Morbidly obese patients: Here’s what to expect
There are several differences in clinical presentations of morbidly obese patients that will impact your assessment and intervention, says Rebecca A. Steinmann, RN, MS, CEN, CCRN, CCNS, a clinical nurse specialist for trauma/critical care at MetroHealth Medical Center in Cleveland. Here’s what to expect:
• Vital signs. Expect increased heart rate, increased respiratory rate, and increased blood pressure.
• Skin assessment. Look for pressure ulcers in unusual places (such as the sides of the feet). Deep skin folds (axilla, breasts, inguinal, and perineal) might harbor fungal growths. Hyperkeratosis and venous stasis of lower extremities is common.
• Airway management. Patents are technically difficult to intubate because of a short and thick neck.
• Circulation. When the patient is lying flat, the weight of the abdominal pannus might impede circulation to lower extremities.
• Medication administration. Due to poor blood flow to adipose tissue, there might be a delayed response. Transdermal patches might have poor absorption through the skin, due to poor vascular supply to adipose tissues. Some drugs are widely distributed to adipose tissue (for example, Fentanyl and hydromorphine), so drug effects might last longer.
• Wound care. There might be impaired healing, increased risk of infection, and poor vascular supply to adipose tissue.
• Imaging studies. Patients might exceed weight limit for CT scans, MRIs, and angiography.
• Stroke. There is a 24% increased risk of ischemic stroke with a body mass index over 30.1
• Endocrine problems. Prevalence of Type 2 noninsulin-dependent diabetes mellitus increases with body mass index over 22.
• Increased volume and acidity of gastric secretions. There is an increased incidence of gastroesophageal reflux. There is also delayed gastric emptying, so assume the stomach is almost full. As a result of this, the absorption and onset of action of any oral medications might be affected.
Reference
1. National Heart, Blood, and Lung Institute. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report. Bethesda, MD; 1998.
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