Post on 21-Dec-2015
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
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
Operating Room
Access to OR Size of OR table Size of instruments Positioning Visualizing the
operative field Anesthesia
challenges & risks Longer time
Post Operative Care
ABCs
• Airway
• Breathing
• Circulation
• Drugs
Post Operative Care
Vital signs
• Pulse
• Blood pressure
• Respirations
• Temperature
• Pain
Post Operative Care
Mobility & Early Ambulation• Bariatric bed• Supportive equipment• Staff support• Preventing
Complications• Thromboembolic• Deconditioning• Pressure ulcers
Post Operative Care
Wound Care• Wound Assessment• Dressings• Binders• Increased risk of
infection
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
September 3, 2002
September 3, 2002
September 10, 2002
September 17, 2002
September 17, 2002
September 19, 2002
September 19, 2002
September 19, 2002
October 9, 2002
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