Super Obese

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in my unit we have had many super obese (500lbs+) pts. Most have been complete care. We only use lifts to get pts oob. it is very difficult to care for such pts because of the logistics and staffing requirements involved. Turning can involve up to 5-6 people. On night shift that might be all/most of the staff. If someone has to be cleaned up that could mean no other nurses or aides on the floor for other pts. And you have to wait for every employee to be available. Hope no other nurse is getting admissions or post ops. Actually lifting skin folds to clean is very exhausting. Depending on the staff working ,5-6 of us can weigh less than the pts. Yes ,I lift weights and the more I get into it , the more it helps but only to an extent. . It is a huge challenge to keep these pts clean and dry and staffing is not increased for it. I have never worked with any lift aside from the hoyer so I don't see how they can help with things like lifting up legs or arms for dressing changes. think a local hospital is rebuilding an area to add bari rooms to accomadate pts but the issue for me is the staffing required to care for such pts. I really hesitated on posting this because I can see it not being well received but I think this part of the "obesity epidemic" and its impact on health care discussed often enough.

Everything you say here I agree with. All of it. The bolded is actually what I mean to say, only with a bit more sympathy than I used. But please understand that I'm not vilifying the obese (or alcoholic or drug addict for that matter). I was simply saying that I do not believe that it should be classified as a disease because it is within the "victims" grasp to help themselves. You yourself say that they should not be absolved of responsibility.

I just get so tired of ppl (not necessarily you) who enable others, you know? Even as a teenager, I've felt that we all should take responsibility for our own indiscretions. But these days, nothing is ever an individuals fault. It's always "Societies" fault, or the Governments fault or they have a somewhat different chemistry in their brain (all of our brain chemistry is somewhat different than anyone else's btw) that compels them to do what they do. While that last is valid for many things, I also gotta say that we all have desires and compulsions that we stave away because they are either dangerous and or unacceptable in society.

This has to stop, as we have already become so mentally week. We cannot foster this anymore.

I ask the forbearance of other posters on this thread for posting somewhat off-topic, but I will bring my post back in to relationship with the theme of this thread.

To PRICHARILLAISMISSED, thank you for replying. I especially appreciate you not perceiving my reply to your earlier post as being an attack. I appreciate, and have thought about the points you made in your post above. I wanted to clarify one thing I didn't mention in my earlier post, and that is when I referred to AA helping alcoholics become and stay sober, I forgot to mention that some people obviously need chemical detox, i.e. rehab, first, before they can be helped by AA. I believe alcoholism and drug addiction are diseases, and should be classified as such, because of the psychological and physiological processes involved. Although it is within the person's grasp to help themself, as you pointed out, I do not know of anyone who was successful in becoming and staying sober without either chemical detox, AA, and a strong support system of family and friends, and even then it was a difficult, arduous, fragile process for everyone involved. When I said I do not believe that people with addictions such as alcoholism or drug addiction should be absolved of responsibility, I meant that their behavior (regardless of the factors that brought the addiction about) is wreaking destruction on themself and those around them and that the responsibility is theirs, because no one else can do it for them, with sufficient support (detox, AA, family/friends, ongoing medical care) to arrest that process. Problems obviously arise when the person's support system is insufficient, as it is for many people, and if the person is not motivated to recognize and deal effectively with their addiction in the first place then the problem continues.

For obesity due to addiction to eating large quantities of food, I come back to believing that a 12-step program such as OA, together with strong support of family/friends, and ongoing medical care, could be helpful for many people. Again, of course not everyone is fortunate enough to have a good support system, or to be able to understand their problem and/or be motivated to take action to stop overeating.

Specializes in Oncology; medical specialty website.
I feel your pain. I used to work on a unit that got all the bariatric patients. We used to question why it took 6-8 firemen to get them to hospital and then they were assigned to one nurse. I guess firemen have a better union.

I used to find the lack of motivation to do anything for themselves in this patient group incredibly frustrating. I understand that there are mental health issues in play but sheesh. Hiding food in your skin folds. Refusing to move and soil yourself in bed because "it's your job to look after me"?

I can understand the despair that the super morbid obese may feel, but I can't go that far.

Specializes in Oncology.

I once got a call-in report on a patient they were planning on bringing to my unit from hours away. No other unit would take her. I normally didn't mind admissions unless they were agitated/confused or narcotic-seekers, but...

She was in her 30's, about 750 pounds. Mind you, my unit was a stand-alone unit, mostly non-acute but very confused or total care but not difficult total care patients (an old man with a feeding tube who was bedridden, a lady with CP who couldn't walk but was totally mentally competent and would help me with my work to the best of her ability and with whom I enjoyed talking, an old man who had a BKA and severe diabetes, etc) with 30+ patients and I was alone at night with 2 nurse aides. One was about 160, 5'4, and the other was about 5'6 and 175. I myself am about 5'2 and 120. I told the woman giving report that she needed to call my nurse manager and that I refused to take the admission. There simply was not enough staff and I was not even going to be able to assess her or clean her up, and I certainly was not about to injure myself trying.

Specializes in Intermediate care.

On a night shift once we had a patient once that required 4 people to turn, and even more to clean. (holding skin folds, legs open etc.) We had 5 RN/CNA on the unit since it was slow. It is required that one always is at the desk. This is because we are a telemetry unit and we need someone to stay by the monitors. Anyway...so we had to clean the patient, but there were only 4 of us that were avaliable to do so. (trust me, this was NOT enough to clean). Which really isn't a good idea because the person watching telemetry coulnd't leave to answer bed alarms or call lights.

