Nursing

LIFE FOR OVERWEIGHT AND OBESE PEOPLE is an everyday adaptation. Life for hospitalized overweight people who need imaging studies can be downright dangerous. The World Health Organization indicated that in 2005, approximately 1.6 billion people over the age of 15 were overweight, and at least 400 million were obese. They estimate that by 2015, approximately 2.3 billion adults will be overweight, and more than 700 million will be obese.¹

The average diagnostic imaging department is designed for people who weigh less than 300 pounds. The gowns, the waiting room chairs, the wheelchairs, the tables, the stretchers, and the imaging technology lose their quality and ability as the patient's weight reaches 300 pounds and higher. Some hospitals are finding construction that occurred some 20 or 30 years ago is no longer supportive of our larger patients.

» Doorways are too narrow for the larger, wider wheelchairs and beds.

» Handrails are not sturdy enough to support a 500-pound patient.

» Stretchers and exam tables are too narrow for obese patients and too high off the floor.

» Dental or otolaryngology chairs are not wide enough or are too high for this population.

A study conducted at Massachusetts General Hospital and reported in 2007 revealed that patients over 450 pounds experienced repeated delays in diagnosis and treatment because of the inability to obtain standard, modern imaging studies to quickly identify the pathology causing the patients' symptoms.²

If a patient is too large to fit on an exam table, into the gantry of the CT scanners, or through the bore of the MRI scanner, then physicians often are forced to practice outdated methods of patient care, which include observation or exploratory surgery. These methods increase pain, patient risk, and hospital length of stay, and often lead to a longer recovery period.

For those patients whose conditions would benefit from a diagnostic imaging study, there may be some help in store. Physicians, engineers, and healthcare companies are teaming up to address these problems.

NURSING CARE Nurses must be open and honest with their larger patients if there are concerns regarding patient care due to their size. Most likely, such patients have had these areas addressed before and will appreciate your concern. It's all right to tell them that you are acquiring the correct-size wheelchair for them, or that the radiology staff wants to schedule them for a particular room that will best suit their needs. Be honest and kind in your patient teaching.

Advise patients that the radiology staff may need to position and reposition them during the exam to obtain the best image. Using pillows, foam wedges, and tape make positioning the patient just right for the picture being taken in radiology.

In their preparatory teaching regarding diagnostic imaging studies, nurses should advise their patients in an honest and fact-based manner. Overweight and obese patients worry every day about whether they will fit, and they will overhear the staff having these conversations. Nurses should be proactive and advise patients that diagnostic staff is committed to obtaining the very best study to answer the questions their doctors have about their signs, symptoms, and possible conditions. Advise patients that each mode of images utilizes different techniques and positions. Reassure patients that although there are weight limits and size limits, every effort will be made to safely care for them.