Upload
winda
View
17
Download
0
Tags:
Embed Size (px)
DESCRIPTION
Skin & Wound Care Considerations in Special Populations: Bariatric. Tucson Affiliate of the WOCN Society Conference March 8, 2014 Karen Lou Kennedy-Evens RN, FNP, APRN-BC. Learning Objectives. Describe the top three most common skin challenges in the bariatric population. - PowerPoint PPT Presentation
Citation preview
Skin & Wound Care Considerations in Special Populations:
Bariatric
Tucson Affiliate of the WOCN Society Conference
March 8, 2014
Karen Lou Kennedy-Evens RN, FNP, APRN-BC
Learning Objectives
• Describe the top three most common skin challenges in the bariatric population.
• Discuss the pathogenic factors contributing to these common alterations in skin integrity.
• Review the skin and wound care considerations of the most commonly seen skin challenges in the obese population.
Incidence of Obesity
• 35% of the world’s adults over 20 are overweight
• World wide obesity has doubled since 1980
Future Generation
Obesity increases risk of:• Hypertension• Type 2 diabetes• Coronary heart disease• Abnormal lipid concentrations• Delayed wound healing• Admissions to acute care, home care and out
patient clinics• Prolonged acute care to prevent complications
One-third of critical care patients are obese or morbidly obese.
Comorbities Associated with Obesity
Surgical/Post-op Complications
Loss is Skin Integrity due to:• Adipose has less blood supply inadequate
oxygenation• Excessive sweating increases skin moisture and
risk of bacterial/fungal invasion especially in deep folds
• Immobility friction and shear due to weight stress
• Malnutrition• Iatrogenic injury due to tubes, catheters and
other interventions
Skin Changes with Obesity• Stretch marks (striae)
• Hirsutism in women
• Aerochordons (skin tags)
• Acanthosis nigricans
Specific Skin/Wound Issues• Atypical pressure ulcers
• Perigenital irritant dermatitis
• Intertrigo
• Fungal infections
• Cellulitis
• Fournier’s gangrene
• Erythrasma
• Diabetic foot ulcers
• Venous insufficiency with possible ulceration
• Lymphedema
• Abdominal elephantiasis
• Surgical site infections– increased chance of dehiscence and evisceration.
Atypical Pressure Ulcers• Skin folds that create pressure on each
other– Neck– Upper back– Upper medial thigh– Flanks– Posterior legs– Pannus
• No risk assessment scales validated for the obese
Interventions
• Relief of pressure
• Skin fold management
• Moisture management
• Appropriate sized beds for repositioning
• Adequate staff for repositioning
• Fabrics
Perigenital Irritant Dermatitis
• Due to urinary and/or fecal incontinence
• Inability for self-care after toileting
• Environment not set up for bariatric clientele resulting in unable to cleanse and dry the urethral and rectal orifices/without the danger of falling
Intervention• Easy cleaning with appropriate equipment &
supplies– Toilet risers
– Extra wide toilet seats
– Bariatric commodes
– Hand rails for support
– Prepackaged cleansing & protection
– Perineal care with each incident
– Appropriate sized briefs and/or pads
– Drying fabrics
Intertrigo• Maceration due to excess moisture
• Infectious or noninfectious
• Friction from two opposed skin surfaces
• painful and/or pruritic
• Presents as:– Erythematous, macerated plaques
– Erosions with possible scaling
– Candida intertrigo: satellite papulo-pustules
– Found in perineal area, deep skin folds
Interventions
• Topical or oral antifungal
• Drying agents
• Fans or cool hair dryer
• Special textiles with drying and antimicrobial properties
Barriers to Skin Care• Body habitus
• Lack of bariatric equipment
• Inappropriate environmental design
• Caregivers fatigue
Bariatric Equipment
Staff/Patient/Family Education
• Bathing & hygiene
• Skin fold management
• Perigental care
• Toileting
• Odor management
• Caregiver injury prevention
Educational Props
Other issues
• Psychosocial issues
• Bariatric-specific surgery
References• Beitz, J., Providing quality skin and wound care for the bariatric patient:
An overview of clinical challenges . Ostomy Wound Management. Jan 2014
• Blackett A., Gallagher S., Dugan S., Gates J., Henn T., Kennedy-Evens K., Lutz J., Caring for persons with bariatric health care issues. Journal Wound Ostomy Continence Nursing. 2011
• Gallagher, S., The intersection of ostomy and wound management, obesity and associated science. Ostomy Wound Management Jan 2014
• Rush A, Muir M. Maintaining skin integrity in bariatric patients. Journal of Community Nursing. 2012
• World Health Organization. Obesity and Overweight. 2013. www.who.int/mediacentre/factssheet/
• Wound Ostomy Continence Nurses Society. Safety and Comfort issues for Nursing Care of the Obese Patient. Mt. Laurel, NJ. WOCN 2013