unit 31

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Unit 31

Caring for

the Bariatric Patient


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.


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.


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.


Objectives

• Describe observations to make and methods of meeting the bariatric patients’ ADL needs.

• List precautions to take when moving and positioning bariatric patients.


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.


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


Introduction

• Obesity negatively affects every body system– Risk factor for many other serious

problems, including a shorter life span


Introduction

• Comorbidities – Diseases and conditions that are either

caused by or contributed to by morbid obesity


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


Obesity

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


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


Bariatrics

• Treatment may be medical or surgical• Some hospitals and long-term care

facilities – Have special bariatric treatment units


Weight and Body Mass Index

• Ideal body weight– Concept developed from life insurance

statistics related to lifespan (longevity) and health



• Registered dietitian – Calculates the ideal body weight (IBW) for

each patient– Includes height, age, sex, build, activity,

medical condition, and need for nutrients



• 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



• People with obesity– Have a BMI of 30‑39


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


Morbid Obesity

• Super obesity– Name for the condition that occurs when

the BMI exceeds 50


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


Effects of Obesity

• Many obese patients hyperventilate – Due to the weight of the chest and the

inability of the diaphragm to descend during inhalation


Interdisciplinary Team Approach to Care

• Bariatric patients– Have many special needs– Many team members representing various

specialties are needed to care for them


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


Environmental Modifications

• Hospital room– Must support the patients’ dignity, while

preventing potential infringement on the rights of other patients


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


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


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


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


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



• Obese persons– Have a greater volume of gastric fluid and

increased intra‑abdominal pressure than people of normal size



• 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


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



• Plan your care so sufficient help and devices are available

• Moving the patient is a high risk procedure for the nursing assistant and 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



• Support the patient’s body during and after moving – This reduces the effects of gravity, making

the move easier


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


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


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


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


Bariatric Surgery

• In some patients– Comorbidities must be treated and

stabilized before surgery can be done


Bariatric Surgery


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


Bariatric Surgery

• Miniature scopes and instruments– Used to visualize and repair the organs on

the inside of the body


Complications

• Patients who undergo bariatric surgery– Have a 40 percent chance of developing

complications within six months


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


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


Complications

• Approximately 7 percent of complications are abdominal hernias

• Some patients develop infections or pneumonia


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


Complications

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


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


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


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

unit 31

Documents

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health copyright

obesity bariatric patients

bariatric patient care

bariatric patientcopyright

bariatric surgery

specialized needs copyright

bariatric patients adl