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 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!