Bariatric patient skin care management is an important nursing consideration to assist in the prevention of wounds. Nurses are aware that bariatric patients pose a challenge in the prevention of loss of skin integrity and the promotion of effective wound healing. Here are some of the reasons why Bariatric patients are at increased risk of loss of skin integrity.
Adipose tissue has a reduced blood supply, leading to poorer oxygenation.
Did you know the epidermal barrier function of the skin is altered which leads to increased transepidermal water loss and dry skin? The lymphatic channels dilate, reducing lymphatic flow which leads to oedema. Bariatric patients also have larger skin pores and collagen and elastin formation is altered which impacts wound healing.
Excess sweat increases moisture on the skin and therefore risk for bacterial/fungal invasion (in particular within skin folds)
The need for shuffling, sliding and the use of mobility aids increases the risk of damage from friction and shear
Weight stress on tissues decreases perfusion, increases shear forces, and will place mechanical strain on wounds healing by primary intention
Do not assume that bariatric patients are well nourished: These patients have often been on a myriad of diets, or eat poorly. They are often protein-deficient and lack the micronutrients for healing.Poor nutrition can lead to inadequate protein, vitamins, and nutrients required for wound healing.
Placement of tubes, catheters, and other interventions under the patient, a limb, or a heavy skin fold can cause damage.Tubes and catheters can burrow into skin folds and lead to medical device-related pressure injuries. Remember to check for pressure damage in the neck folds from tracheostomy ties.
Beds for bariatric patients take into account the patient’s weight and girth Standard hospital beds are generally 81–91cm wide; this size is often not wide enough for a bariatric patient to turn onto their side.The mattress should be able to support the patients weight without ‘bottoming out’ onto the bed frame. Bottoming out means your patient ends up laying on the frame of the bed, rather than the mattress. Pressure injuries can develop rapidly.
The width and strength/weight limitations of the bedside chair, commode and walker frame must also be considered.
Bariatric patients have been found to have three times the risk for pressure ulcer development than those of a healthy weight. While pressure ulcers develop in common sites, such as the sacrum, ulcers may be discovered late and be fully necrotic. Pressure ulcers can also be found on uncommon anatomical locations, such as the abdomen, where pressure damage caused by equipment such as the side rails of chairs or bed frames can result.
Assess the skin of the patient at least twice daily. Arrange for assistance to lift the skin folds to see properly underneath. Don’t try and lift large skin folds by yourself as you may injure your back and accidentally create scratches or skin tears on your patient. In particular
check the abdominal panniculus (sometimes called an apron), the symphysis pubis, the neck, upper back, and lateral chest which are common areas for skin breakdown.
Observe for Intertriginous dermatitis which can develop from the friction between one skin fold and another fold rubbing & becoming heated may result in maceration, inflammation and ulceration. Bacterial and fungal infections, such as candidiasis, may also occur.
We have created a short info sheet that you can download which identifies reminders for Bariatric Patients regarding their skin. Download it and pop it up in your workplace as a reminder!
The Nurses for Nurses Network provides great information and CPD on an array of nursing topics including wound care in a range of easy learning ways including webinars and quizzes on the latest information that Nurses need to know – remember the Nurses for Nurses Network was created by Australian Nurses for Nurses! www.nursesfornurses.com.au
Reference: Clinical Practice Bariatric Skin care Wounds International 2015 www.woundsinternational.com