that could cause complications during surgery if previously undiag-
nosed. Obstructive sleep apnea, diabetes, heart conditions, GERD and
hypertension are among the many problem areas. A full physical exam
and interview, an evaluation of medications in use, and treatment of
pre-existing conditions should be undertaken before surgery whenever
possible. Note that usable X-rays and ultrasounds are more difficult to
generate with obese patients.
"With any patient who is a larger size, you may need clearance from
a cardiologist or pulmonologist or nephrologist," says Dawn Williams-
James, MSN, RN, BC, bariatric nurse coordinator with Cone Health in
Greensboro, N.C. "Obesity is a disease, but there are many other dis-
eases that play into it, like cardiovascular, respiratory and others.
Make sure your patients are healthy enough to have surgery."
Dr. Sinha stresses that you need to know when to say "no" — to
demand that because of a patient's pre-op condition, the operation
needs to be performed in a hospital, or at least an outpatient setting
that's attached to a hospital, and not a standalone ASC.
3. Scheduling
Because of their special needs, obese patients often require more time
in the OR. If your schedule doesn't account for this, you could end up
falling behind, and requiring overtime from staff. In some cases, you
might not even be aware of the patient's weight or BMI until just
before the procedure is supposed to take place, so it's important to
find out that information before scheduling the patient, especially if
your center isn't equipped to handle a person of that size.
4. Hygiene
The cleanliness of any patient going into the OR is key to prevent
SSIs. But obese patients have a more difficult time cleaning them-
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