Bariatric patients
What makes an apple shaped person?
Apple: carries weight high , abdomen rigid due to ascites(fluid collection)
How should you prepare before initiating a flat spin techinique?
Bed should be deflated, locked, and blocked up against the wall for added stability. Bed should be at lowest level. Make sure thighs are parallel to the floor and feet are not hanging free
What makes a pear shaped person
Carries weight low with significant tissue between knees. Excessive posterior tissue bulk (gluteal shelf) Hip and knee flexion limitations but can roll easier than an apple
How do you perform an EGRESS test?
Clearance test(independent or assisted with draw sheet): patients ability to lift butt off edge of seat and take weight through legs Sit to stands Marches in place in standing (with assistance) Steps in place standing (step and return each foot)
When is a patient considered bariatric?
Either 350 pounds, BMI greater than 40 Patient of size = up to 500 lbs Patient of significant size= greater than 500 lbs
What is defined as obesity?
Having a BMI over 30kg/msquared Waist circumference of greater of 40 inches in males and 35 in females Can be at risk for premature death with a bmi over 35
How does breathing fatigue work in bariatrics?
High risk when breathing rates over 35bpm in them and 45 in normal person. check for apical and paradoxical breathing may wear cpap or bipap
What are some mobility concerns that deal with bariatric patients?
Limited trunk flexion shortness of breath poor supine or prone tolerance
What is some different equipment for bariatric patients?
Maxi Sky- used for up to 600lbs: used for dependent patients for wheechair, bedside commode and bed transfers Maxi-Move: for SCI population up to 440 lbs Sara plus- must bear weight on at least one leg 420 lbs.
Which demographic has the highest and lowest prevalence of obesity ?
Non- Hispanic Asians have lowest Hispanics have highest
What are some sleeping problems for bariatric patients?
Obstructed breathing in supine also may need many pillows to lay evenly check for MRSA/ORSA (antibiotic resistant)
What is considered a screen for a bariatric patient?
Screening ability to roll in bed with or without bedrails, move supine to sit, pull to sit using overhead trapeze, flatspin (dependent technique) Ability to hold unsupported sitting balance ability to scoot forward to the correct position at the edge of bed, using the following descending order of independence Screen lower extremity active movement (egress test)
What is a more common way for a bariatric patient to fall?
Vertical due to knees not supporting them. Very seldom to fall to the side due to the wide base of support
What are the surgeries for bypass?
Vertical sleeve gastrectomy adjustable gastric band gastric bypass
What makes up the decision tree for transfers?
Walking transfers- walk from bed to wheelchair (if they can pass egress test) Step-Turn transfers (stand pivot transfer with upper extremity support) used if they pass everything except 3 step in place part of egress test Squat pivot (used if patient cannot perform sit to stand or march in place) Sliding board transfer: (if unable to perform one clearance test or move legs against gravity) Mechanical transfers (bariatric lift) : if they cannot maintain erect sitting or anything higher
What is ANASARCA?
generalized edema with morbid obesity can be a medical emergency
What is an apple panus distribution?
more mobile since belly hangs down Can get panniculectomy to reduce it
What are some struggles that bariatrics have when diagnosing ailments?
trouble with DVT even with doppler since visualization of veins is difficult. also hard to see due to overall edema
