Janet Hope - Director

Australian Bariatric Innovations Group1

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Prevalence of overweight, ages 20+, both sexes

www.AusBIG.com.au3

Prevalence of Obesity, ages 20+ both sexes

www.AusBIG.com.au4

� 14 million Australians are overweight or obese.

� More than five million Australians are obese.

� If weight gains continue at this rate, by 2005 close to all adults & a third of all children will be overweight or obese.

� Obesity has overtaken smoking as the leading cause of premature death and illness.

� Obesity has become the single biggest threat to public health.

� Present trends predict that by the time our kids reach 20 they will have a shorter life expectancy

� Aboriginal & Torres Strait Islanders are 1.9 times as likely to be obese.

www.AusBIG.com.au6

� 55 yrs+ in the national obesity epidemic.

� +/-1 million obese older Australians =1:5 (2004)

� Trebled in 20 years, due to ageing pop. & obesity epidemic.

� Older Australians are 6–7 kg heavier on average today than 20 years ago.

� 50-60yr olds gain weight as

they gain years & are at greater

risk of chronic diseases, disability

& social impairment. www.AusBIG.com.au

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Weight distribution & what impact thiscan have on equipment prescription?� ClassificationClassificationClassificationClassification◦ Anasarca◦ Apple Ascites -Carry their weight high & often have proportionately slim legs.◦ Apple Pannus◦ Pear Abducted◦ Pear Adducted & Gluteal Region

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� Severe generalized oedema

� Potential postural oedematous deformity; inability to flex, adduct, loss of end of range joint ROM, difficulty ADLs

� Susceptibility to frictional burns - skin unable to meet shear tension loads

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� Apple Apple Apple Apple AscitesAscitesAscitesAscites Distribution: Distribution: Distribution: Distribution: weight� carried high; abdomen may be rigid� Apple Apple Apple Apple PannusPannusPannusPannus Distribution; Distribution; Distribution; Distribution; weight carried high; abdomen mobile, hangs to the floor (known as apron); legs could be normal.

� Apple Android Distribution; Apple Android Distribution; Apple Android Distribution; Apple Android Distribution; the fat is stored around the waist area

� Flexion – often obstructed� Breathing - Semi Fowler position (30°head elev), difficulty tolerating flat postures

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� Pear Abducted Distribution ◦ Weight carried below waist: significant tissue between knees.

� Pear Adducted Distribution ◦ Weight carried below waist: tissue bulk on outside of thighs.

� Pear Gynoid Distribution ◦ the fat is stored around the hip area.

� Bulbous Gluteal Region ◦ Excessive buttock tissues creating protruding shelf.

(Rush, A; 2005)

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Morbidly obese 52-year-old woman with lipoedema result-

ing in secondary lymphoedema.

Morbidly obese 38-

year-old African

American woman with lipoedema

leading to secondary

lymphoedema.

Morbidly obese 75yr old Caucasian woman

with lipoedema, secondary lymphoedema, &pitting oedema due to congestive heart failure

www.AusBIG.com.au17

29 years old – died after

bariatric surgery 400+kg

� Breathing problems / SOB � Problems lying flat (supine or prone)� Problems turning in bed� Altered posture in both lying and sitting� Altered normal pattern of movement (sit to stand, walking etc.)

� Limited range of movement / joint pain� Sweating� Fragile skin/skin ulcers� Difficult hygiene situation� Difficulties applying the sling� Clothing challenges

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� Pressure within skin folds◦ Tubes and catheters

◦ Side rails &

◦ pannus pressure

� Ill fitting furniture/equipment

� Can be avoided by appropriate

assessment & intervention

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� Risk assessment to identify elements likely to increase skin breakdown.

� The physiology of bariatric patients must be considered during all phases of assessment, planning and care:◦ adipose tissue is poorly vascularised and can lead to soft tissue breakdown, infection and pressure ulcer development ◦ skin folds can be sites of atypical pressure ulcers as small items, tubing and clothing can be caught and act as a focus for pressure ulcer development ◦ difficulty controlling body temperature causes increased perspiration

� Urinary incontinence in females due to increased intra abdominal pressure on urinary structures.

� In males there is penis retraction within the excessive amount of suprapubic adipose tissue.

Pressure Ulcer Prevention Collaborative, Queensland Health.www.health.qld.gov.au/psq/pip/docs/pup_obeseobeseobeseobese.pdf

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� Assessment of need / why prescribe

� Patient assessment / ability of user

� Bariatric body types

� Correct fit / equipment dimensions

� Patient Measurement

� Assessing the patient’s weight

� Capacity of equipment

� Environment (home & hospital)

www.AusBIG.com.au 22

www.vicbig.com.au

Knowing the size does matter!

height sagittal

height

abdominal

circumference

weight

shoulder

width

sitting width

seat depth

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Emergency Department

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Bed bound with no equipment assistance available

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� It’s derived from the word “pannus,” which refers to a flap, or apron, of hanging tissue. When a pannusis present on the lower abdomen, it's called a panniculus.

� The tissue itself is made up of skin and fat and is graded by degree of severity:◦ Grade 1: the panniculus reaches the pubic hair

◦ Grade 2: the panniculus lies over the genitals down to the thigh crease

◦ Grade 3: the panniculus reaches down to the upper thigh

◦ Grade 4: the panniculus hangs down to mid-thigh level

◦ Grade 5: the panniculus reaches the knees (it can go beyond)

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Challenged with changed conditions

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� Ensuring the well-being of bariatric patients is a challenge to all professionals within health

� Skin care is an integral part of the holistic management of bariatric care.

� Appropriate equipment prescription to maintain skin integrity, patient dignity & well-being.

� Bariatric education is the key to good management

� Organisations should have bariatric specialties, strategies and systems in place to ensure the seamless management of a bariatric patient through an episode of care.

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� Educating staff on the management of bariatric patients is the key to eliminating the fears of being injured while providing care. It should be part of an organisation’s education program to fully equip nurses to provide a high level of care that prevents tissue damage and reduces the inherent risks associated with handling bariatric patients.

� Pressure ulcer prevention is part of the holistic care management pathway for bariatric patients.

� Effective management of skin integrity is a challenge for all nurses, but we should empower patients in this particularly vulnerable group to work in collaboration with the multidisciplinary team to help to prevent the formation of pressure ulcers.

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