Ok, so there's this obese patient... - page 3

....I'm caring for. She's approx 400lbs, and since I'm in the prn pool, naturally I am assigned to her for the night. So as usual, I dive right in and bathing her, cleaning her room. I normally... Read More

  1. by   gwlillith
    Quote from 11:11
    I worked in an ICU that had to deal with the bariatric cases that didnt go well, and I dont mean that facility but all over the nation.

    Some of these people were so big we sent them to Sea World or Marine Land to be imaged.

    Afet admitting one gal that weighed of 700lbs I found a remote, a 9volt battery, and a pen in her abd folds.

    Another was so big it took nine people to roll her, eleven to roll her then reinsert her foley.

    Then there was the 500+ lbs gal that coded on the commode out on the step down unit. I dont remember how many people it took to get her back in bed, but a number of us had to stand on the bed, including me with her diarrhia on my shoes. She was found in a pool of it on the floor.

    Why dont they show that on ER?

    Another gal was flown in. She and her daughter both had the surgery, like a juerry springer special. The mom had a fistula from her bowels to one of her lungs. It was a large family (no pun intended) and it wasnt pretty when this gal passed.

    I wouldnt ever let anyone I know and love have this surgery.

    I wont work float pool period. I dont want to be any floor's gopher boy. And for some reason it is in human nature to not take care of those that wont be around to return the "favor". Too bad its not just the opposite.

    In EMS they say "you first, partner second, pt third". I try to apply that to nursing when it comes to my safety. God only knows some of the risks Ive taken that I shouldnt have. When it comes to your back, nobody else can protect it. And if you are injured what hospital is going to take care of you and your family?

    You of all people, a veteran truama nurse should know better. You and your family come first.

    If you have a back injury why are you working float pool?

    Have you considered peds or NICU instead?

    11
    No Peds or NICU...can't work with the babies...
    The only reason I've chosed the float was to get some experience at the 3 different hospitals, and stay away from the "politics" . I'm considering taking a staff position at one of them since this is definately not for me.
    I'm trying to maintain a good attitude to counteract those staff nurses who are burnt out and just plain ol' hags! The majority of them are at one of the hospitals that's definately not on my first choice list.
    In my entire career I have never met or worked with such angry, rude, ignorant people. You hit the nail on the head with this statement. ( I dont want to be any floor's gopher boy. And for some reason it is in human nature to not take care of those that wont be around to return the "favor". )
    I have to say I'm extremely disappointed and sad that this hasn't worked out for me. I was looking forward to meeting and networking.
    Well, thanks for the advice...
  2. by   11:11
    Quote from elizzy
    No Peds or NICU...can't work with the babies...
    Why not, back cant handle it?

    How about PACU. It can be fun, your ICU background would be valuable, fast pace, no baths, and there'd always be someone there to help you.

    Or, how about supervising. Radiology etc?

    11
  3. by   LindaMarie76
    I wanted to comment on the devices mentioned. The lift device is indeed great, once it is correctly under the patient. You can't leave a patient lying on the sling, so whenever you want to move the patient, the patient has to be rolled at least once to each side in order to get the device under him/her. In addition, all of the patients that have ever been placed on this sling have complained about it being painful to whatever body parts are pressed against it. One night we were moving a 400 lb patient and he had a full-blown temper tantrum while up in the swing. Two nurses got hurt as a result.

    There was also a second device demonstrated on the poster that we have tried also. It seems like a great idea, a mat that you place under the patient, inflate when you want to move him/her, then deflate. However...again, you can't leave your patients lying on this device because it promotes skin breakdown. So...everytime you want to move the patient, you have to roll from side to side to get the gizmo underthem.

    There has to be a better way. There just has to be.

    Linda

    Quote from w8liftinglady
    I know someone mentioned a hoyer lift,but let me elaborate a little...we also deal a lot with Sizewise,and they have this huge hydrolic lift that works with a sling placed under the patient..the lift slides over the patient's bed,and is controlled by a handheld device.by attaching the hooks to one side,you can turn the patient by yourself,almost,as well as "pull" him up in bed.This device was a must for our obese patients http://www.sizewise.net/pdf/ProductPoster.pdf
    This poster illustrates it pretty well.Maybe you could see about getting them in your facility?We used it in our icu-with all the equipment,you could still get around it.
  4. by   PCloudy
    Everyone has an equal right to quality health care. This includes the staff.
    We have NO bariatric equipment yet we admit morbidly obese patients to our ICU on a regular basis. It's rare anymore to get one less than 300 pounds.

