Obesity is a public health issue linked to high morbidity and mortality among critically ill patients. There are approximately 15.5 million morbidly obese adults in the United States. The purpose of the project was to develop and implement an educational program using evidence-based protocols for bariatric care to educate nurses and caregivers regarding best practices when attending to obese patients. The practice-focused question examined whether learning about evidence-based bariatric care would improve the knowledge of nurses and caregivers caring for morbidly obese patients in an acute care setting. The theoretical foundation was Bandura'€™s self-efficacy theory. A questionnaire using a Likert scale was used to collect data from the 100 participants before and after the learning intervention. The selection criteria involved the inclusion of all nurses and caregivers working at the adult in-patient unit. A paired-samples t-test was used to evaluate levels of improvement in knowledge of the causes, treatment, management, and care of patients with obesity and the challenges in caring for morbidly obese patients. The findings indicated a statistically significant increase in participants'€™ knowledge of the causes (p < 0.000), treatment, management, and care of patients with obesity (p < 0.000) and the challenges involved in caring for morbidly obese patients after the learning intervention (p < 0.004). Thus, the implementation of an educational intervention may be effective in improving nurses'€™ knowledge of bariatric care. The implications of the project for social change involve the improvement in nurse'€™s knowledge of clinical guidelines, which can lead to increase in patient satisfaction, and improved overall health outcomes.

Formation of atelectasis, defined as reversible collapse of aerated lung, often occurs after induction of anaesthesia with mechanical ventilation. As a consequence, there is a risk for hypoxemia, altered hemodynamics and impaired respiratory system mechanics. In certain situations, the risk for atelectasis formation is increased and its consequences may also be more difficult to manage. Anesthesia for bariatric surgery in morbidly obese patients and surgery requiring one-lung ventilation (OLV) with capnothorax are examples of such situations. In Paper I (30 patients with BMI &gt; 40 kg/m2 scheduled for bariatric surgery) a recruit­ment maneuver followed by positive end-expiratory pressure (PEEP) re­duced the amount of atelectasis and improved oxygenation for a prolonged period of time. PEEP or a recruitment maneuver alone did not reduce the amount of atelectasis. In paper II we investigated whether it is possible to predict respiratory function impairment in morbidly obese patients without pulmonary disease from a preoperative lung function test. Patients with mild signs of airway obstruction (reduced end-expiratory flow) in the preoperative spirometry developed less atelectasis during anaesthesia. In paper III we developed an experimental model of sequential OLV with capnothorax using electrical impedance tomography (EIT) that in real-time detected lung separation and dynamic changes in pulmonary ventilation and perfusion distributions. OLV to the left side caused a decrease in cardiac output, arterial oxygenation and mixed venous saturation. In paper IV we used our model of OLV with capnothorax and applied a CO2-insufflation pressure of 16 cm H2O. We demonstrated that a PEEP level of 12-16 cm H2O is needed for optimal oxygenation and lowest possible driving pressure without compromising hemodynamic variables. Thus, the optimal PEEP was closely related to the level of the capnothorax insufflation pressure. With insufficient PEEP, ventilation/perfusion mismatch in the ventilated lung and redistribution of blood flow to the non-ventilated lung occurred.

No description available.