Obesity - Implications For Nursing

Ms Kylee · Nov 2, 2007

Strong obese patient.. yep.. had one of them today. Combative to the core. Practically broke my wrist and the IV team lady's wrist while she was trying to start an IV line. Kicked me twice and sent me flying across the room and into the hallway. Thank God I landed on my bum.

And, he tried 3 times to rip out his Foley. Today, I really earned my pay.....

oneLoneNurse · Nov 11, 2007

Just went to a "pork fest" at a chinese buffet last night. Wonderful assortment, but the taste just wasn't there. My girflfriend noted it as well. Horrible commentary on America. $12.00 for an all you can eat buffett, included crawfish, crab legs, etc., etc.. People just seemed to be "chowing down." We think we are getting a super deal, but the food for some reason just stunk. We won't be back.

Place was packed.

Back to the topic of this thread. I have had some combative obese patients. I have one psychotic insulin dependent diabetic right now. Problem is when he wants to give himself the insuline, do I give him the needle or not? My co workers say yes, I am leary, but guess I would be fast enough if he decided to hurt me with it.

llg, PhD, RN · Nov 11, 2007

Taking a different train of thought ...

Nurses are also becoming more obese, and having more health problems because of that extra weight. That means more nurses who have physical problems that make the job more difficult, more nurses calling out sick, etc.

MB37 · Nov 11, 2007

How common are "no lift" hospitals? I'm a student, and we had a lecture on proper body mechanics last week in Fundamentals. Our ethical/legal textbook from last semester had a chapter in which it explained the ANA's position on lifting, and how body mechanics don't reduce injury when we're moving human beings. So, I raised my hand and asked my teacher about it, and she actually laughed at me. She said so far as she knew, hospitals in FL weren't going to become "no lift" any time soon, so we'd better pay attention and deal with it. She's actually a great teacher, but she didn't seem to want to answer my question - she just continued on with what she had from the textbook on proper mechanics. Oh, and why did she go into teaching? Back injury.

VivaRN · Nov 11, 2007

And another obesity angle:

The rise in childhood obesity among (mainly) minority and low-income populations.

This is due to a number of factors: fast food is cheap and filling, parents in bad neighborhoods don't want their kids to play outside, poor access to quality food in low-income neighborhoods, wacky portion control... marketing... you can't fix it all by saying "eat right! play outside!"

These kids are developing chronic problems earlier in life, which means more years as our patients and more years with disease to develop complications.

How icky is that?

To MB37: get involved with your state nursing association. You don't have to "deal with" anything, especially if it's an occupational hazard. See if anyone's working on a bill to make "No Lift" a state law. Other states have done it. You have a precedent to follow.

registerednut1221 · Nov 11, 2007

I was just wondering what everyone thought the implications of the rise in obesity has been for nurses/nursing?
Obviously with the rise in type2 diabetes, strokes, heart problems etc we have more to care for
And the cost of it to the NHS is going to mean more money is spent on that than other much needed areas.
Bigger beds are needed, larger comodes etc.
What else do you think the implications are/have been?
xxxx

In my hospital about 50-75% of our patients are mobidly-super morbidly obese and are mostly hospitalized for reasons directly related to their obesity (diabetic amputations, resp failure, etc). It completely floors me when a 500# patient is perfectly capable of walking but is content to lie in bed and expect us to "waite" on them hand and foot. We actually have a 575# patient right now that is capable of walking >20ft but refuses therapy because he says "at home I only need to be able to get from my bed to my chair." he complains because we aren't able to get him to the shower on a daily basis, he complains that we won't let him eat (he's trached and we can't get him off cpap and recieves tube feeds---duh, how about lets not let you aspirate). He calls every 5 minutes for something..."I need to be pulled up in bed, empty my urinal, when can I eat, blah, blah, blah" We have another patient that weighs about 300# and insist that we help her get up to the BSC. Our OT pulled his back and was out for 3 days, then one of our techs pulled her back out doing the very same thing. The patient refuses the lift because she says she is "scared of it" and with 'customer service' being what it is we are forced to play by her rules. As far as 'no lift' policies go---that just means if you hurt yourself, you are on your own.

Pepper The Cat, BSN, RN · Nov 11, 2007

Another problem presented by obese pts is the need for larger sized (we call them bariatric) equipment. Larger beds, commondes, w/c, BP cuffs, etc. We had a 350+ lb pt- had to rent a special bed for her. The bed was huge! Sheets didn't fit, took up more room etc. Sure created challenges!

