A bariatric patient is an individual who is morbidly obese (BMI>40). This may lead to severely decreased mobility and the development of a variety of additional health problems.

Symptoms

A bariatric patient is one with a BMI over 40 and whose size and lack of mobility has affected their health.

Risk Factors

There are a number of aspects about a bariatric patient that increase their risk for developing skin problems or chronic wounds. Poor circulation keeps damaged tissues from getting sufficient oxygen. Increased sweating and difficulty keeping themselves clean puts the patient at risk for skin maceration and breakdown. Body folds which are not cleaned multiple times a day are susceptible to intertrigo or inflammation, along with eczematous lesions and fungal growth. Bariatric patients often have limited mobility and/or problems lying prone, which can lead to the development of pressure injuries. It is not uncommon for bariatric patients to fail to acquire the nutrients required to heal and prevent wounds.

Diagnostic Studies

Pressure mapping is an excellent way of assessing the risk faced by bariatric patients. Areas which are at risk for pressure ulceration can then be offloaded and monitored more closely. Beyond this, weight monitoring and regular skin assessment for areas of breakdown can help avoid or minimize wounds.

Treatments & Interventions for Bariatric Patients

To reduce the risk of pressure ulceration to the bariatric patient, the use of specialized offloading devices such as lifts, chairs, beds and commodes on a regular schedule is key. Additionally, it is important to clean and dry the patients skin folds multiple times daily to reduce maceration and skin breakdown and to assess skin conditions and any emerging ulcers or wounds. It is also important to provide the bariatric patient with adequate nutrition.

References

Collins N, Craggs-Dino L. Obesity, Bariatric Surgery, and Wound Healing. Ostomy Wound Management. 2011:12-16.
Corbyn C. Challenges of wound management in bariatric patients. Wounds UK. 2010;6(4):62-71.
Rush A. Bariatric Care: Pressure Ulcer Prevention. Wound Essentials. 2009;4:68-74.
Swezey L. Top 5 ways to Prevent Skin Breakdown in Bariatric Patients. WoundSource. http://www.woundsource.com/blog/top-5-ways-prevent-skin-breakdown-bariat.... Updated April 2, 2015. Accessed October 17, 2019.

Images copyright Medetec (www.medetec.co.uk). Used with permission.