New CCN article offers guidance on providing optimal care to critically ill obese patients

The U.S. obesity epidemic means more critically ill patients have weight-associated conditions affecting their illness or are at greater risk of specific complications during their hospital stay.

Hospitalized critically ill obese patients present unique challenges to the nurses who provide care for them in critical and progressive care units, and an article in the August issue of Critical Care Nurse (CCN) offers guidance on providing optimal care to obese patients.

Diabetes, high blood pressure, heart disease, gastroesophageal reflux, incontinence, sleep apnea, joint disease and pressure ulcers are among the various conditions and diseases associated with obesity. During a hospital stay, critically ill patients with weight-associated conditions may need more frequent nursing assessments and increased monitoring.

The article "Progressive Care of Obese Patients" provides specific information about obesity-related complications, assessments and interventions and discusses specific nursing competencies integral to providing care to obese patients. A sample plan of care details each body system and lists interventions and resources needed to implement each activity.

Lead author Lori A. Dambaugh, RN, DNP, CNS, PCCN, ACCNS-AG, is an assistant professor of nursing and clinical nurse specialist track coordinator at Wegmans School of Nursing, St. John Fisher College in Rochester, New York.

"With up to a quarter of critically ill patients classified as obese, nurses must be aware of how obesity may change how their patients respond to their illness," Dambaugh said.

According to the article, obese patients who have been in an intensive care unit (ICU) may benefit from a stay in a progressive care unit before being transferred to a general care unit or discharged to home. Progressive care may also be appropriate for hospitalized obese patients with unstable clinical conditions.

Co-author Margaret M. Ecklund, RN, MS, CCRN, ACNP-BC, is an advanced practice nurse working as a clinical nurse specialist with the wound, ostomy and skin care team for Legacy Health, Portland, Oregon. She is also the contributing editor of the journal's Progressive Care column.

"Progressive care is the unifying term for the increased level of care and nursing vigilance needed by patients who are not in the ICU but have complex healthcare needs," Ecklund said. "Progressive care units may be an excellent setting for obese patients who require increased monitoring and may have unstable clinical conditions."

Other common terms for progressive care settings include stepdown, intermediate, telemetry, transitional, high acuity, direct observation or medical-surgical progressive care units.

As the American Association of Critical-Care Nurses' bimonthly clinical practice journal for high acuity, progressive and critical care nurses, CCN is a trusted source for information related to the bedside care of critically and acutely ill patients.

AACN offers progressive care nurses a multitude of clinical and educational resources, including a clinical guide of essentials for progressive care nursing, the core curriculum for this growing practice area and PCCN certification - AACN Certification Corporation's fastest-growing credential.