Toileting Morbidly obese patients?

  1. Does anyone have any tips or tricks or tools for toileting morbidly obese patients?
    For women, I've found that bedpans don't always work and sometimes the pee goes up.
    Men sometimes need help with a urinal because they can't reach down there.
    And some patients who can walk to the bathroom are unable to wipe themselves (they're too big), which becomes an issue if they have urinary frequency or diarrhea, and need assistance every 20 or 30 minutes...

    Ideas, suggestions? I've had some really frustrating shifts and want to come up with some ideas to meet the patients needs and make it easier on everyone. I work med-surg.

    Thanks.
    •  
  2. 15 Comments

  3. by   kanashe
    If Spread the legs a little bit;It helps keep the urine in the pan and not shoot up in the air or over the rolls.
  4. by   lwd338
    When I take them to the BR for a BM or the commode Ialways have them spread there cheeks wide apart when they sit so the BM just drops into the toilet and doesnt smear (sorry for the grossness)
  5. by   Dolce
    For the morbidly obese men I turn the urinal upside down--helps to prevent pee from getting all over the bed.
  6. by   Private Peds Nurse
    First of all, please be very sympathetic and ask the patient if there is anything you can do to help them with voiding and so on. It is very embarassing for most obese patients ( or anyone for that matter) to need help. When my mother was in ICU, she was incontinent for the first time in her life and I cried as I tried to help her so her modesty could be protected) Can you imagine how obese patients must feel. Lots of kindness and understanding not only helps the patient, but also helps to give you more patience and realize how blessed you are that you are the one who is assisting someone who desperately needs help and not the one needing help.
    I know some patients take a lot of extra tlc, but, remember they are someone family, and then what if this was your family or you. I know this sounds crude, but, please don't forget its frantic and embarrassing for the patient as well.
  7. by   RN007
    Quote from Private Peds Nurse
    First of all, please be very sympathetic and ask the patient if there is anything you can do to help them with voiding and so on. It is very embarassing for most obese patients ( or anyone for that matter) to need help. When my mother was in ICU, she was incontinent for the first time in her life and I cried as I tried to help her so her modesty could be protected) Can you imagine how obese patients must feel. Lots of kindness and understanding not only helps the patient, but also helps to give you more patience and realize how blessed you are that you are the one who is assisting someone who desperately needs help and not the one needing help.
    I know some patients take a lot of extra tlc, but, remember they are someone family, and then what if this was your family or you. I know this sounds crude, but, please don't forget its frantic and embarrassing for the patient as well.
    Thank you, PPN. I said in one of my old posts that it's an honor to be allowed to help patients with their toileting -- a very private activity for many. I was laughed at by some for saying it, but I will always feel that.
  8. by   leslie :-D
    wonderful post, private peds.
    thank you for that reminder.
    some day (which will come) we very well will require the assistance of those more fortunate.
    whenever i'm with a pt that is 'challenging' me, i am always humbled when i remind myself, this could be me.
    and my bad attitude is gone just like that.

    for ambulatory, obese pts, i'm not really concerned how they sit on the toilet.
    but when i wipe them, i have them lean on the sink so i can thoroughly wash them up.
    i have a ton of wipes, soap, towels waiting to be used.

    leslie
  9. by   madwife2002
    These poor people know they are a problem to others and I havent met one who wouldnt be a size10 or less if they could be. Most obese pts I have looked after have appologised for asking you to help for asking to be wiped, for asking for anything. If only we were all perfect
  10. by   jbudrick
    I am a nurse in home care. When we have a patient who is morbidly obese and has difficulty performing hygiene, we call in an Occupational Therapist. There are toileting sticks and other devices and procedures patient's can learn to enable them to perform their own hygiene. Good luck with your patients.
  11. by   CathyLew
    With the very obese using the bed pan, I take a soaker pad, and put it inbetween their legs, folded with the absorbent side out, and fanned out over their lower abdomen, to help hold the legs apart. That way any urine that shoots up gets soaked up in the pad, and at least saves a whole bed change.

    urnal same thing, urnal upside down, wedged with the soaker under and arround it. That way they think they are hitting the urnal, even if they don't. I just tell them the soaker pad is to keep the plastic edges of the urnal from hurting their skin.

    we do have a problem with the med surg bathrooms being too small to get into and help wipe the obese. Our hospital is very out of date. If an obese patient is in the bathroom, you can't even reach in sideways to help. Often times you have to have them back out of the bathroom and bend over. Our plumbing is also quite old, and we have had several obese person's try to pull themselfs up using the sink, and rip it right off the wall. Tell me that isn't a mess!

    and they want to start bariatric surgery at our hospital!
  12. by   traumaRUs
    If at all possible, try to get the pt to an oversized bedside commode. Some of the bariatric centers of excellence have many devices to help care for the morbidly obese. Often, taking them into a small bathroom does not work because of the confined space and inability to use the toilet due to weight restrictions on the toilet. I had an experience where an ambulatory 350# pt went to the BR, sat on the toilet (mounted on the wall) and the toilet fell, causing the pt to fall also.

    Here is an excellent article:

    http://enw.org/Obese.htm
  13. by   southernbeegirl
    our OT dept made a reacher thingy so that a patient we have could wipe herself. she cried she was so happy to be able to wipe herself.
  14. by   casperx875x
    I agree with ordering bariatric equiptment for your patients. Also, for females on a bedpan, have them bend/spread their legs as much as they can and place a pad between their legs. Any urine that doesn't make it into the bedpan will be absorbed by the pad.

close