1. PERIOPERATIVE NURSING CARE OF THE MORBIDLY OBESE PATIENT

2. 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),

3. 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.

4. 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.

5. 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

6. 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

7. 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

8. INFLATED PATIENT TRANSFER PAD

10. ALLEN STIRRUPS

11. CANDY CANE STIRRUPS

12. PNUEMATIC LIFT FOR LITHOTOMY

14. 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

15. 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..

16. Duodenal Switch

17. Gastric Sleeve

18. 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!