1/10. Care of the morbidly obese patient in a long-term care facility.Morbidly obese patients in a long-term care (LTC) facility have special physical and emotional needs that must be considered when planning care. Special attention to the skin, vital sign monitoring, and rehabilitative care are among the interventions that must be integrated into the otherwise standard care of the morbidly obese patient. A case study is used to illustrate the challenges and special needs of such patients in an LTC facility in new york state. Morbidly obese people (nonambulatory people who are obese) frequently are unable to perform self-care. The care of the morbidly obese adult who resides in an LTC or postacute care facility, in particular, offers unique challenges to nursing staff.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/10. Vertical banded gastroplasty: a treatment for morbid obesity.stomach stapling to aid the morbidly obese patient with weight loss has been available for years. Unfortunately, some methods of bariatric surgery (e.g., gastric bypass surgery) can lead to serious complications. This article discusses vertical banded gastroplasty (VBG) and presents on overview of morbid obesity and its inherent medical problems, the screening process and the physical and psychological needs of patients undergoing bariatric procedures, the anatomy and physiology of normal digestion, and the perioperative nursing considerations in caring for a patient undergoing VBG.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/10. ventricular fibrillation caused by electrocoagulation during laparoscopic surgery.A 35-year-old man with morbid obesity was admitted to our hospital to undergo gastric banding gastroplasty by the laparoscopic approach. Aside from his morbid adiposity, with a body mass index (BMI) of 49.9 kg/m2, the patient was healthy. During the procedure, he developed ventricular fibrillation (VF) while a diathermic knife was being used. After defibrillation, his heart rate returned to normal. The postoperative clinical course was uneventful, and there was no evidence of permanent heart failure. Although the VF could have been caused by patient- or material-related variables, it was most likely the result of unwanted electrical effects. Specifically, the occurrence of an arc between the patient's tissue and the tip of the electrode during cutting in the coagulation mode can lead to low-frequency current. The modified low-frequency current may produce arrhythmias. Thus, the use of the coagulation mode to cut tissue in the cardiac region during laparoscopic procedures could increase the risk for arrhythmias. An understanding of the physical principles of electrosurgery, as well as familiarity with the equipment and its various functions, is essential for the patient's safety. In addition, cardioversion equipment should be readily available on every surgical unit.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/10. Laparoscopically performed gastric banding in a 13 year-old girl with morbid obesity and end stage renal insufficiency allows lifesaving weight loss and hemodialysis.OBJECTIVE: In adults, laparoscopic gastric banding is applied to treat morbid obesity, usually in combination with dietary and psychological intervention and increased physical exercise. However, little information is available on gastric banding in children. PATIENT AND methods: The 13 year-old girl suffered from end stage renal failure. Complications with hemodialysis catheters due to her extensive subcutaneous fat pads led to a life-threatening deterioration of her uremia. Intensive conventional schedules for weight reduction failed to be effective, so the morbidly obese girl (body mass index [BMI] 37.7 kg/m2, 3.6 standard deviation score [SDS]) underwent laparoscopic gastric banding at the age of 13 years after informed parental consent was obtained. RESULTS: After laparoscopic gastric banding there was a notable weight loss of 14 kg and an eventually adequate hemodialysis was possible. Total weight loss of the now 15 year-old girl was 24 kg (present BMI 28.3 kg/m2, 2.2 SDS). CONCLUSION: Even in childhood, laparoscopic gastric banding may be considered in cases of morbid obesity in critically ill patients.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/10. Postoperative rhabdomyolysis with bariatric surgery.rhabdomyolysis has been reported in all postoperative patients including those in prone, supine, lithotomy and lateral decubitus positions. Only a few reports suggest that bariatric surgical patients are at risk for rhabdomyolysis. We describe a male (BMI 69 kg/m2) who underwent an uneventful open Roux-en-Y gastric bypass for weight reduction lasting 5 hours. Postoperatively the patient suffered oliguria. Evaluation included subjective pain in both hips, a normal temperature and physical examination, creatinine increase to 3.5 mg/dl, CPK levels as high as 41,000 IU/L, and urinalysis showing a large amount of occult blood with 5-7 RBCs/HPF. Intravenous hydration with 0.9% normal saline, bicarbonate, and mannitol demonstrated initial success, but the patient eventually developed renal failure, respiratory distress, and tachycardia leading to cardiac arrest. Prior to his death, intraoperative evaluation demonstrated intact anastomoses. Obese patients undergoing bariatric surgery should be considered at risk for rhabdomyolysis, especially in view of prolonged surgeries, difficult physical examination, low volume status, and larger or immobile patients.- - - - - - - - - - ranking = 10.750715115088keywords = physical examination, physical (Clic here for more details about this article) |
6/10. electroconvulsive therapy complicated by life-threatening hyperkalemia in a catatonic patient.electroconvulsive therapy (ECT) requires brief general anesthesia, and succinylcholine is a depolarizing neuromuscular blocking agent that is frequently used for this procedure. Its use leads to intracellular potassium release into the extracellular space, usually increasing the serum potassium level by 0.5-1 mEq/L, with little clinical significance. However, long-term immobilization has been associated with changes at the neuromuscular junction (up-regulation of nicotinic cholinergic receptors) and subsequent serious hyperkalemia following succinylcholine administration. We report the case of a severely obese patient, immobilized due to her catatonic state, who developed life-threatening ventricular tachycardia after succinylcholine administration for ECT. Resumption of normal physical activity reverses these neuromuscular junctional changes, allowing subsequent safe succinylcholine administration. Current drug development may eliminate the need for succinylcholine use during ECT.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/10. Vanishing penis syndrome: the Ife experience.Twenty-five cases of vanishing penis syndrome as a rare cause of mechanical impotence seen over a nine year period in Ile-Ife are presented. Local aetiological factors some distinct from those earlier recorded in literature are highlighted. The prominent role which surgery can play in the management of this form of physical and mental handicap, loss of sexual function let alone becoming a social out cast is stressed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/10. Hazards of air travel for the obese: Miss Pickwick and the Boeing 747.A morbidity obese woman took a touring holiday which included two long flights and a stay at altitude. At the end of the second week of her holiday she was admitted to hospital in respiratory and cardiac failure. When she was better she travelled home by a combination of air ambulance and scheduled flights with a medical escort. This extreme case illustrates some of the physiological and physical challenges of air travel to the obese passenger, which may precipitate respiratory and cardiac decompensation in susceptible individuals. When advising these patients, consultation with the airline medical department is recommended, and preflight testing by altitude simulation may be helpful. If medical transport is required, there may be particular problems in lifting and accommodating these patients on board normal air ambulance aircraft.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/10. Case study: melatonin in severe obesity.Nocturnal serum melatonin was measured at half-hour intervals from 6:30 P.M. to 7 A.M. in two sisters, one severely obese 15-year-old and one somewhat overweight 12-year-old. Both, otherwise, were physically and psychiatrically healthy. In the severely obese sister, there was a significant increase in the serum melatonin mean level, a delayed phase-shift, and a delayed peak. Also, her overnight urine melatonin and its metabolite, 6-hydroxymelatonin sulfate, were significantly higher. Could there be a relationship between dysregulation of the pineal gland and severe obesity?- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/10. Morbid obesity and spinal cord injury: a case study.With obesity on the rise in the united states, most nurses will probably encounter the unique challenges that result from the pathophysiological changes in this population. The combination of morbid obesity and any other disease process or injury create complex medical management issues for caregivers during hospitalization and after discharge. Complications of spinal cord injury are intensified with obesity. Prevention and treatment of secondary complications require nursing practice to go above and beyond the standards of care. This paper clearly illustrates the nursing challenges by focusing on the experience of caring for a morbidly obese person who sustained a C5-6 spinal cord injury. Complications unique to this patient, as well as adjustments in care, will be discussed with a main focus on the acute rehabilitation phase. Ms. Z. is a 24-year-old female who worked as a home health aide. One cold winter day, as she was driving to a client's house, she lost control of her truck and struck another vehicle. The result of Ms. Z.'s accident was a C5-6 complete spinal cord injury (SCI), which would be complicated by her weight of more than 400 pounds. When the accident occurred, Ms. Z. was not wearing a seatbelt and had not worn one since age 12 because they did not fit. In fact, it is reported that obesity is associated with decreased seat belt use (Lichtenstein, Bolton & Wade, 1989). It took an hour to extricate Ms. Z. from the truck. She was then flown via Mayo One life support helicopter to our Type I Emergency Trauma Unit/Center. There she received methylprednisolone 4.8 gm i.v./1 hour followed by 22 cc/hr or 5.4 mg/kg over 23 hours. After medical personnel made assessments, they sent her to the operating room for cervical fusion. Ms. Z.'s obesity complicated positioning, X-ray, draping, and all facets of the operative procedure. Ms. Z. was in the intensive care unit (ICU) for six weeks, where she faced more complications that included: prolonged ventilator dependence; right upper lobe collapse; three episodes of asystole after being turned; a midback adipose fold wound; and urinary tract infections. Members of the rehabilitation team (physicians, nurses, physical therapists, occupational therapists, and a psychologist) became involved in her care at the beginning of her ICU stay. Early intervention by the rehabilitation team was essential to provide Ms. Z. with collaborative care and to eventually ensure an adequately prepared transition to the rehabilitation unit while maintaining continuity of care. Innovative planning for Ms. Z.'s transition to rehabilitation and mobilization included careful selection of beds, wheelchairs, and lifts to accommodate her weight and body size.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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