Nursing care for the severely obese patient.

Care of the morbidly obese person (BMI greater than or equal to 30) during the perioperative period is specific and differs from routine nursing care. Effective communication, preplanning, and psychologic and physiologic assessment, with appropriate intervention (pulmonary and circulatory), result in positive care outcomes. Preoperative care emphasizes both psychologic and physiologic support concurrent with evaluation of vital signs, fluid status, teaching, and administration of preoperative medications (see Table 1). Intra- and postoperative care incorporates the necessity of additional personnel, transport precautions, physical protection, positioning, oxygenation, and early ambulation coupled with accurate arterial blood gas sampling, intraarterial line care, and cardiopulmonary and fluid status monitoring (see Tables 2 and 5). New information regarding hypothermia and shivering documented to occur in the recovery room underlines the need for accurate core temperature monitoring (see Tables 3 and 4; Figs. 1 and 2). An assessment tool (see Fig. 3)--an effective reminder of important aspects of patient care in the recovery room and until hospital discharge--provides a systematic guide to facilitate nursing care, recording, and reporting.