    About 6 months ago, I enlisted the help of 12 other people (13 counting me) to move a 700 pound woman from one bed to another. The big boy bed that she was on had to be saved to use as a stretcher as the other one wouldn't fit through the door. Hello fire marshall!

    Anyway, she barely fit on the bartlett bed (the largest that my hospital has access to through the rental agency). In the process of moving her, I herniated 2 cervical discs and subsequently had to have them fused.

    The woman didn't live to tell about it. She died about a week later when her trach became dislodged during an attempt to reposition her and ENT was not able to replace it.

    The body builders and the muscle men pride themselves at lifting 1000 lb blocks of steel in a controlled setting. That's not impressive. I'd like to see these guys lift 800-1000 lbs of slick, flowing flesh that is barely contained and certainly has nothing to grab onto. It doesn't matter how many helpers you have, these people are nearly impossible to move.

    Now to assist in the transfer of such patients, the hospital has installed new pile carpeting in the pt transport halls to REALLY make things easy. Our rooms are small and can barely accommodate a normal sized person with a vent or CVVH, etc. When you have a person that occupies the same space as 6 or 8 patients would in the same square footage, you have the makings of a disaster.

    I feel for these people. I'm honestly not trying to be ugly about it (I am overweight myself) but I think that people of cetacean porportions would be better served if they were admitted to a facility that has the manpower and the equipment to handle such enormous tasks.

    Am I alone in this?
  5. by   gwlillith
    Quote from PCloudy
    Everyone has an equal right to quality health care. This includes the staff.
    We have NO bariatric equipment yet we admit morbidly obese patients to our ICU on a regular basis. It's rare anymore to get one less than 300 pounds.

    About 6 months ago, I enlisted the help of 12 other people (13 counting me) to move a 700 pound woman from one bed to another. The big boy bed that she was on had to be saved to use as a stretcher as the other one wouldn't fit through the door. Hello fire marshall!

    Anyway, she barely fit on the bartlett bed (the largest that my hospital has access to through the rental agency). In the process of moving her, I herniated 2 cervical discs and subsequently had to have them fused.

    The woman didn't live to tell about it. She died about a week later when her trach became dislodged during an attempt to reposition her and ENT was not able to replace it.

    The body builders and the muscle men pride themselves at lifting 1000 lb blocks of steel in a controlled setting. That's not impressive. I'd like to see these guys lift 800-1000 lbs of slick, flowing flesh that is barely contained and certainly has nothing to grab onto. It doesn't matter how many helpers you have, these people are nearly impossible to move.

    Now to assist in the transfer of such patients, the hospital has installed new pile carpeting in the pt transport halls to REALLY make things easy. Our rooms are small and can barely accommodate a normal sized person with a vent or CVVH, etc. When you have a person that occupies the same space as 6 or 8 patients would in the same square footage, you have the makings of a disaster.

    I feel for these people. I'm honestly not trying to be ugly about it (I am overweight myself) but I think that people of cetacean porportions would be better served if they were admitted to a facility that has the manpower and the equipment to handle such enormous tasks.

    Am I alone in this?
    No you're sure not alone. It's definately a challenge, a frustrating one at that, that we are consistently expected to perform nursing care on obese patients as though they were a person of normal size and weight.
    Where ever I have worked there seems to be only a handful of equipment accessible to us for these kind of patients.
    I don't even think they covered this in nursing school, did they???
  6. by   happthearts
    I remember my first day as an aide in 1974 I had a PT that was about 600 pound the poor women had a decub that you could have literally put your elbow down in at least 4 inches. The women could turn so that did help matters. But it Scared the stuffing right out of me she leaned up against that bar and it when flat out to the side of the bed and the whole bed groaned.

    I always worried if this lady falls from this bed we will never get her off the floor as her skin was just like Jello. The one thing that did help instead of using pillows to prop her .We used a huge foam wedge with a hole cut the center of the wedge ,to get air to the back side a bit Wasn't the best way but it did keep her on an angle and not totally on the back and some air did get to the backside .
  7. by   LindaMarie76
    Thanks for that excellent suggestion.

