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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.

Fiona59

Has 18 years experience.

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"?

Blue Roses

Specializes in Rehab, Med-surg, Neuroscience. Has 4 years experience.

How do the 500lb+ patients get that way? I'm not trying to be mean, I'm seriously confused by what life circumstances cause them to get themselves into these situations!

meanmaryjean, DNP, RN

Specializes in NICU, ICU, PICU, Academia. Has 40 years experience.

How do the 500lb+ patients get that way? I'm not trying to be mean, I'm seriously confused by what life circumstances cause them to get themselves into these situations!

I have often wondered the same thing. At what point in their lives did food become more important than anything else? Freedom, independence, family, health.......all thrown away for food.

I well remember a 750# RN I cared for. It's been 25 years ago, and I am still haunted by the memory of her.

applewhitern, BSN, RN

Specializes in ICU. Has 30 years experience.

The patient doesn't even have to weight >500 lbs. A 250-300 pounder wears me out! Especially if they can't/won't help you.

Palliative Care, DNP

Specializes in Family Nurse Practitioner.

Things such as this are why I went to graduate school. Come 2015 no more floor nursing here! It's the most thankless job ever and I would like to grow old with my back.

250lbs is doable for 2-3 staff members even if complete care but very tiring. But the 500lbs+ require a lot more staff. And anyone who has worked on a busy med surg floor knows staff isn't just lounging around. 5-6 have to make time together for one pt. and our other pts can be busy too! Lifting up the pannus can take 2 ( little room for more) and after my arms HURT. getting in between the skin folds isn't too easy or even doable sometimes. If we are heading in this direction we need more staff for same number of pts. 10 complete care on the floor under 250lbs is completely different than 10 complete care over 500.

Fiona59

Has 18 years experience.

I remember a 180 kilo ICU nurse who had bariatric surgery. Totally helpless and had a very "under the thumb" husband. Who had to be reminded that Mars bars were not a good idea post op.

We quickly learnt to use flannel sheets to dry them. The bath sized towels just don't cut it.

VivaLasViejas, ASN, RN

Specializes in LTC, assisted living, med-surg, psych. Has 20 years experience.

I can tell you how people allow themselves to balloon up to 500, 600, 700 lbs. and so on.

It's called "self-medication". Not too long ago, I was well over 300 lbs. myself and headed for 400, so I can empathize very easily with the super obese. Yes, mental disorders can cause compulsive overeating; once I was treated for mine, the drive to stuff myself until I was miserable went away, and I've lost over 40 lbs without much effort. But many people NEVER discover what, literally, is eating them, and since food is the one addiction that can never be completely overcome due to the necessity of eating to live, they go on until it kills them.

I do know how hard it is to care for such patients. Back when I was a hospital nurse, we had a frequent flyer who weighed ~ 650 lbs. and literally required 10 staff members to get OOB. Bathing him took half a dozen.......three were needed just to hold up the enormous pannus that probably went at least 250 lbs. all by itself. He was one of the nicest patients I've ever cared for; polite, respectful, totally non-demanding, only pushed his call light when he desperately needed something. He passed away at age 48, not surprisingly from CHF. The take-home lesson from taking care of him was simply this: Obese people have ears. They have feelings, too, and they know when we healthcare providers don't like them. Sometimes, they act out because they know they're disliked!

Believe me, your basic 500+ pounder is VERY aware that a) they are dangerously obese, and b) they're not going to live long if they continue eating as much as it takes to maintain such a large body. If you yourself knew you were going to die soon, wouldn't you want to indulge what few pleasures were left to you? I know I would......and since food is often these patients' only source of satisfaction, can anyone out there understand why they may choose to continue stuffing themselves?

BrandonLPN, LPN

Has 5 years experience.

When it comes to long term care for such patients, I think there clearly needs to be some sort of special facility set up for such people. Throwing them into the traditional nursing home mix is murder on the staff. We have 1 LPN and 2 CNAs on nights for 49 residents. Four of our residents are in the 500lb range and total care. Our super obese residents take almost as much time to care for per shift as all the others put together. Unfair to the other residents.

I'm sorry, this may sound unkind, but maybe morbidly obese people who work should have to pay a larger percentage of their income to social security. They'll end up using far more as (if) they age. And unlike cancer or genetic disorders, obesity is usually controllable.

andreasmom02

Has 7 years experience.

How do the 500lb+ patients get that way? I'm not trying to be mean, I'm seriously confused by what life circumstances cause them to get themselves into these situations!

I agree. I understand if a patient has a true medical problem - underactive thyroid, has lost a limb, etc. But I don't understand how once healthy adults allow themselves to become 500 + lbs.

What I don't understand is how the staffing is not any different for caring for this patient population. It is not fair to the patients or the nurses. My job description requires that I can lift 50# - that's it. I am quite fit and can lift my 50# without difficulty. However, I am 40+ and weigh 145#; I cannot even be a safe stand-by for someone 300#. If they go down, I can't help. I am not risking my body, because I won't be able to catch them anyway. This is not safe for anyone involved.

lifting a 50lb box or weights is different than lifting a 125 panus with a completely awkward angle unless i were on the bed too. same with trying to roll such pts and keep them on their sides while the other coworkers race to clean them. and not everyone is the same height although it helps that most of the staff is between 5'1 and 5'7

Some hospitals, like the one I am precepting in, are implementing a special 'lift team' that are the primary lifters. There are 2-3 of them that go around unit to unit every 2 hours turning patients. If they require further assistance they grab the nurses and aids, which is much better because you are not using the entire unit to lift/clean one patient. I think this puts less stress on the unit, and I cant wait till more articles are published to support the better outcomes.

