Holistic Care of a Bariatric Patient - Essay Example

? HOLISTIC CARE OF A BARISTIC PATIENT s Bariatric patients are increasing in number, and there is the necessity to ensure that these patients are given health care in a dignified manner and without predisposing the care giver to risks of back injury. The body weight of bariatric patient is usually higher than that of ordinary patients and, therefore, they cannot fit in the convectional stretchers, beds and wheel chairs. Previously, due to lack of specialized equipments to carry these patients, they could be carried on the floor of the ambulance and dragged down the corridors of the hospital. However, this is not only demeaning but also exposes the patient to risks of injury and bruising their skin. Hospitals must take it into consideration by procuring specially tailored equipments for such patients such as the mobile floor lifts, blood pressure devices having a larger cuff and bigger beds. In addition, in the response activity, there is need to ensure that adequate number of health staff are dispatched. Introduction Quick response to an emergency is critical to help save lives but it must always be backed by adequate preparation. On receiving an emergency call, paramedics must always ensure that they carry have the required equipments and care givers before embarking on responding to the emergency (Grant and Newcombe, 2004, p. 309). This is because different patients have varying needs and require specific care as they are being taken to hospital. When offering paramedics/ambulance services, care givers must always strive to ensure that holistic care is given to the patient. In addition to preparation of specific equipments and caregivers, paramedics must also ensure that the team dispatched has the ability of meeting the psychological and social needs of the patient (Brown, 2001,p. 108). This paper will look at a holistic paramedic emergency response for a bariatric patient. Generally, bariatric is an internationally recognized term for describing patients having body weight that supersedes the recommended guidelines and whose body size limits mobility, access to present service and health (Wilson and Clark, 2004, p. 426). The population of obese people is rising significantly in developed countries such as the UK and the USA. Persons with a Body Mass Index (BMI) of 30 are considered obese while those registering more than 40 BMI are described as morbidly obese (Loughborough University, 2007, p. 17). In the period between 1999 and 2000, age adjusted prevalence of obesity in the USA stood at 30. 5 percent. This is presenting high risks to manual handling in social and health care. In emergency response, the pathway for carrying the patient from their homes to the hospital is mostly complex and risky to both the patient and the care givers. Currently, ambulance services mostly respond with some ambulance staff and emergency personnel and only seek help from the fire services in case additional assistance is required (Loughborough University, 2007, p. 17). The rescue procedures for bariatric patients may be undignified and demeaning to the patients. There have been reports of bariatric patients being carried on the floor of the ambulance instead of the recommended secured stretcher (Loughborough University, 2007, p. 17). In addition, on arrival to the hospital, due to lack of the required equipments, bariatric patients are literally dragged down the hospital corridors. This demand for emergency response teams to procure equipments that will meet the need of the bariatric patients. Bariatric Equipments The health risks associated with obesity have been well understood with some being identified as having domino influence on related health conditions and can hospitalization at any stage of the patient (Blackwood, 2004, p. 35). Health conditions linked to obesity include diabetes, heart disease, high blood pressure, osteoarthritis and some types of cancer. In addition, bariatric patients are observed to have increased chances of wound infection and complications following a surgery (Wilson and Clark, 2004, p 426). To cater for a bariatric patient it is critical to find out whether the equipments are products available can accommodate the patient. Moreover, it is critical to find out whether the care givers are adequately trained in using those equipments. Different suppliers have come up with equipments to help caregivers lift the patient into the ambulance. This is necessitated by the need to secure the health of caregivers while ensuring that the patient is carried in a dignified manner. One of the items that should not be left is the floor lift. Some suppliers of hospital equipments have come up the ambulatory lifts which are developed in an attempt to reduce risks of back injury on care givers when lifting the patient (Byrns, 2005, p. 42). Akridge (2005, p. 48) notes that ARJO, a company dedicated in supplying bariatric equipment, has a 705 pounds lift, in addition of the 600 and 1000 pounds ceiling lift having overhead gantry. Moreover, the company has a Dynamic Positioning System with four hanger bars and a sling which allow bariatric patient to be rotated into a seated position without having to push the legs of the patient or tugging him onto the sling handles (Akridge, 2005, p. 53). The other equipments that should be included by paramedics are a mobile floor lift and overhead lift system. Different suppliers offer equipments with varying capabilities and, therefore, the procurement process must consider different options in the market. Liko Inc, bariatric equipments’ supplies company, has an UltraTwin overhead system which offers patients a chance to tilt forward and backwards when they are suspended on the bed, commode or wheelchair. This subsequently improves the comfort of the patient and improves their breathing (DeJohn, 2005, p. 4). The company also sells the mobile floor lifts which weigh about 95 pounds but have a lifting capability of up to 660 pounds. Air transfer devices are also listed as important when dealing with bariatric patient. These devices are important when transferring patients from their bed onto the stretcher. An example of this equipment is the Airpal lateral system in which a nylon transfer pad is usually placed under the patient (Akridge and Klein, 2006, p. 26). It is then inflated using a potable air supply which lifts the patient and allow the caregivers perform a job that would have previously required four or more persons. This equipment gives a patient the comfort they deserve and protect their skin. The paramedic response team should also have a transport chair with ability to be easily transformed into stretcher which is already available in the market. A stretchair has various widths and can support up to 1000 pounds. This chair reduces the dependency on equipments such as walkers, bedside chairs and canes. Since bariatric patients are usually predisposed to hypertension, it is critical to use accurate equipments to measure the patient’s blood pressure (Holland, et al., 2001, p. 39). They argue that the use of adult size cuff on bariatric patients is most common cause of misdiagnosed hypertension. Consequently, the paramedic team rescuing a bariatric patient should consider having long and extra size cuffs which facilitates