    Quote from happthearts
    I remember my first day as an aide in 1974 I had a PT that was about 600 pound the poor women had a decub that you could have literally put your elbow down in at least 4 inches. The women could turn so that did help matters. But it Scared the stuffing right out of me she leaned up against that bar and it when flat out to the side of the bed and the whole bed groaned.

    I always worried if this lady falls from this bed we will never get her off the floor as her skin was just like Jello. The one thing that did help instead of using pillows to prop her .We used a huge foam wedge with a hole cut the center of the wedge ,to get air to the back side a bit Wasn't the best way but it did keep her on an angle and not totally on the back and some air did get to the backside .
  8. by   PCloudy
    When I got out of nursing school. Someone that weighed 300 was enormous. They were an oddity. Now the norm is around 600 it seems.
    Try a 5'1'' woman that weighs 850. You can easily get lost in there. Doing pericare generally takes about 6-8 people. That many spare hands is hard to find. Nevermind the spelunking equipment required to place a foley. There's no easy solution but our bodies we not made to carry that much weight nor to care for that much weight. Routine exam gloves are useless...they only get filled with yuck. Can't buy calving cloves in this country unless you're a licensed DVM. Where are the UFO's when you really need them (just joking)??
  9. by   safewaygreenbox
    Oh my :uhoh21: . I nurse in the UK - have never heard of the term 'bariatic' - just looked in my 'Dictionary of nursing' ... its not in there ... looked in 'Oxford Englich Dictionary'....its not in there.

    We occationally get large patients - not sure of exact weights - about 30stone max I have seen. In which case health and safety and our 'no lifting' manual handling policy have ensured that we get beds that are extra wide and strong they are electric and can tip the patient out of bed to a standing position (I guess too large and they carn't stand!!) We would also use an air matress after doing risk assessments. I guess all that doesn't help with turning to clean check pressure area etc

    Oh my :uhoh21: OK may seem a stupid ? but......
    Can you explain the term baritric and what proportion of your patients are morbidly obese? What kind of diet and support to change lifestyle do they have while in hospital?

    Cheers

    Kay the 2nd
    All of a sudden i don't fancy my half eaten packet of crisps now :chuckle
  10. by   CoffeeRTC
    We've been getting a few bariatric pts in LTC too. I don't have a problem with this,but as we've been discussing it might take 6 or more people to turn them...do the math on this one..on 3-11 shift we have 5-6 staff in the building. on 11-7 ther is a total of 3! Don't even talk about transfering them...or the fact that their big boy bed doesn't fit thru the door...Gee...do the math? Proper care ain't happening.
  11. by   PCloudy
    Hi - thanks for the reply. I will start over as I accidentally lost the last explanation before it was "posted."

    In this country - I am guessing that close to half the population would be deemed as overweight. It's my understanding that the percentage of "morbidly obese" people is about 2.2% of the entire population which means that roughly 5 million people could be classified as morbidly obese in the United States - something that we are definitely not proud of.

    Morbid obesity is defined as having a BMI of 40kg/m2. In the average person that would be approximately 45kg overweight. That's highly variable.

    Bariatric refers to the care of morbidly obese patients. This requires special equipment and large beds, etc. Hill-Rom (a major manufacturer of medical equipment) is now developing a bed to accommodate a 1000 lb (455kg) person. It's truly unbelievable.

    When I visited the Hill-Rom factory in Indiana last Oct, we fit 3 people comfortably in one of the larger wheelchairs. I took a picture that I can email to you if you'd like. Can't put it here.

    In the US, obesity is a national epidemic. There is exponential growth in diabetes (especially Type II - even in young kids). I doubt that you have seen someone THAT large in the UK. I visited a friend in Manchester a few years ago. I was about 53 kg at the time and I was generally the largest person anywhere I went with few exceptions. Here, that is relatively small by comparison. We went many places between the Lake District and London.

    I could go forever about this topic especially since it directly affects me - and will continue to affect me. Although I have no problems to speak of from the cervical fusion last year, there is the ever-present risk of having the same thing happen again. The patients are only getting bigger all the time.

    Did I answer your question or am I simply rambling? Sorry.
    Last edit by PCloudy on Mar 23, '05
  12. by   safewaygreenbox
    Hi

    Thanks for that info - its very interesting and worrying and must be distressing to see such a waste of active living. We too use Hill-Rom where I work. The UK is supposed be be going the way af the US - weight wise

    cheers
    Kay the 2nd

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