So we had decided that 2 staff members need to stay out by the desk (one for telemetry and one for call lights/bed alarms). This left 3 of us to clean the patient, which was NOT possible. our "sister unit" is the critical care unit, so we called over to see if they could spare a nurse or a tech to help for a little while. They sent us a nurse, and then we also got the HOM to help us. It was quite the ordeal just to clean this patient up, or even round up the people necessary to do it. In the mean time while we are rounding a "team" up she is hollering "CLEAN ME!! SOMEONE NEEDS TO CLEAN ME NOW!!!"

i went in to calm her down and i told her we need to get more help because we cannot risk injuring anyone she was like "i don't care about that. Clean me now"

people like that....seriously???

Specializes in Intermediate care.

i am going to add about the use of lift with these patients. YES, we DO use lifts when turning/moving these patients. We have ceiling lifts in every room, and have special bariatric ones in our bariatric rooms. however, these are useless when CLEANING apatient. This is because the lift uses the turn sheet to hold them on their side. However you need to move the turn sheet to clean their bottom. If you move the turn sheet they just end up on their back again.

So...you need atleast 5 people to hold these obese patients. Which, can be at times your entire staff. That puts others at risk and neglect.

So i don't use the whole "use the lifts" as an argument, because you can't when cleaning. Turning/moving, yes. Cleaning their bottom, no.

Another thought. . .has anyone noticed that a typical salad at a fast food joint always costs in the $5.00 to $6.00 range, whereas a double cheeseburger can be obtained off most value menus or dollar menus for $1.00? What is a lower income person to do?

Many supermarkets in my area charge staggering prices for fresh veggies and fruits because most things are grown in other states. However, the rice, pasta, potatoes, ramen noodles, white bread, bulk cereal, and other starchy foodstuffs are dirt cheap. Again, what is a lower income person to do?

I wish our government subsidized other fresh produce items to the same extent that they provide price supports for wheat, corn, and other fattening starches.

For $15 I get over 25 pounds of fruits and veggies a week from a farmers market that delivers to my school. Last I saw, most obese persons aren't eating 1 double cheeseburger. They are eating several at one sitting.

It comes down to personal choices and personal responsibility. Sadly some people cant see the forest through the trees.

I personally have dealt with depression and have found myself indulging in food items. And usually once my pants get too tight I realize I need to gain some control.

My mother is obese- she's inactive and depressed. I hurt for her because its effected her lifestyle and she has realized where's she's put herself. I think she feels hopeless. I'm sure most obese people do.

I have turned my fair share of all types of pts. If they are unable to help the more they weigh the more difficult it is. period. Obviously a 450lb mobile walkie talkie is easier to care for then a 150 contracted pt with a peg tube and foley and wound vac and trach.

Are we seeing more super obese pts or not? has it leveled off or is it increasing? I have only been a nurse for an few years and it seems about the same adult pt wise. But as a kid I rarely saw obese children . 15years later I see a lot more. If it is increasing than hospitals better get with it ( another project to be nursing responsibility @@?).

These are valid questions. People are overweight, children are overweight--but our culture has changed so much. "Back in the day" we all went outside running around 99% of the time. Families walked due to just one car. Now, depending on where one lives, kids are no longer safe to to walking anywhere--nor are outdoor entertainment the #1 thing to do. Entertainment was camping, hiking--lots of outdoor stuff. Now things have drastically changed, but some cling to the old way of eating--I love butter and whole milk and all the things I grew up on. (When I hit 45, everything I put in my mouth goes to my butt--story for another thread LOL).

But if we are talking bed bound morbidly obese, I don't think there's an increase. Disordered eating is a process and the result of something other than too many cheeseburgers. Takes a multi-dynamic plan of care. And truly, if your unit is over run with the morbidly obese bed bound patients, then you should take the reins and make some adjustments to how one would care for them.

Even when surgery becomes an option for some, the skin that they carry requires a great deal of care--can be well over 50 pounds of loose skin, so again, a specialized, multi-dynamic plan of care.

A no lift hospital is a reality in a number of facilities. So unless anyone can get up on their own accord, whether it be someone who is 100 pounds or 600 pounds the best interest of your unit team is to do what you can to talk about the reality of equipment, lift teams, and multi discipline, reality based plans of care. Because a 600 pound patient is not going to go home soon--nor is a contracted 100 pound patient with all the bells and whistles--to be cared for by one family member--or a family member and one caregiver.

Specializes in Acute Care Cardiac, Education, Prof Practice.

Perhaps, like confused patients who need additional help and are provided private sitters by family, those who need extra help with turning and cleaning due to weight should be approached about hiring private staff while in the hospital?

New Jersey woman striving to weigh 1,000 pounds, become world's fattest lady - NYPOST.com

[h=1]"NJ woman attempting to become world's fattest lady[/h]

[h=1]A New Jersey woman, who now tips the scales at 604 pounds, said it'd be a "fantasy" to gobble her way to fame and someday weigh 1,000 pounds.[/h]To help pick up the tab on her $750-a-week eating habit, Simpson puts herself on the Internet where people can pay to watch her eat."

That's one thing I always wondered about, how these obese people can afford their grocery bill.

Why would anyone WANT to be an invalid and risk death or disease? Does she only find value in herself by being that large? Is there nothing else to live for? People won't pity her when she passes away from being obese- no one will say "wow, she lived such an honorable life."

I seriously can not believe that someone would willingly shorten her life span considerably and put her glutinous habits on public display to beat a world record. Something is seriously wrong.

Specializes in PICU, NICU, L&D, Public Health, Hospice.
I seriously can not believe that someone would willingly shorten her life span considerably and put her glutinous habits on public display to beat a world record. Something is seriously wrong.

This could be another symptom of her mental illness...

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