ERRNTraveler, RN · Nov 11, 2007

Strong obese patient.. yep.. had one of them today. Combative to the core. Practically broke my wrist and the IV team lady's wrist while she was trying to start an IV line. Kicked me twice and sent me flying across the room and into the hallway. Thank God I landed on my bum.
And, he tried 3 times to rip out his Foley. Today, I really earned my pay.....

Thank God for Haldol......

leslie :-D · Nov 11, 2007

allow me to veer off topic for one moment?

i read, in amazement, that so many refer to the obese as these super-powered beings, with the strength of hercules?

i have NEVER seen this.

sure, i've dealt w/angry, adrenaline-pumped pts, both obese and non-obese.

but i have never found an obese pt to be particularly strong.

first of all, they're slow as all heck, and don't possess the quick reflexes that are so necessary in a fit of rage.

second, it's not their strength one is feeling, but the weight of their fat.....not muscle.

i've been pushed by obese, and never got thrown across the room.

i'm trying to figure out the logistics of this?

maybe the difference is, i am thinking of 500+ lbs and not 300?

but i always keep in mind, that obese people are typically not fit or fast.

therefore, i do not find them intimidating to deal with...

interestingly, i got assaulted the other day at work, by a young (skinny) meth addict in withdrawal.

i remember sitting there afterwards, trying to catch my danged breath.

since that day, i quit smoking (again), in hopes of reclaiming some much needed 02.

i weigh 118 lbs and have toned muscles.....which doesn't do me a danged bit of good as long as i'm coughing and gasping.

my point being, i think we all have perceptions of what is considered healthy or intimidating, or not.

personally, i don't find any threat in dealing w/the morbidly obese.

i've had my son's 17 yo friends, tell josh, "i wouldn't want to make your mom mad".

if they only knew...

leslie

GadgetRN71, ASN, RN · Nov 11, 2007

Its about time you all had a "No lifting" policy. Its a disgrace the way some patients expect a nurse, even if they are similar weights, to lift them. We never lift patients. Have all sorts of devices to get them out of bed & up and about, but never, ever lift.

The last place I worked, we had a lift team. They would be called when we had a big patient to lift/turn. They were trained in all the lifting equipment. Some patients and families were offended that we had to call for help but hey, some of these patients are dangerous to move alone. Nothing wrong with protecting your back.

flightnurse2b, LPN · Nov 11, 2007

I was just wondering what everyone thought the implications of the rise in obesity has been for nurses/nursing?
Obviously with the rise in type2 diabetes, strokes, heart problems etc we have more to care for
And the cost of it to the NHS is going to mean more money is spent on that than other much needed areas.
Bigger beds are needed, larger comodes etc.
What else do you think the implications are/have been?
xxxx

bigger beds, larger commodes, bigger briefs, etc... but also

-bigger stretchers in the ED (ours maxxed out @ 420)

-bariatric ambulances (which are becoming more common)

-more staff to: 1)help move/lift/transfer pt. or 2)replace the staff that threw out their back

-hoyer lifts (which also max out @ 420)

-hoyer pad/hoyer mat

-specialty matresses

-super-morbidly obese pts are incredibly difficult to perform CPR on and to intubate.

half of the super-morbidly obese patients i have taken care of were wonderful, even if they werent ambulatory, they would do whatever they could to help themselves. but the other half were the ones that gave up already, want you to pull them up, move them, feed them, fluff their pillow, etc etc, and then get incredibly angry when you leave for a minute to get help.

i had a pt a couple yrs ago that was over 600 lbs, who came to the ED with a bedsore i could put my head into... she said "going to the BR was too much work, so i just went in bed..." ended up dying of sepsis @ age 27.

had another frequently flyer, age 25, weighing in @ 726 lbs. CHF, NIDDM, CRF, etc, etc... but always had to let mom in at night to bring him his Bojangles, Arbys, McD's..whatever he wanted. when he coded and died, mom blamed us for killing him....

had a woman who was so large when i was working EMS, we had to knock down the entire front end of her house and transport her to the ED on a garden flat... she needed emergency surgery to be extracted out of her loveseat. (this one made the EMS strangest hall of fame) the OR's only option was to chain two beds together... but didnt make it that far. she died on the way.

mak2 · Nov 11, 2007

I was at a meeting at a large local hospital, not mine, honest. this meeting was about some hospital equiptment I was interested in. Another topic came up while I was there. It was a bunch of doctors and admin types but the issue of obese pts and specialized equiptment came up. The admin types, in no uncertain terms stated most equimptment was not cost effective. MRI's CT's other Xray equiptment no way. Some big boy beds, but not many. Some hoyer lifts etc were cost effective becasue of employee injuries. I guess I was kinda shocked about how matter of fact and dollar and cents it was. But at least for now there are not enough 400 lbs around to spend the money on.