Unit 31

1. Unit 31 Caring for the Bariatric Patient

2. 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.

3. 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.

4. 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.

5. Objectives • Describe observations to make and methods of meeting the bariatric patients’ ADL needs. • List precautions to take when moving and positioning bariatric patients.

6. 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.

7. 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

8. Introduction • Obesity negatively affects every body system • Risk factor for many other serious problems, including a shorter life span

9. Introduction • Comorbidities • Diseases and conditions that are either caused by or contributed to by morbid obesity

10. 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

11. Obesity • Experts believe that society's treatment of, and response to the obese person increases the risk for emotional problems.

12. 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

13. Bariatrics • Treatment may be medical or surgical • Some hospitals and long-term care facilities • Have special bariatric treatment units

14. Weight and Body Mass Index • Ideal body weight • Concept developed from life insurance statistics related to lifespan (longevity) and health

15. 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

16. 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

17. Weight and Body Mass Index • People with obesity • Have a BMI of 30‑39

18. 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

19. Morbid Obesity • Super obesity • Name for the condition that occurs when the BMI exceeds 50

20. 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

21. Effects of Obesity • Many obese patients hyperventilate • Due to the weight of the chest and the inability of the diaphragm to descend during inhalation

22. Interdisciplinary Team Approach to Care • Bariatric patients • Have many special needs • Many team members representing various specialties are needed to care for them

23. 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

24. Environmental Modifications • Hospital room • Must support the patients’ dignity, while preventing potential infringement on the rights of other patients

25. 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

26. 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

27. 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

28. 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

29. 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

30. Nutrition and Hydration • Obese persons • Have a greater volume of gastric fluid and increased intra‑abdominal pressure than people of normal size

31. 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

32. 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

33. 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

34. 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

35. Moving the Bariatric Patient • Support the patient’s body during and after moving • This reduces the effects of gravity, making the move easier

36. 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

37. 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

38. 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

39. 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

40. Bariatric Surgery • In some patients • Comorbidities must be treated and stabilized before surgery can be done

41. Bariatric Surgery

42. 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

43. Bariatric Surgery • Miniature scopes and instruments • Used to visualize and repair the organs on the inside of the body

44. Complications • Patients who undergo bariatric surgery • Have a 40 percent chance of developing complications within six months

45. 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

46. 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

47. Complications • Approximately 7 percent of complications are abdominal hernias • Some patients develop infections or pneumonia

48. 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

49. Complications • Blood clots and cardiac abnormalities and rhythm disturbances may also develop.

50. 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