Morbidly obese patients

  1. Hi, I am a new grad and am working on a medical/tele unit. I cared for this obese patient last night, who recently had gallbladder surgery. She came to our hospital because she was having chest pain. She is very whiney and demanding and is unable to move or chooses not to move. It takes 6 people to move her safely. She won't do anything to help herself from using her IS to refusing blood transfusions for her extremely low H&H. The doc wanted to prep her for a colonoscopy but she refused the Miralax because she wanted a good nights sleep. When I offered her sleep medication to aide in her good night sleep she refused. This patient calls constantly when shift change is happening. This morning I went in to ask her a question she blew me off because she was on the phone. Any advice with dealing with this woman would be helpful, I can't understand how she can expect the nurses and docs to fix all her ills when she won't do anything to help herself. Has anyone had a patient similar to this????
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  2. 20 Comments

  3. by   miko014
    Yes! I feel like I've had millions of them! It sounds like she has "hotel syndrome" - in that she thinks she is in one. We had a pt not long ago who was a young man with pancreatic problems and DM type 1. He would just whine and whine, and be on his call light all the time. I once saw him come out to the nurses station and show his RN a cut on his finger She said "Oh yeah, it looks like you have a little paper cut." He said (very loudly), "But I haven't had any paper!" - he ws very upset about it. Never mind the book he was reading...silly me, I thought books were made of paper. But it was like he was just constantly after everybody. He once came and found me in the break room while I was taping report to ask me for something and HE WASN'T EVEN MY PT! My manager finally sat down with him and they made a contract. It said that he was to get off the phone when the RNs or MDs or anyone was in the room, he was not allowed to come to the station unless his call light had been on for more than 10 minutes, the RN would check with him once every x amt of time, etc, and they both signed it. It helped a little bit. The big thing was that we had to set limits with him. That's really what he wanted. I think maybe someone should talk to her about what her health goals are and why she is there. Maybe she hasn't been in the hospital much and doesn't "get it", or maybe there are some psych issues underneath that make her not want to do anything for herself? Just a suggestion! Hope it helps!
  4. by   suzy253
    Were you working 3-11 at my hospital last night? Sounds like almost the same patient that we have transferred from another floor...just the med problems were different.
    I just do the best I can do and document!
  5. by   tvccrn
    I think we have all had patients like this. I agree the aonther poster that said "hotel syndrome". I have always wondered why people come into the hospital if they are going to decline everything we try to do for them to help them recover.

    Just nit picking, but the title of the thread doesn't accurately reflect your post. It just happens to be one characteristic of your patient.

    tvccrn
  6. by   VivaLasViejas
    Quote from tvccrn
    I think we have all had patients like this. I agree the aonther poster that said "hotel syndrome". I have always wondered why people come into the hospital if they are going to decline everything we try to do for them to help them recover.

    Just nit picking, but the title of the thread doesn't accurately reflect your post. It just happens to be one characteristic of your patient.

    tvccrn
    Agreed. Please, let's not turn this into another thread bashing the obese....we already have enough problems as it is.
  7. by   NurseyBaby'05
    I was going to say something similar. The woman's obesity seems like it is secondary to her hotel syndrome. Many of our patients want to be waited on hand and foot (on their time schedule, I might add). I had a 18 yr old, 95 pound girl who was able to go out for a smoke q1h and roll around the bed with her boyfriend all night, but got really po'd at me because I handed her pillow cases for her pillows instead of putting them on and fluffing the pillows for her. I won't even get started with my urology patients (who have come in all shapes and sizes) and their wives.
  8. by   TazziRN
    There needs to be an interdisciplinary meeting about this pt. She needs to have the charge nurse AND her doctor tell her under no uncertain terms that she is there for a medical reason, and that if she refuses treatments and tests then there's nothing more you can do for her. And that she is to stop interfering with your jobs.
  9. by   Marie_LPN, RN
    To the OP:

    Perhaps this lady needs a psych consult, since there might be an underlying problem aside from the physical ailments.




    A side note:

    If her physical characteristic is what's limiting her ability to do these things for herself, it's a factor in all of the problems the OP listed. And perhaps the OP didn't know what to title the post, since they are new here.

    However, it would be nice to be able discuss anything about obesity on this forum without some people taking it all personally, but i know that's not going to happen.
  10. by   KIAN
    I agree with a multi-disciplanery plan to set goals for being able to take care of herself. Does she have or need help at home when she is dismissed? Sometimes we find it easier just to do things for them than to devise plans to help them or require them to do it on their own.
    This is a difficult patient to deal with. I know I don't have time to coddle them and I sometimes feel resentful (not at all nurse like) and blame their obesity for all their problems.
  11. by   Katnip
    One thing I fail to understand.

    What does her obesity have to do with her attitude? I've had many, many patients who behaved the same way or worse but were not obese.
  12. by   EmerNurse
    I think the OPs point wasn't to bash the obese but rather to point out that while ALL demanding patients will drive us nuts, it's a bit tougher when one of them requires more than just one staff member to do anything for her.

    I can reposition a 98lb PIA LOL by myself, get her on a bed pan even if I think she's perfectly capable of getting herself on the BSC, but with someone very very heavy, I have to pull other staff to help. That makes it harder.

    Not a bash on obese folks, just logistics.
  13. by   ortess1971
    Quote from cyberkat
    One thing I fail to understand.

    What does her obesity have to do with her attitude? I've had many, many patients who behaved the same way or worse but were not obese.
    I don't think her obesity is responsible for her attitude but when you have a patient who is morbidly obese,capable of moving, but refuses to, then there is a problem. In my hospital, we have a lift team who will come up with a hoyer lift rather than some nurse throwing out her back...I'm NOT bashing the obese, trust me. I'm a big girl but if I am capable of moving or at least helping, I'll do so.
  14. by   mandana
    SO, I'm not bashing the obese here, but I will say that I have had many obese patients that absolutely refuse to do anything for themselves. I HAVE had patients of all shapes and sizes with hotel syndrome, but I honestly do not recall an average sized patient ever refusing to reposition themselves, or to get up to use the restroom, or shower, while many obese patients that I've encountered have. I can even take it one step further - it's usually a female, usually between the ages of 30 and 40. (Again, not bashing - I fit two of the three mentioned categories).

    It got so bad while I was on the floor that I just refused to bathe or toilet these patients (when there was no medical reason for them to be unable to do so). I've got nothing against helping someone with these necessities except when they are physically capable of doing it themselves and refuse. It's NOT healthy to coddle them, IMO. They need to be encouraged to be active participants in their healthcare (and basic personal hygiene), if they still refuse, I feel as if they must be suffering from depression and will ask the MD to address that with the patient.

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