Just a thought....

I've been wanting to do this post for awhile now. Seems like a funny weekend for me to choose to post this though, being our Thanksgiving weekend, and with all the good food that is going to be around.

With that being said, I want to talk about something....... weight.

In my 16 years as a RN, I have seen people of all shapes and sizes. The anorexic's the bulimic's the morbidly obese and the one's that I would call the average person, those are the one's who are within 5 - 10lbs of their ideal weight.

I am by no means an expert on food addiction issues and will not even attempt to address those issues. I will leave that to the folks who specialize in eating disorders. What research tells us is that people are overweight for a variety of reasons, genetics, lifestyles, and drug interactions just to name a few.

The purpose of this post is to bring to light the concerns I have when nursing an obese patient, and the challenges they present the health care system.
Please don't get me wrong. I try to provide all of my patients with the same level of care. The issue is that due to their size I am limited to what kind of care I can provide. Let me give you a couple of examples.

Mr. Smith(not his real name)arrives to the ICU post op for overnight observation for sleep apena. Mr. Smith is 291kg(640lbs). We don't even have a bed in our hospital that will accomadate him. So we order one in. Our over head lifts to help move patients in bed will not move him as their weight capacity is 190kg (420 lbs.) So immediately, I am faced with how do I care for him. How do I perform a proper assessment on this gentleman when I can't even move him. How do I listen to his lungs? How do I manage to give him a thorough post op wash? How do I provide him with some privacy and dignity when our hospital gowns don't even fit him? I couldn't care for him the way I could my other patients due primarily to his size. That is not right. It took 6 of us to move him( 4 female RNs and 2 male respiratory therapists) We don't generally have that luxury of having extra people around to help change, clean, and assess a patient. Normally I would do this on my own. Did he get the best care I could give him? Sorry to say no he did not.

Then there is the woman who is 5', her weight is 98kg(215 lbs). She is having chest pain and can't move herself around in bed. She slides to the bottom of the bed constantly,even with positioning the bed for her, somehow she manages to get to the bottom of the bed. It takes 3 of us to move her. I must apply ECG elctrodes to her chest. Finding the appropriate placement is difficult due to her size. As she is a cardiac patient we always want to minimize their movement hence decreasing the stress on the heart. It comes time for a washup. I assist her, while washing her I notice that she has skin irritation under her breasts and under abdominal folds. This causes her discomfort. These skin irratations are primarily there a result of her not being able to provide the best personal hygiene care due to her size. I help her with her wash and ask the doctor to order cream for the skin irritation. The medication comes and needs to be applied twice a day. By this time my shoulder is aching and I ask my colleague to help me lift the patients skin folds so I can apply the medication. The poor patient, where is the dignity in that. But I just can't do it alone anymore.

I have injured myself to many times trying to reposition larger patients in bed, give them bed baths, or to prevent them from falling on the floor. My poor shoulders and lower back have been strained one time to many.

I could go on, but I think you are getting the jist of what I am trying to say here. Never mind the increased costs that obesity puts on the individual and the health care system. It is the sheer reality, that I don't believe these patients get the best care they should, simply do to their size.

I am posting this after nursing two obese patients on my last set of shifts. By 0600 in the morning, my body has had it. Sorry folks but I can not do one more turn or repositioning it will have to wait until the next shift. How wrong is that?

I wish you all good health.