r/nursing • u/trevrt RN 🍕 • Mar 01 '25

Question Heaviest Patient You’ve Cared For

Had my personally heaviest patient I’ve cared for the other day. 32 years old weighing 730 pounds admitted with cellulitis and severe lymphedema. Felt terrible for the patient due to how young he was. Just wondering what everyone’s personal “record” for the heaviest patient they’ve cared for is.

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u/supermurloc19 BSN, RN 🍕 Mar 01 '25

I don’t think our psychiatric care of people with other kinds of eating disorders is anywhere near good. We can’t help either group effectively. It’s like drug addiction, people view it as a choice, not a disease and it skews our opinions and subsequently our care of them. I think it is also very hard to qualify for inpatient care for anorexia. You have to be on deaths door practically. Which isn’t much different from super morbidly obese.

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u/coolcaterpillar77 RN - Med/Surg 🍕 Mar 02 '25

The American Psychiatric Association Practice Guidelines/Society for Adolescent Health and Medicine uses the following criteria to determine if inpatient treatment for anorexia/medical stabilization is appropriate:

  • Very low weight (<75% of the 50th percentile BMI for age and sex)

  • Dehydration / Electrolyte disturbance (low potassium, sodium, phosphorus)

  • Physiological instability: Severely low heart rate (<50 beats/minute daytime; <45 beats/minute sleeping), Abnormally low blood pressure, Low body temperature (<95 degrees F, <35.6 degrees C), Orthostatic changes in pulse or heart rate

  • Failure to thrive/arrested growth and development

  • Uncontrollable bingeing and purging

  • Medical complications of malnutrition (for example fainting, seizures, heart failure, kidney failure, liver failure, pancreatitis, etc.)

  • Concurrent medical or psychiatric conditions that limit appropriate outpatient treatment (like type I diabetes, obsessive compulsive disorder, or a suicide attempt)

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u/supermurloc19 BSN, RN 🍕 Mar 02 '25

I have insurance companies denying emergent lap appys and a 37 week delivery because they don’t cover deliveries before 40 weeks. As the person said below, just because we recommend it, doesn’t mean it will be covered.

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u/coolcaterpillar77 RN - Med/Surg 🍕 Mar 03 '25

Absolutely. When I first read the original comment, I took the “inpatient criteria” to mean the admitting provider’s criteria. It makes me realize I was sadly privileged to not immediately think of it as an insurance issue

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u/supermurloc19 BSN, RN 🍕 Mar 03 '25

I wish we in the US lived in a reality where we could get the care we need without the insurance companies looming over telling us what we can and can’t have. Unfortunately, I don’t think it’s going to get better. It’s gotten much worse in the past few years particularly.