The Effects of Obesity on the Cardiopulmonary System: Implications for Critical Care Nursing

Kim Garrett, RN, MS, CNP; Kathy Lauer, RN, PhD; Beth-Anne Christopher, RN, MS

Disclosures

Prog Cardiovasc Nurs. 2004;19(4) 

In This Article

Nursing Care Considerations

Cardiac monitoring for arrhythmias is an important assessment of cardiac function, activity tolerance, and oxygenation status. Arrhythmias may be caused by a variety of factors, including coronary artery disease, electrolyte imbalances, increased circulating catecholamines, hypoxia, hypercapnia, OSAS, and OHS.[16,17]

Alterations in the hematologic system, immobility, and venous stasis place the critically ill obese patient at increased risk of thrombus formation. Because increased adipose tissue may mask swelling in the patient who develops deep vein thrombosis, routine assessment of circulation and pain or warmth in the extremities is essential. Certain body positions may effect circulation because the excess adipose tissue can actually impede blood flow. For example, the weight of a large abdominal panniculus may restrict blood flow to the lower extremities within minutes in the sitting position.[17] The use of sequential compression boots and anti-embolism stockings should be used routinely but may be limited due to size limitations in the extremely obese. Wrapping the legs with elastic bandages will produce a similar effect to the use of anti-embolism stockings. Prophylactic strategies include performance of routine range of motion exercises and use of low-molecular-weight heparin to improve blood flow.

Obesity also impacts nursing assessment of the pulmonary system, which includes the ability to auscultate breath sounds, monitor oxygen status with pulse oximetry, and assess respiratory rate and character.

Continuous monitoring of arterial oxygen saturation with pulse oximetry may be negatively effected if adipose tissue prevents adequate penetration of light. Poor tissue perfusion and poor probe placement may exacerbate the problem; therefore, specially adapted probes should be used at alternate placement sites, such as the nose or earlobe.

As with heart sounds, auscultating breath sounds may be impaired by excess adipose tissue. The same adjustments made to control the physical environment to optimize cardiac assessment are helpful during pulmonary assessment as well. In addition, movement of the patient to auscultate the lung bases posteriorly may require additional help to hold the patient in an adequate position for proper assessment.

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