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Scenerio
47 year old female Weight = 505 lbs Height = 5’6” BMI = 81.5 Medical History: Asthma, sleep apnea,
pulmonary hypertension, arterial hypertension, diabetes, DVT, osteoarthritis, non union of tib-fib fracture, bedrest for 1 year
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Surgery & Initial Postop Course
Roux en Y gastric bypass on August 2, 2002 Initial Postoperative Course
Ventilator dependencyTracheostomyAtrial fibrillationStrokeFluid and electrolyte imbalancesDiarrhea from tube feedingSepsis from TPNAcute renal failureRashes from plastic allergy and Candida
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Operating Room
Access to OR Size of OR table Size of instruments Positioning Visualizing the
operative field Anesthesia
challenges & risks Longer time
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Post Operative Care
ABCs
• Airway
• Breathing
• Circulation
• Drugs
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Post Operative Care
Vital signs
• Pulse
• Blood pressure
• Respirations
• Temperature
• Pain
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Post Operative Care
Mobility & Early Ambulation• Bariatric bed• Supportive equipment• Staff support• Preventing
Complications• Thromboembolic• Deconditioning• Pressure ulcers
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Post Operative Care
Wound Care• Wound Assessment• Dressings• Binders• Increased risk of
infection
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One Month Postoperatively
Height = 5’6” Weight = 395 lbs BMI = 63.7 Albumin = 2.7 Still on ventilator in AICU Renal failure recovering– off dialysis Multiple skin and wound problems
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September 3, 2002
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September 3, 2002
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September 10, 2002
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September 17, 2002
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September 17, 2002
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September 19, 2002
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September 19, 2002
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September 19, 2002
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October 9, 2002
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Treatment of Pressure Ulcers
Astute and thorough skin and wound assessment Risk assessment Adequate hygiene Toileting assistance Skin care Encouraging mobility and independence Appropriate equipment Pressure reduction Nutrition for healing Local wound care Oxygenation and perfusion