BARIATRIC PATIENTS. Lynn Browne-Wagner, MSN, RN Northland Pioneer College

Transcription

1 BARIATRIC PATIENTS Lynn Browne-Wagner, MSN, RN Northland Pioneer College

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3 OBESITY

4 Who is Obese 97 million Americans Approx 1/3 of adults Approx 17% of children million are MORBIDLY OBESE

5 MYTHS

6 WHY ARE WE SO BIG????

7 REALITY

8 BODY MASS INDEX BMI = kg wt/height (m) FT = 90.9/5.02 = FT = 90.9/2.71 = FT = 90.9/1.80 = 50.5

9 DEFINITION per NIH OVERWEIGHT = BMI between OBESE = more than 20% above ideal body weight or BMI between MORBIDLY OBESE = more than 100 pounds overweight or double your ideal weight or BMI>40

10 CDC STATS

11 HEALTH RISKS

12 HEALTH RISKS

13 HEALTH RISKS CVA DVT RESPIRATORY DISTRESS PSYCHIATRIC CONDITIONS EARLY DEATH

14 ISSUES Difficulty in auscultation/palpation Difficulty in finding pulses Needles not long enough Larger amounts of fluid needed Equipment not appropriate size Non verbal communication

15 RESPIRATORY/LANDMARKS We know how it looks on the outside, but What is really happening on the inside

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17 POOR ECG READINGS

18 Musculoskeletal Problems

19 Fractures Dislocations Difficulty in assessing these injuries

20 INTEGUMENTARY

21 What to do Baby powder or antifungal powders under skin folds Cleanse thoroughly frequently Towels or cloth between folds Clean and dry after diaphoretic events

22 STAFF INJURIES FALLS STRAINS BENDING LIFTING POOR BODY MECHANICS MOVING BEDS/WHEELCHAIRS/GURNEYS

23 FACILITY ISSUES SAFETY, SAFETY, SAFETY DOOR WIDTHS SPACE TO MOVE AND TURN BEDS EQUIPMENT

24 SOLUTIONS Exercise Diet Drugs

25 WHAT TO DO Be empathetic Monitor your own non verbal communication Assess as best as possible

26 Do you know who & where they are How to get them out of the house What happens when your equipment fails What happens when you can t intubate What if you don t have enough personnel

27 What if you don t have enough room in the ambulance Is there a bariatric ambulance that can respond What if they need C-spine and can t breathe Do you have CPAP/BIPAP or did you remember to bring theirs Hyperoxygenate before flight to avoid barobariotrauma

28 Class 1: Full visibility of tonsils, uvula and soft palate Class 2: Visibility of hard and soft palate, upper portion of tonsils and uvula Class 3: Soft and hard palate and base of the uvula are visible Class 4: Only Hard Palate visible

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31 The ambulance can be lowered, wider How are the shocks and suspension Center secured stretcher Extra large BP cuffs, longer IV needles, electronic stethoscopes More available oxygen

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33 SURGERY

34 GASTROPLASTY

35 LAP BAND

36 GASTRIC BYPASS ROUX-EN-Y

37 VERTICAL SLEEVE GASTRECTOMY - VSG

38 COMPLICATIONS PULMONARY EMBOLUS RESPIRATORY FAILURE ANASTAMOSIS LEAKS

39 More complications Tachycardia Peritonitis Sepsis Abdominal pain Hypotension Vomiting/diarrhea/volume loss

40 HOSPITAL?????? What do you do to preserve their dignity: Being ashamed or embarrassed about their weight Hearing hurtful comments that the health care provider or staff may say about their weight Being disrespected by staff or health care providers in the past

41 ?????? What happens if they fall out of bed What if you don t have enough personnel Do you have CPAP/BIPAP ready for their arrival What happens when your equipment fails

42 BARIATRIC EQUIPMENT

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44 May need a PICC line or other long catheter Are there IV catheters that are at least 3 in length in the range? More prone to infection

45 In 2008 the cost of obesity was $147 billion It is anticipated that with the current rate of obesity within the USA that by the year 2030, the cost for care of bariatric patients will be about $540 billion

46 ABC Anticipate Before Complications

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48 REFERENCES Choquet H, Meyre D. Genetics of obesity: what have we learned? Curr Genomics. 2011;12: