Caring for Obese Critical Care Patients

Obese Critical Care Patients: Christina Sun, Concordia University, Irvine. Introduction: In today's society, obesity has been a growing problem in intensive care units (ICU). Many of these patients were not admitted solely for obesity, but rather for the complex health issues combined with their weight status. This poses a challenge for critical care nurses in the way they care for these patients. Due to their body mass index (BMI), obese patients are predisposed to other health issues, such as cardiovascular diseases and type 2 diabetes (Robstad, Soderhamn & Fegran, 2017).

Patients who are non-obese in the ICU are already having difficulties moving around. Therefore, for patients who are both obese and critically ill, their mobility in the hospital can be extremely limited. Difficulties in moving around may include changing locations to and from bed or transferring them to another room. With the assistance of nurses, these patients are capable of preventing further health complications. Therefore, this paper will shed light on this issue by explaining the basic pathophysiology, recognizing a major nursing diagnosis, and identifying three nursing interventions for obese critical care patients. Pathophysiology: Before nurses can properly care for obese critical care patients, they first need to understand the pathophysiology behind obesity. Patients become obese when they lack the necessary nutrients the body needs to regulate certain chemicals (Ignatavicius & Workman, 2015). There are two chemicals in the body that are responsible for metabolism and appetite: leptin and orexin (Ignatavicius & Workman, 2015). The dysfunction of these chemicals triggers obesity. Leptin, released from fat cells in adipose tissues, functions to control appetite (Ignatavicius & Workman, 2015). When there are high levels of leptin in the body, hyperleptinemia can occur, which can put patients in a state of leptin resistance (Ignatavicius & Workman, 2015).

Once leptin resistance occurs, the individual loses the sense of hunger suppression. Consequently, the individual keeps eating, thereby gaining weight. Another consequence of high levels of leptin is inflammation of the blood vessels and thickening of the left ventricle (Ignatavicius & Workman, 2015). This results in increased susceptibility to cardiovascular disease due to the inflamed blood vessels and hypertrophic left ventricle (Ignatavicius & Workman, 2015). Thus, regulating leptin levels in the body is crucial to avoid the consequences of hyperleptinemia or leptin resistance, a hormonal dysfunction that leads to overeating. With an understanding of how leptin resistance affects obese critical care patients, nurses can cater to the unique health problems these patients present in a critical care setting.

The primary nursing diagnosis for obese critical care patients is ineffective airway breathing (Doenges, Moorhouse, & Murr, 2014). This may be linked to hypoventilation syndrome and body positioning that hinders proper lung expansion (Doenges, Moorhouse, & Murr, 2014; Shetty & Parthasarathy, 2015). Evidence supporting this diagnosis includes decreased vital capacity (< 4500 mL), and bradypnea (< 12 respirations per minute) (Doenges, Moorhouse, & Murr, 2014; Shetty & Parthasarathy, 2015; Sole, Klein, & Moseley, 2017).

Obese patients in critical care face several challenges that impede the recovery process. One such problem is the difficulty in breathing properly at rest. This issue is exacerbated for obese patients, as they struggle more with ambulation compared to non-obese patients (citation needed).

The problem is that patients on bedrest have a decreased ability to fully expand their lungs. Less expansion of their lungs can cause potential respiratory complications such as atelectasis and pneumonia. The introduction of these complications can debilitate these patients further, potentially extending their hospital stay. Fortunately, there are three beneficial nursing interventions for the care of obese critical care patients with ineffective airway clearance: monitoring respirations and breath sounds, educating on head-of-the-bed elevation, and encouraging slow, deep breathing exercises. Monitoring respirations and breath sounds is crucial as it allows nurses to gauge the patient's baseline and assessments (Sole, Klein & Moseley, 2017). Any abnormalities in respirations and breath sounds could indicate potential respiratory complications, like alveoli not ventilating properly (Doenges, Moorhouse & Murr, 2014; Sole, Klein & Moseley, 2017). Another intervention is the education of patients on elevating the head of the bed to improve lung expansion (Doenges, Moorhouse & Murr, 2014). Nurses need to encourage them to elevate the head of the bed to at least 30 degrees to prevent complications arising from lying in a supine position (Sole, Klein & Moseley, 2017). Improvement in lung expansion increases patients' oxygen intake and carbon dioxide output (Sole, Klein & Moseley, 2017). This allows for proper ventilation and perfusion in the lungs (Sole, Klein & Moseley, 2017). Lastly, nurses should encourage slow, deep breathing exercises, which assist patients in achieving a more controlled breathing pattern (Doenges, Moorhouse & Murr, 2014). Teaching patients to breathe slower and deeper, potentially with incentive spirometers, helps the lungs intake adequate oxygen and expel the right amount of carbon dioxide (Cassidy, Rosenkranz, McCabe, Rosen & Mcaneny, 2013). All three interventions can help in the prevention of respiratory complications such as pneumonia and atelectasis (Sole, Klein & Moseley, 2017).

Proper breathing intervention and care for obese critical care patients can reduce the risk of nosocomial infections, helping to treat the diagnosis they initially came in very promptly with, rather than subsequent hospital-related problems they may acquire. In conclusion, obesity is a growing issue in the critical care setting. Obesity patients face more complications compared to non-obese patients with similar diagnoses. Nurses struggle to care for obese patients due to their underlying obesity status. Although there can be many complications and restrictions in treating obese patients in critical care units, nurses can tailor their care by applying appropriate interventions that promote healing, such as the breathing interventions mentioned earlier. Hospitals can't always fully cater to the comfort of obese critical care patients like they can with non-obese patients. The treatment of obese patients in intensive care units is restricted due to the challenges presented by obesity. Fortunately, public health interventions are in effect to tackle obesity and hopefully, decrease the number of obese patients admitted into ICUs.

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