Special Considerations in the Perioperative Environment for Registered Nurses

Body Mass Index (BMI)

Perioperative Nursing Considerations When Caring for Low BMI Patients 

Care must be taken to protect patients with low IBW in the operating room. Because they have decreased body fat and reserves, underweight patients are at elevated risks of hypothermia. The perioperative nurse should ensure the patient remains covered until the team is ready to position. Warming devices may be required even for short cases where one would not normally use them. 

Ensure additional caution is taken when positioning the underweight patient. Extra padding and cushioning may be required. Skin may be very fragile, so care must be taken when using tapes, and ensure that wires and cords are well padded. 

Caring for Patients with High BMI in the OR 

Patients who have an ideal bodyweight (IBW) that is 110-120% are considered morbidly obese. These patients have additional risks when coming to the OR. Patients who are 10% or more overweight have an increased risk of morbidity and mortality due to: 

  1. Increased workload on the heart for the body to meet the demands of additional adipose tissue, pulse, cardiac output, stroke volume and blood volume. This eventually causes hypertrophy of the heart which can lead to congestive heart failure and coronary artery disease. 
  2. Hypertension. 
  3. Varicose veins and edema because of poor venous return. 
  4. Pulmonary function abnormalities – decreased tidal volumes can lead to hypoxemia. 
  5. Respiratory compromise including sleep apnea. 
  6. Gastrointestinal disease including gallbladder, liver disease or diverticulosis. 
  7. Osteoarthritis which can limit mobility. 
  8. Diabetes type 2. 
  9. Malnutrition because of protein deficiency or metabolic disturbances. 
  10. Delayed wound healing and increased risk of infection. 
  11. Higher risk of thromboembolic complications. 

(Phillips & Hornacky, 2021) 

Perioperative Nursing Considerations when Caring for Patients with High BMI 

Care must be taken to protect perioperative team members from injury when transporting and transferring any patient; however, extra care must be taken when moving obese patients. 

(Phillips & Hornacky, 2021) 

📽️ AORN CINE-MED VIDEO  

Navigate to the AORN Cine-Med website and make sure that you are logged in before clicking on the link below.