Beck L A
St. Mary's Hospital, Rochester, MN, USA.
SCI Nurs. 1998 Mar;15(1):3-5.
With obesity on the rise in the United States, most nurses will probably encounter the unique challenges that result from the pathophysiological changes in this population. The combination of morbid obesity and any other disease process or injury create complex medical management issues for caregivers during hospitalization and after discharge. Complications of spinal cord injury are intensified with obesity. Prevention and treatment of secondary complications require nursing practice to go above and beyond the standards of care. This paper clearly illustrates the nursing challenges by focusing on the experience of caring for a morbidly obese person who sustained a C5-6 spinal cord injury. Complications unique to this patient, as well as adjustments in care, will be discussed with a main focus on the acute rehabilitation phase. Ms. Z. is a 24-year-old female who worked as a home health aide. One cold winter day, as she was driving to a client's house, she lost control of her truck and struck another vehicle. The result of Ms. Z.'s accident was a C5-6 complete spinal cord injury (SCI), which would be complicated by her weight of more than 400 pounds. When the accident occurred, Ms. Z. was not wearing a seatbelt and had not worn one since age 12 because they did not fit. In fact, it is reported that obesity is associated with decreased seat belt use (Lichtenstein, Bolton & Wade, 1989). It took an hour to extricate Ms. Z. from the truck. She was then flown via Mayo One life support helicopter to our Type I Emergency Trauma Unit/Center. There she received methylprednisolone 4.8 gm i.v./1 hour followed by 22 cc/hr or 5.4 mg/kg over 23 hours. After medical personnel made assessments, they sent her to the operating room for cervical fusion. Ms. Z.'s obesity complicated positioning, X-ray, draping, and all facets of the operative procedure. Ms. Z. was in the intensive care unit (ICU) for six weeks, where she faced more complications that included: prolonged ventilator dependence; right upper lobe collapse; three episodes of asystole after being turned; a midback adipose fold wound; and urinary tract infections. Members of the rehabilitation team (physicians, nurses, physical therapists, occupational therapists, and a psychologist) became involved in her care at the beginning of her ICU stay. Early intervention by the rehabilitation team was essential to provide Ms. Z. with collaborative care and to eventually ensure an adequately prepared transition to the rehabilitation unit while maintaining continuity of care. Innovative planning for Ms. Z.'s transition to rehabilitation and mobilization included careful selection of beds, wheelchairs, and lifts to accommodate her weight and body size.
随着美国肥胖率的上升，大多数护士可能会遇到因这一人群的病理生理变化而产生的独特挑战。病态肥胖与任何其他疾病过程或损伤相结合，给护理人员在患者住院期间和出院后带来了复杂的医疗管理问题。肥胖会加剧脊髓损伤的并发症。继发性并发症的预防和治疗要求护理实践超越护理标准。本文通过关注护理一名患有C5-6脊髓损伤的病态肥胖患者的经历，清晰地阐述了护理挑战。将讨论该患者特有的并发症以及护理调整，主要聚焦于急性康复阶段。Z女士是一名24岁的女性，曾是一名家庭健康助理。在一个寒冷的冬日，她开车前往一位客户家中时，卡车失控撞上了另一辆车。Z女士事故的结果是C5-6完全性脊髓损伤（SCI），她体重超过400磅，这使情况更加复杂。事故发生时，Z女士没有系安全带，自12岁起就没系过，因为安全带不合身。事实上，据报道肥胖与安全带使用减少有关（利希滕斯坦、博尔顿和韦德，1989年）。花了一个小时才将Z女士从卡车中救出。随后，她乘坐梅奥一号生命支持直升机被送往我们的一级紧急创伤单元/中心。在那里，她接受了静脉注射4.8克甲泼尼龙/1小时，随后在23小时内以每小时22毫升或每千克5.4毫克的速度给药。医务人员进行评估后，将她送往手术室进行颈椎融合手术。Z女士的肥胖给手术定位、X光检查、铺巾以及手术的各个方面都带来了困难。Z女士在重症监护病房（ICU）住了六周，在那里她面临更多并发症，包括：呼吸机依赖时间延长；右上叶肺不张；翻身三次后出现心脏停搏；背部中间脂肪褶伤口；以及尿路感染。康复团队成员（医生、护士、物理治疗师、职业治疗师和一名心理学家）在她入住ICU之初就参与了她的护理。康复团队的早期干预对于为Z女士提供协作护理并最终确保在保持护理连续性的同时顺利过渡到康复单元至关重要。为Z女士过渡到康复和活动制定的创新计划包括精心挑选床位、轮椅和升降机，以适应她的体重和体型。
