Bariatric Times - December 2008 - (Page 11)

Bariatric Times • December 2008 Patient Management Perspective 11 pounds or more. Tubes and catheters burrow into skin folds, especially if the tissue is edematous, fragile, damaged or cellulitic. This causes erosion of the skin surface. Pressure from side rails and armrests not designed to accommodate a larger person can cause skin or deep tissue injury on the patient’s hips and trunk/torso.4 (clinical experts) and tools (equipment) are the essence of repositioning. NUTRITIONAL CONSIDERATIONS Upon admission, the patient should have a consultation with a dietitian to determine the best nutritional plan to prevent risk and support healing. A malnourished person does not have the ability to synthesize enough protein to repair REPOSITIONING THE LARGER, HEAVIER PATIENT Atypical skin breakdown can be minimized by using properly sized equipment. Additionally, the patient needs to be repositioned at least every two hours, as do tubes and catheters. Tubes should be placed so that the patient does not rest on them. Tube/catheter holders may be helpful in this step. The abdominal panniculus must be repositioned in order to prevent pressure injury. Alert patients are usually able to lift the pannus off of the suprapubic area or describe to clinicians the manner in which the patient prevented injury at home. If clinically appropriate, the dependent, weak, or unconscious patient can be placed in the sidelying position and the nurse can lift the pannus away from the underlying skin surface, allowing air to flow to the regions while relieving pressure. Rotation therapy is available to ensure sufficient repositioning for a very large patient who otherwise may pose a realistic challenge to frequent turning. Despite the value of rotation therapy in the prevention and treatment of skin injury among obese patients, it is necessary to take precautions to prevent friction and shear. Correct pressure settings, fitting the patient to the appropriatesized surface, and assessment for skin changes can provide these precautions.5 Keep in mind that full-body lateral rotation therapy serves as an adjunct to turning and repositioning for purposes of promoting skin and preventing caregiver injury.6 The inability to adequately reposition patients is a significant concern, especially among obese patients.7 The challenge of repositioning the patient is at the heart of external factors that contribute to pressure ulcer formation. Additionally, caregivers who fear injuring themselves during repositioning procedures are likely to hesitate to provide adequate care. Consider the numerous resources available to help in lifting, transferring, and repositioning patients who are unable to do so for themselves. Specialized training, resources tissue. The dietitian should conduct a nutritional assessment that includes a thorough history and a physical examination. If malnourishment is suspected, lab tests should be run to check serum albumin and lymphocyte counts. If the patient is found to be at risk for malnutrition, it is imperative to begin nutritional intervention with proteins, dietary supplements, and nutrients. Meeting concerns of malnutrition and obesity is best addressed using an interdisciplinary approach, including specially trained staff members. MOISTURE CONTROL Moisture is problematic on many levels. Excess moisture on the skin surface, which collects in skin folds, threatens the general health of the skin. Bacterial, fungal, or viral overgrowth can occur in a warm, http://www.nascobal.com http://www.nascobal.com http://www.qolmed.com http://www.qolmed.com

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Bariatric Times - December 2008 Table of Contents Patient Management Perspective Diabetes Perspective Interview: ASMBS’s Georgeann Mallory Editorial Message Editorial Board Body Contouring Perspective Meeting Perspective Journal Watch Advertiser Index News & Trends

Bariatric Times - December 2008

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