks, J. S., Stroup, D. F., & Gerberding, J. L. (2004). Actual cause of death in the United States. Journal of the American Medical Association, 291 (10), 1238-1245.

Health Burdon Type 2 diabetes Hypertension Cardiovascular disease Stroke Dyslipidemias Osteoarthritis Cancers Sleep apnea Gall bladder disease Female infertility Psychological issues Obesity is recognized as a chronic, debilitating and potentially fatal disease. Obesity has approached smoking as a leading cause of preventable death.

SAFETY CONCERNS & SPECIAL EQUIPMENT HIGH BMI/ BARIATRIC PATIENT HAVE RIGHT TO BE TREATED W/ COMFORT, DIGNITY, RESPECT & PRIVACY CULTURE OF SAFETY FOR BOTH PATIENTS AND CAREGIVERS IDENTIFY MECHANICAL LIFTING EQUIP & APPPROVED PATIENT HANDLING TECHNNIQUES.

ASSESSMENT OF HIGH BMI/ BARIATRIC PT SENSITIVE TO PATIENT PERCEPTION- BEDS, GURNEYS, WHEELCHAIRS THAT FIT TALK TO THEM ABOUT WHAT TO EXPECT ASSESS AS ALL PATIENTS PLUS: GERD/CIRCULATION/ RESPIRATORY HIATAL HERNIA, SLEEP APNEA, ABDOMINAL GIRTH/JOINT ISSUES ANESTHESIA – WEDGE/ DIFFICULT INTUBATION CART DVT PREVENTION PHYSICAL ASSESSMENT CO-MORBIDITIES: DIABETES/ CAD

ROOM PREPARATION/ POSITIONING OR BED CAPACITY IN SPECIFIC POSITION STANDARD (1000#)/ REVERSE (#500) SAFETY STRAPS, GENERALLY AT LEAST TWO SETS TRANSFER SYSTEM ALREADY ON BED AWARE OF ANESTHESIA NEEDS US DOPPLERS GLIDE SCOPE LINE PLACEMENT WEDGE PILLOW EXTRA PILLOWS, GEL PADDING , EGGCRATE

POSITIONING CONSIDERATIONS SUPINE: ARMBOARD –ULNA/ HYPEREXTENSION/ NEUTRAL POSITION SAFETY STRAPS – THIGHS/ LOWER LEGS PILLOW UNDER KNEES – NEED HEEL PROTECTION REVERSE TRENDELENBERG- FOOTBOARD ARMSLEDS W/ PADDING IF NEED TO TUCK FOLEY INSERTION – GET ASSISTANCE TO ACHIEVE PROPER TECHNIQUE LITH: CANDY CANE – DO NOT LET LEG REST AGAINST POLE CREATIVE SIZING FOR ALLEN STIRRUPS HISTORY OF HIP INJURY/ TOTAL JOINT REPLACEMENT PRONE: LARGE GEL ROLLS/ RESPIRATORY/ PADDING/ PRESSURE POINTS ARMS MOVED CAREFULLY TO NEUTRAL POSITION LATERAL: AXILLARY ROLL/ PADDING/ ALIGNMENT INCLUDING HEAD/NECK PRESSURE POINTS – EAR,SHOULDER, HIP, LATERAL TO TOES

INFLATED PATIENT TRANSFER PAD

ALLEN STIRRUPS

CANDY CANE STIRRUPS

PNUEMATIC LIFT FOR LITHOTOMY

Gastric Band Decrease in appetite, good weight loss (loss of 45% of excess weight in 2 years) Slow but steady 2-3 pound weight loss per month 45 minute procedure, walking in hours, able to return to work in about 2 week

Roux-en-Y Gastric Bypass Good satiety, good weight loss (70-80% of excess weight in the first year, sometimes even in the first 6 to 8 months 1.5 to 2 hour procedure, walking within hours of surgery, back to work in about 2 weeks You change – tastes, activity, etc..

Duodenal Switch

Gastric Sleeve

TAKE HOME PROVIDE SUPPORTIVE & RESPECTFUL ENVIRONMENT OF CARE FOR ALL PATIENTS, REGARDLESS OF BMI! IDENTIFY MECHANICAL LIFTING EQUIPMENT AT YOUR INSTITUTION! GET HELP, SAVE YOUR BACK!