accurate measurement of blood pressure. Bariatric patients experience breathing problems. This is because respiratory organs do not increase in size as the patient becomes obese. In addition, the diaphragm fails to fully descend given that the adipose tissue and the expansion of the chest is impaired. Consequently, the patient has reduced vital capacity and tidal volume thereby compromising supply of oxygen to tissues (Wilson and Clark, 2004, p. 426). This means that mechanical ventilation must be included by the paramedic’s equipment. When rescuing a bariatric patient, a special ambulance should be used which has enough space to accommodate the patient. Moreover, a bariatric trolley should be used. McGrath (2002, p. 251) note that having the required trolley helps ensure great manoeuvrability and ensures safety of the care givers. The trolley must be wide enough to give the patient a chance of turning independently in the bed. The mattress used when transporting a bariatric patient must be checked to ensure that it has the ability of accommodating the weight of the patient. According to Gallagher (2001, p. 3), at least three staff members are required when transporting the patient and the trolley. However, in case the patient is being transported on a bed; four or more staff would be required. Moreover, when transferring a patient using the slide sheet and Patient Assisted Transfer Slide, a minimum of six staff must be present. The sling used when transporting a bariatric patient must be chosen taking into consideration the weight distribution of patient. This means that a rescue team must ensure they include slings of different sizes. In case a patient has pear body type, a sling having a long leg to wrap up the leg and in case the leg has a lot of weight. In addition, caregivers must excess caution taken to ensure that the sling cannot cause friction or result into damaged skin to the patient. In case the bariatric patient has exaggerated buttock tissues, it becomes difficult to use a sling and therefore slide sheets are required (Grant and Newcombe, 2004, p. 315). Paramedics must ensure that they include sufficient number of hoist slings which are within the patient’s weight. Given that in most cases the response team cannot tell the weight of the patient they are going to rescue, it is important to ensure that they include hoists of varying sizes and ones with the ability accommodate varying body shapes. When rescuing bariatric patients, health care givers involved must be well trained in order to take care of themselves and cater for the social and psychological needs of the patient. Wilson (2001, p. 112) asserts that the independence of the patient is crucial as it prevents the patient from getting a feeling of being judged by others. Control of the urinary system usually gives bariatric patients problems. Furthermore, high intra-abdominal pressure over the secondary adipose layer predisposes bariatric patients to urinary incontinence. This can create a favourable environment where micro-organisms can thrive and destroy the skin. Consequently, paramedics must have incontinence pads although care must be exercised in the use of these pads to ensure that the do not degrade the dignity of the patient. In addition, the equipments could include urinary bottles which are used for male patients or the slipper pan used by female patients (Wilson, 2001, p. 112). Commode positioned at the bedside may also be used for passing urine by patient. In the ambulance, there should be a nurse who will help the patients who are not able to access the perinea area and position the urine containers. Catheters must be included among the equipments carried by rescue team. Bariatric patients are usually exposed to risk of heart attack and, therefore, the rescue team must never leave behind a portable, battery-operated defibrillator. This must have the ability to discharge electrical discharges of below 25 watt-seconds (Blackwood, 2004, p. 35). This is important to resuscitate a person who may have a heart attack before getting to hospital. Moreover, the ambulance may either have a stand alone or an integrated transcutaneous cardiac pacemaker. Bariatric patients have been recognized to be at a great risk of diabetes. Consequently, in rescuing these patients, the paramedic must always include blood measuring equipments or a glucometer to assess the blood sugar of the patient. In addition the team should include reagent strips used in monitoring blood sugar. The teams must be armed with insulin which can be injected into the patient in case their sugar level is above the normal levels. Other equipments included in ambulance response of a bariatric patient are; intravenous arm boards, intravenous equipments micro drip and macro drip and needles and syringes of varying sizes (Loughborough University, 2007, p. 75). To ensure the cleanness of the care giver, the ambulance or the paramedic team should be armed with hand gel dispenser. Communication is critical in any response system. In ambulance and paramedic response, there must be effective communication equipments which helps the rescue team carry out well coordinated response operation with the hospital where the patient will be taken. Communication will ensure that the doctors are well prepared to receive the patient and will have organized necessary equipments to help the patient on arrival. Conclusion Bariatric patients continue to increase in number and lead to the need to critically assess the equipments needed to cater for these patients. Bariatric patients are considered to have higher body weight than other patients. Indeed, any person having a body mass index of more than 30 is considered to be obese while those who exceed 40 BMI are considered as morbidity obese. Bariatric patients usually have their movement restricted and are predisposed to some health risks such as diabetes, hypertension and cardiac arrest. Moreover, such patient’s skin is at risk of being damaged when being handled. Care givers taking care of these patients must be well trained on manual handling of the patients and how to take care of themselves. When going to rescue bariatric patient, it is critical that an adequate number of health professionals is involved given that they have heavy weight that cannot be lifted by two persons. In addition, normal stretchers should not be used but instead the team should consider use of mobile floor lifts. The ambulance used should be fitted with a large bed and a mattress with ability to support the body weight of the patient. The team should never leave behind an oxygen system to help in the respiration of the patient as this is usually impeded by adipose layer over the diaphragm reducing the active capacity. In addition, bariatric patients are usually prone to hypertension and, therefore, it is critical that a correct diagnosis is made. However, since the cuff size may be larger than that of regular patient, the rescue team must ensure that they carry a blood pressure machine with a larger cuff size. Given that bariatric patients are predisposed to cardiac arrest, a defibrillator must also be carried by the response team. Bibliography Akridge, J. & Klein, M., 2006. Bariatric equipment puts ergonomics, safety to the test. 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