Transcript Unit 31

Unit 31
Caring for
the Bariatric Patient
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Objectives
• Spell and define terms.
• Define overweight, obesity, and morbid
obesity, and explain how these
conditions are different from each other.
• Explain why weight affects lifespan
(longevity) and health.
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Objectives
• Define comorbidities and explain how
they affect a person’s health.
• Briefly state how obesity affects the
cardiovascular and respiratory systems.
• Explain how stereotyping and
discrimination affect persons with
obesity.
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Objectives
• List some team members and their
responsibilities in the care of the
bariatric patient.
• Explain why environmental
modifications are needed for bariatric
patient care.
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Objectives
• Describe observations to make and
methods of meeting the bariatric
patients’ ADL needs.
• List precautions to take when moving
and positioning bariatric patients.
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Objectives
• List at least five complications of
immobility in bariatric patients.
• Describe nursing assistant
responsibilities in the postoperative care
of patients who have had bariatric
surgery.
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Introduction
• People who are overweight weigh more
than they should
– According to standards based on height
and bone frame and size
• Obesity
– Considered being overweight by 20 to 30
percent of the ideal body weight
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Introduction
• Obesity negatively affects every body
system
– Risk factor for many other serious
problems, including a shorter life span
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Introduction
• Comorbidities
– Diseases and conditions that are either
caused by or contributed to by morbid
obesity
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Obesity
• Chronic condition with many causes
– Is often misunderstood
• People who are overweight and obese
– Are often recipients of unkind words,
behavior, and jokes
– May experience prejudice
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Obesity
• Experts believe that society's treatment
of, and response to the obese person
increases the risk for emotional
problems.
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Bariatrics
• Field of medicine
– Focuses on treatment and control of
obesity
– As well as medical conditions and diseases
associated with obesity
• Bariatric patients have many highly
specialized needs
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Bariatrics
• Treatment may be medical or surgical
• Some hospitals and long-term care
facilities
– Have special bariatric treatment units
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Weight and Body Mass Index
• Ideal body weight
– Concept developed from life insurance
statistics related to lifespan (longevity) and
health
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Weight and Body Mass Index
• Registered dietitian
– Calculates the ideal body weight (IBW) for
each patient
– Includes height, age, sex, build, activity,
medical condition, and need for nutrients
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Weight and Body Mass Index
• Body mass index (BMI)
– Calculation used to determine whether a
person is at a healthy, normal weight, is
overweight, or obese
• Ideal weight
– Considered as having a BMI that is less
than 26
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Weight and Body Mass Index
• People with obesity
– Have a BMI of 30-39
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Morbid Obesity
• Morbid obesity
– Having a BMI of 40 or above
– Being 100 pounds or more over the ideal
body weight
• People with morbid obesity
– Usually qualify for surgical treatment, or
bariatric surgery
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Morbid Obesity
• Super obesity
– Name for the condition that occurs when
the BMI exceeds 50
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Effects of Obesity
• Obesity
– Places great strain on heart and lungs
• Hyperventilation
– Breathing very fast and deep
– Results in excessive amounts of oxygen in
the lungs and reduced carbon dioxide
levels in the bloodstream
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Effects of Obesity
• Many obese patients hyperventilate
– Due to the weight of the chest and the
inability of the diaphragm to descend
during inhalation
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Interdisciplinary
Team Approach to Care
• Bariatric patients
– Have many special needs
– Many team members representing various
specialties are needed to care for them
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Interdisciplinary
Team Approach to Care
• Some facilities
– Have specialists called advocates
– They speak on behalf of the bariatric
patients
– Have special knowledge and skill in
bariatric health care
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Environmental Modifications
• Hospital room
– Must support the patients’ dignity, while
preventing potential infringement on the
rights of other patients
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Environmental Modifications
• Special equipment and furnishings
– Needed to care for bariatric patients
• Nursing assistant
– Must anticipate and plan for equipment and
supplies needed for patient care
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Assisting with ADLs
• Protect the patient’s dignity
• Avoid comments that are insensitive
about the patient’s size
• You may need to be creative and
modify personal care procedures
• Anticipate and prevent complications of
immobility
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Assisting with ADLs
• Skin is very sensitive to the effects of
moisture, pressure, friction, and shear
force
