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25
Shear
1. Force applied
Tissue
Damaged blood vessel
2. Skin stays stationary
3. Damage can occur
Ways to help minimize friction and shear injuries:
• Selectclothingthatisroomyenoughtominimizeskin-
to-skin contact and allow for adequate positioning.
2
• Usecornstarch-basedpowders,cottonfabric,gauze
or other padding material to separate skin surfaces
from one another.
2
• Placesofttowels,papertowelsorlinenpillowcases
between surface contact areas. This helps keep skin
off skin and absorbs excess moisture. If the pieces
of fabric are large enough, they may even be useful
during repositioning.
2
• Repositionobesepatientseverytwohours.
1
- A mechanical full body lateral rotation device
can be helpful. Although it can be an effective
tool, mechanical repositioning is not a substitute
for human touch. Further manual repositioning of
arms, legs, breast and pannus is often required.
1
- Be watchful about repositioning tubes and catheters
as well. They should be placed so that the patient
does not rest on them. Tube and catheter holders
may be helpful.
1
• Providebariatricequipmentthatiswideandsturdy
enough to prevent rubbing and accommodates
proper positioning (beds, chairs, geri-chairs, and
wheelchairs).
2
Pressure from side rails and arm rests
not designed to accommodate a larger person can
cause pressure ulcers on the patient’s hips.
1
• Usepressurereductionandpressurereliefdevices
specially designed for bariatric patients (mattress
overlays, mattress replacements, specialty beds,
and chair and wheelchair cushions).
2
• Minimize high Fowler’s and semi-Fowler’s positions.
2
Toileting hygiene issues and incontinence dermatitis or
incontinence-related skin breakdown. Difficulties manag-
ing personal hygiene, as well as incontinence caused by
increased abdominal pressures, predispose obese patients
to incontinence dermatitis and incontinence-related skin
breakdown.
2
People who experience leakage of urine or stool due to
increased intra-abdominal pressures on the bladder or
bowel may benefit from scheduled toileting programs,
fluid management schedules, dietary interventions (fiber
and fluid), or biofeedback.
2
Ways to help to minimize incontinence dermatitis
and incontinence-related skin breakdown:
2
• Usealong-handledmirrorregularlytoinspect
the perineal and buttock area for skin integrity.
• Usewipesorsprayno-rinsewashesroutinely
following urination and defecation.
• Useahairdryeronthelowsettingtokeepthe
perineal and buttock areas dry.
• Useassistivedevices,suchashandheldshower
heads, for personal hygiene whenever possible.
• Provideaccesstoappropriatelysizedtoileting
devices (bariatric commodes and bariatric bedside
commodes).
• Atthefirstsignofskinbreakdown,applyaskin
protectant product.
Pressure ulcers. Skin often breaks down at the occiput
due to the bull-head configuration of the head and neck.
Skin folds and skin-to-skin areas can create so much
force that a pressure ulcer occurs in an area that is
normally not at high risk.
4
Ways to help prevent and/or care for pressure ulcers:
4
• Orderspecialbariatricpressure-reducingequipment
for all immobilized or high-risk bariatric patients,
including beds, commodes, and wheelchairs.
• Vigilantpressureulcerprophylaxisiscritical,including
frequent inspections and turning and repositioning.
• Carefullymonitorhighriskareasforbreakdown,
including heels, sacrum, occiput between skin folds,
and skin-to-skin areas (especially the penis, buttocks
and thigh folds).
• Carefullyinspectalllinesandtubestomakesure
they are not creating pressure points or caught in skin
folds (i.e., under the pannus and skin-to-skin areas).
Educating obese patients and caregivers about these
potential problems and empowering them with knowl-
edge, strategies, and products goes a long way in
helping to minimize bariatric skin problems.
2
Providing
patients and caregivers with written materials can help
motivate them to incorporate preventive skin care strat-
egies into their daily routines.
2
References
1 Camden SG, Shaver J, Cole K. Promoting the patient’s dignity and preventing caregiver
injury while caring for a morbidly obese woman with skin tears and a pressure ulcer. Bar-
iatric Nursing and Surgical Patient Care. 2007;2(1):77-82.
2 Krasner DL, Kennedy-Evans KL, Henn T. Infection control perspective - Bariatric skin
care: Common problems and management strategies. Bariatric Times. 2006;3(2):16-17.
3 Skin Care. In: Nurse Pressure Ulcer Prevention Program. Medline Industries. 2008.
4 Krasner DL, Kennedy-Evans KL, Henn T. Wound care perspective - Bariatric wound
care: Common problems and management strategies. Bariatric Times. 2006;3(5):26-27.
99156_MKT211390_CAT_Bariatric_tk.indd 25 11/8/11 3:27 PM