skin & wound care considerations in special populations: bariatric tucson affiliate of the wocn...
TRANSCRIPT
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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
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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.
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Incidence of Obesity
• 35% of the world’s adults over 20 are overweight
• World wide obesity has doubled since 1980
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Future Generation
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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
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One-third of critical care patients are obese or morbidly obese.
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Comorbities Associated with Obesity
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Surgical/Post-op Complications
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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
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Skin Changes with Obesity• Stretch marks (striae)
• Hirsutism in women
• Aerochordons (skin tags)
• Acanthosis nigricans
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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.
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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
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Interventions
• Relief of pressure
• Skin fold management
• Moisture management
• Appropriate sized beds for repositioning
• Adequate staff for repositioning
• Fabrics
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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
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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
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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
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Interventions
• Topical or oral antifungal
• Drying agents
• Fans or cool hair dryer
• Special textiles with drying and antimicrobial properties
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Barriers to Skin Care• Body habitus
• Lack of bariatric equipment
• Inappropriate environmental design
• Caregivers fatigue
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Bariatric Equipment
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Staff/Patient/Family Education
• Bathing & hygiene
• Skin fold management
• Perigental care
• Toileting
• Odor management
• Caregiver injury prevention
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Educational Props
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Other issues
• Psychosocial issues
• Bariatric-specific surgery
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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