• Keeping skin clean, dry, and free from
rashes and breakdown are essential
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Assisting with ADLs
• Panniculus or pannus
– Fatty apron of abdominal skin
• Skin folds
– Susceptible to rashes, breakdown, and
painful yeast infections
– Keep clean and dry
– Use soft flannel to keep skin folds from
rubbing
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Nutrition and Hydration
• Despite the patient’s size
– Attention must be given to correcting
nutrition and hydration problems
– These are:
• Malnutrition
• Diabetes
• Eating disorders, including binging and purging
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Nutrition and Hydration
• Obese persons
– Have a greater volume of gastric fluid and
increased intra-abdominal pressure than
people of normal size
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Nutrition and Hydration
• Reflux
– Higher incidence in obese patients
– Backflow of fluid
• Stomach juices and food flow back from the
stomach into the esophagus and mouth
• Causes heartburn
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Moving the Bariatric Patient
• One worker
– Should never lift or move more than 35
pounds of body weight without extra help
or a mechanical device
• Four to six people
– May be needed to move or reposition the
total care patient safely
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Moving the Bariatric Patient
• Plan your care so sufficient help and
devices are available
• Moving the patient is a high risk
procedure for the nursing assistant and
patient
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Moving the Bariatric Patient
• Avoid moving the patient by tugging on
his or her body
– This increases the risk of injury to patient
and staff
• Use lifting devices, including slings,
draw sheets, and full sheets
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Moving the Bariatric Patient
• Support the patient’s body during and
after moving
– This reduces the effects of gravity, making
the move easier
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Complications of Immobility
• Bariatric patients are at very high risk of
complications of immobility
• To prevent complications
– New postoperative patients get out of bed
within 24 hours after surgery
– Or sooner, if possible
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Complications of Immobility
• Patients who are unconscious or
bedfast are at high risk of developing:
– Pneumonia
– Atelectasis
– Deep vein thrombosis (blood clots in legs)
– Pulmonary embolism (blood clot in lungs)
– Pressure ulcers
– Yeast infections in skin folds
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Bariatric Surgery
• Surgery on the stomach and/or
intestines
– This helps the patient with morbid or super
obesity lose weight
• Many different procedures may be done
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Bariatric Surgery
• Surgery may be done for persons with a
BMI over 40
– Or on those with a BMI over 35 with
potentially serious comorbidities, such as
heart disease or type 2 diabetes
– Refer to Figure 31-33
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Bariatric Surgery
• In some patients
– Comorbidities must be treated and
stabilized before surgery can be done
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Bariatric Surgery
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Bariatric Surgery
• All of the accepted bariatric surgeries
can be done by using a minimally
invasive (laparoscopic) technique.
• Minimally invasive surgery
– Procedure that can be done through a
small cut or incision
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Bariatric Surgery
• Miniature scopes and instruments
– Used to visualize and repair the organs on
the inside of the body
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Complications
• Patients who undergo bariatric surgery
– Have a 40 percent chance of developing
complications within six months
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Complications
• In some procedures
– Complications occur while the patient is
still in the hospital
– With others, complications may develop
weeks or months after surgery
• Surgeon will monitor for complications
for at least a year
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Complications
• Most common complications:
– Vomiting, reflux, and diarrhea
• Strictures
– Narrowing of a passageway may be
caused by inflammation or scar tissue
– Condition is also called stenosis
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Complications
• Approximately 7 percent of
complications are abdominal hernias
• Some patients develop infections or
pneumonia
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Complications
• Gastric leaks may occur when a staple
fails
– Stomach contents leak internally, creating
a serious or fatal infection
• Postoperative care
– Targeted to reduce pressure and strain to
both the internal and external staples
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Complications
• Blood clots and cardiac abnormalities
and rhythm disturbances may also
develop.
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Complications
• Signs and symptoms to report:
– Pulse/heart rate above 100
– Hypotension
– Feeling anxious, having a sense of
impending doom
– Hypoxia, decreased oxygen saturation,
signs of air hunger
– Fever above 102° F
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Complications
• Signs and symptoms to report:
– Abnormal appearance or volume in drains
– Signs or symptoms of wound infections
– Nausea, vomiting, or diarrhea
– Presence of blood in emesis or stool
– Persistent cough
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Continuing Care
• Diet is slowly advanced from ice chips
to liquids
• Monitor intake and output
• Patient is discharged on third day, if
stable
• Provide postoperative teaching
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