Immobility and the Bariatric Population

Presented By:

Skila Jennings, PT, MEd in Exercise Physiology

Jennifer McCollum, MPT, Back School Coordinator

Immobility can lead to…..Skin breakdownDVTPneumonia/Breathing dysfunctionAtrophy of musculatureEmotional components

Skin IssuesIncreased risk of cellulitisIncreased risk of skin breakdown

due to increased pressureSkin breakdown due to shear

forcesMoisture in folds

BreathingLungs do not increase in size with

obese patients.The diaphragm is fully able to

descend due to the increase adipose tissue, thus decreasing their vital capacity and tidal volume.

Hyperventilization leads to increased risk for DVT

AtrophyDecreased muscle strengthDecreased muscle enduranceDecreased efficiency of already

compromised cardiovascular system

Emotional factorsDepressionA feeling of failureAnxiety or guilt over needing so

much helpEmbarrassment

Other metabolic concernsTemperature control, excess

sweatingMisuse of proteinAffect on resting metabolic rateDiabetes controlContractures at foot/ankle

Proper EquipmentManual Handling equipment

◦Bariatric FWW◦Gait belt◦Maxi slide

Lift equipment including appropriate slings◦Appropriate size

Bariatric bed

Yes it takes more staff, but we got to get these folks moving!

TransfersUse proper equipmentUse mechanical advantage of

bedBlock knees

References Davis, Crawford (2002) Persistant leg ulcers in an obese patient

with venous insufficiency and elephantitis. Journal of wound ostomy and continence. 29:55-60

Groszek. D (1982) Promoting wound healing in the obese patient. Advances in skin and wound care. 5;1132-8

Guillet C, Masgrau A, Doirie Y (2011) Is protein metabolism changed with obesity? Curr. Opinion Clinical Nutrition Metabolic Care.

Maklebust, Seiggreen (1992) Pressure ulcers: Guidelines for prevention and nursing management. 2nd Edition. Springhouse corporation. Manual Handling Operations Regulations (1992)

Milton Stokes (2004) The impact of obesity on Healthcare delivery. Trimble T (2003) Outsize patients – a big nursing challenge!

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