assessing the obese

[IowaCindy]

In clinicals this week I had a patient who was close to 350# - my first patient who was that large. Obviously when I ausculatated lungs and abdomen it was difficult. And doing a full assessment was somehow intimidating as I wasn't sure if differences I noted were size related or disease/condition related. Things such peripheral pulses, skin condition ......

Can any of you experienced nurses please share some thoughts on appropriate assessment techniques for the obese?

Thanks!

Cindy

[zumalong]

Iowacindy--assessing the obese should be done using same techniques as any other patient. You should be able to hear heart and lung sounds. Make sure you use a bp cuff large enough for pts arm (thigh cuff usually). Periferal pulses should still be felt and edema noted. Most morbidly obese have some level of DOE but not all. Make sure the equipment is the size (ie scales, bed etc.) to accomondate patient. But most important remember that the person still has same feelings as someone who is 'normal' weight.

One caution is safety. If patient is ambulatory make sure bed is against a wall as most hosp beds will slide if pt 'rests' against side of bed.

[IowaCindy]

I could hear posteriorly but not anteriorly. And abdomenal sounds were very muffled which I assumed was from the amount of tissue as there was no evidence of fluid in the abdomen.

This gentleman was truly a gentleman. Kind, gentle and with a remarkable positive attitude. We dealt well together - I tried very hard to pick up any cues he gave which he surely presented - he did NOT want any assistance in the shower so I stayed in his room and tidied it spotless while he was washing up. I didn't want to be far away if he did need help.

I appreciate the words. I'll keep them in mind.