Toileting Bariatric Patients

What are some of your challenges when toileting bariatric (obese) patients?
Good hygiene, in all those those nooks and crannies.

The transfer from bed to w/c or toilet chair. Chairs are not wide enough, the bathroom is not big enough.

Transferring from bed to commode, especially if a Hoyer lift is involved.

encourage clients to help himself as possible.

How did the pt manage prior to hospitalization? !!!!

It can get dicey when the patient is capable of helping to clean themselves or reposition, but refuses to do so.

Like mamamerlee, I want to know what they were doing at home prior to being in the hospital. Their needs may be different in the hospital environment but it gives me a baseline of what I can expect or at least a goal for where they should be prior to discharge.

The most recent... A very obese man, and he needed a urinal, but could not reach the area himself (abdomen in the way...). In addition, he either had a "peekaboo" penis or it was hiding somewhere in the layers of fat. So I lift the gown and look... and I see nothing. Nothing that tells me where I should aim. Being that the guy is totally alert, I can't just start poking around looking for it... I almost asked "where is it" but bit my tongue soon enough. I was SO embarrassed.

For some reason, obese men tend to retract their penis up into their abdomens. Obtaining a U/A by cath is difficult ro say the least. I have a patient who is unable to use the urinal because he cannot reach that far. We pad him very well to save him the embarrassment of using geri-briefs.

One of the biggest difficulties I've found is innapropriate equiptment. You can't put a 400lb person on a comode that is only 3ft wide. They just aren't comfortable. Our hospital also has special bariatric rooms where the toilets are mounted to the floor rather than the walls. I guess there have been issues with wall mounted toilets not staying mounted.

Having been a bariatric patient, I can tell you-post op, things are different then when I was at home before surgery. I had an open RNY which made movement post op very difficult when it came to using the bathroom. I used flushable wipes which helped alot. Some patients have told me they used various tools-like a backscratcher, wooden spoon handles, anything they could find to help them out once they got home.

Our hospital also has special bariatric rooms where the toilets are mounted to the floor rather than the walls. I guess there have been issues with wall mounted toilets not staying mounted.[/QUOTE]This was not a hospital situation, but a private employer - one of the very heavy employees had the experience of the wall mounted toilet ripping out of the wall when they used it.