In Part 1, you learned some facts about the rising incidence of obesity in the United States and how it will impact your duties as a CNA. The obesity epidemic is changing healthcare, especially the front-line caregivers. That’s you!
Now let’s talk about some ways you can provide great care to these patients. Some areas, from assessment to skin care to self-image, may be different with obese (also called bariatric) patients.
ASSESSMENT: There are two things to consider when you meet the patient:
1. Overall assessment. As a CNA, you are accustomed to evaluating each assigned patient. Is he in any distress? Can she tell you how she’s feeling? When you take vital signs, do you notice anything unusual? Take time to learn what is “normal” for the patient.
2. Needs assessment. Does your patient require any special equipment, such as a larger blood pressure cuff or a wider wheelchair? Is the patient able to assist in turning, or will you have to ask one or two co-workers in order to do it safely? Never compromise the patient’s or your own safety. Ask for help, and let your supervisor know what you need to do the job properly.
SKIN CARE: Because of weight, the bariatric patient is more likely to develop pressure sores. Repositioning is essential, yet a challenge for a single CNA. A draw sheet may not be sufficient to roll or move a patient who is not able to assist. Find out what your facility provides for obese patients: slide sheets, Hoyer lifts, or simple aids such as wedges. Ask that additional staff be available for scheduled times to move and reposition the patient.
CONTINENCE CARE: Research shows a correlation between obesity and incontinence. One study found that half of nursing home patients who weighed more than 250 pounds required a urinary catheter. You already know the need to keep the genital region clean and dry in order to prevent skin breakdown and urinary tract infections. Both urinary and fecal incontinence are issues with obese patients, requiring frequent monitoring and inspection. These patients will need meticulous cleaning of the genital areas, as well as nearby skin folds. If the patient has frequent urinary incontinence, inform the nurse. An indwelling catheter may be necessary.
RESPIRATORY SYSTEM: Heavier patients can have a difficult time fully expanding their lungs, making them prone to conditions such as pneumonia. They can also have problems maintaining open airways at night. They may snore loudly or even stop breathing for a few seconds; both are signs of sleep apnea, a serious disorder. Because listening to breath sounds isn’t easy with obese patients, pay close attention to the patient’s vital signs. An increased respiration rate, shortness of breath, or an increased temperature should be reported to the nurse.
SELF-IMAGE: Obese patients struggle with self-esteem. Most have had life-long battles with their weight and health. Society is not kind to those who are overweight, often judging them harshly. Discrimination is common. By the time these patients arrive at your facility, they are depressed and overwhelmed. The best thing you and your colleagues can do is to simply treat them with the same respect and dignity you provide to all patients.
In Part 3 of this series, we’ll share some practical tips from other CNAs about how to care for obese patients. We welcome your comments and suggestions, too.
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