Morbidly obese patients

[1husband]

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????

[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.

[Hoozdo, ADN]

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????

Well, if I were you, I would tell her she is working herself up to transferring to the ICU - which is true. Tell her she is going to get pnuemonia and maybe end up getting intubated without moving or using her IS. Explain to her that if she is refusing transfusions, (and it is not religion related), the physiological consequences and ask her if she wants that. I also would explain politely that you are very busy, and have x number of pts to take care of, and you CAN NOT wait till she is off of the phone to do any treatment of her. If this doesn't work.......take it up the chain of command.

[leslie :-D]

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.

and this is precisely what i would tell her.

many of these folks need limit-setting and reminders of such self-care deficits.

as for attempting to ambulate, reposition or even toilet this women, she needs to be firmly and politely reminded that extra staff will be necessary w/assisting and so, has to be coordinated with the staffs' available time....not hers.

that has nothing to do with bashing the obese but rather, the mere reality of caring for such a pt.

leslie

[Marie_LPN, RN, LPN, RN]

that has nothing to do with bashing the obese but rather, the mere reality of caring for such a pt.

Thank you.

[NewEastCoastRN]

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.

:yeahthat:

[tvccrn, ASN, RN]

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).

I didn't say the OP was bashing the obese, I was merely pointing out that the title didn't fit the entire post as it was only one aspect of the patient. The OP also didn't say that was the reason for the behavior.

I have to say that I have had patient of all shapes and sizes as well and I have had many more average size patients decline to participate that I have had bigger ones. The attitude I get is "You're here to wait on me hand and foot because (cough, cough) I'm here and paying for this, now untuck my blankets and hand me the remote which is 6 inches from my fingers."

tvccrn

[all4schwa]

Has anyone had a patient similar to this????

yeah, i had a patient like that. she refused everything because she wanted to die and she was demanding because she was bitter.

[royr]

It has been my experience that many of these pts are actually clinically depressed. They become cranky/nasty because it is the EASY way to get our attention. The key is to treat them with kindness - but time the kindness to reward POSITIVE behavior rather than go nose to nose and waist time and effort on conflicts. I guess this is why I usually am called to help out with these pts if I am available.

[indigo girl]

and this is precisely what i would tell her.

many of these folks need limit-setting and reminders of such self-care deficits.

as for attempting to ambulate, reposition or even toilet this women, she needs to be firmly and politely reminded that extra staff will be necessary w/assisting and so, has to be coordinated with the staffs' available time....not hers.

that has nothing to do with bashing the obese but rather, the mere reality of caring for such a pt.

leslie

Absolutely agree. I would not allow this type of personality to manipulate any caregiver's time. I would suggest a team meeting, and a contract ASAP. An occupational therapist should have done an evaluation, and self care goals can be part of the contract.

I have no time to waste on doing things that any reasonably able patient can do for themselves. If a nurse comes in to speak with her or to provide some kind of care, this takes priority over a phone call unless there is another agreement in place between the patient and the staff.

And, yes she does need to know the reality of the situation with regard to how much time is available, and the coordination necessary with other staff. Preventing injury to staff as well as to the patient should be pointed out. The issue of why she needs to be more physically active should be addressed and specific goals should be set. Get OT involved immediately.