JeanettePNP, MSN, RN, NP

Specializes in Pediatric Pulmonology and Allergy. Has 8 years experience.

When it comes to long term care for such patients, I think there clearly needs to be some sort of special facility set up for such people. Throwing them into the traditional nursing home mix is murder on the staff. We have 1 LPN and 2 CNAs on nights for 49 residents. Four of our residents are in the 500lb range and total care. Our super obese residents take almost as much time to care for per shift as all the others put together. Unfair to the other residents.

I'm sorry, this may sound unkind, but maybe morbidly obese people who work should have to pay a larger percentage of their income to social security. They'll end up using far more as (if) they age. And unlike cancer or genetic disorders, obesity is usually controllable.

Viva right above you explained quite well some of the factors that may have caused them to "get like that." If we recognize alcholism as a disease and drug abuse as a disease it's about time we realized that people do not willingly choose to become that obese. Although there usually is a codependent somewhere in the picture who is providing them with food.

As far as making them pay a larger percentage of their income to SS -- I guess that should apply to anyone whose illness was due to lifestyle choices. And since we will never be able to fully break down how much an individual's health issues are due to lifestyle choices versus factors out of their control, I don't think this is a system we could ever implement. Many health plans do offer incentives for things like gym membership or healthy eating habits, and there are also interventions on a community level like bike paths and public recreation areas. Bloomie's soda tax backfired on him but there are other interventions that can make an impact -- like replacing vending machines in schools with healthier options, etc. Obesity is a multi-faceted problem and just pointing fingers at the obese for bringing it upon themselves is not the solution.

Jammin' RN

Specializes in Orthopedics. Has 3 years experience.

Some hospitals, like the one I am precepting in, are implementing a special 'lift team' that are the primary lifters. There are 2-3 of them that go around unit to unit every 2 hours turning patients. If they require further assistance they grab the nurses and aids, which is much better because you are not using the entire unit to lift/clean one patient. I think this puts less stress on the unit, and I cant wait till more articles are published to support the better outcomes.

What a great idea! Obese patients are difficult to take care of and as nurses we need to think about possible solutions. I also like the post from someone else mentioning LTC facilities to meet the special needs of the obese patient. Any other hospitals implementing anything to help in the care of the obese patient? I'm interested in hearing.

Tait, MSN, RN

Specializes in Acute Care Cardiac, Education, Prof Practice. Has 14 years experience.

Viva right above you explained quite well some of the factors that may have caused them to "get like that." If we recognize alcholism as a disease and drug abuse as a disease it's about time we realized that people do not willingly choose to become that obese. Although there usually is a codependent somewhere in the picture who is providing them with food.

As far as making them pay a larger percentage of their income to SS -- I guess that should apply to anyone whose illness was due to lifestyle choices. And since we will never be able to fully break down how much an individual's health issues are due to lifestyle choices versus factors out of their control, I don't think this is a system we could ever implement. Many health plans do offer incentives for things like gym membership or healthy eating habits, and there are also interventions on a community level like bike paths and public recreation areas. Bloomie's soda tax backfired on him but there are other interventions that can make an impact -- like replacing vending machines in schools with healthier options, etc. Obesity is a multi-faceted problem and just pointing fingers at the obese for bringing it upon themselves is not the solution.

Ty for this. Pretty much summed up what I was thinking. I remember watching a Lifetime special on morbid obesity. One of the moms of an obese son brought him food everyday. She was so damaged from the infant death of her first child that she felt obsessed to do anything and everything for the second, including enabling the habits she had created. It's easy to point a finger and blame, but another task entirely to try and see where the problems might truly arise and appreciate that we all struggle with something.

VivaLasViejas, ASN, RN

Specializes in LTC, assisted living, med-surg, psych. Has 20 years experience.

Although there usually is a codependent somewhere in the picture who is providing them with food.

Obesity is a multi-faceted problem and just pointing fingers at the obese for bringing it upon themselves is not the solution.

DINGDINGDING!!! We have a winner!!! :D

Co-dependency is a HUGE (sorry) problem with the super-obese. You know darn well they can't get up out of bed themselves..........somebody's got to be bringing them the food. And it's not a burger and an order of fries, either---it's more like 4 burgers and orders of fries, and a half-gallon of soda to wash it all down with. Might as well hand an alcoholic a bottle of Jack Daniels, or give a suicidal person a .38 Special.

But like other types of addicts, many food addicts can be sneaky and manipulative, and they use guilt to force their family members to bring them the foods they crave. It's an unbelievably tough situation. I've seen a few hospitalized super-obese patients berate their caregivers for bringing them "only" one bag of Hershey's Kisses, or for failing to stop at the store to fetch their nightly Big Gulp. But again, this is a symptom of addiction, not a moral failing or character defect. :no: