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Scenerio

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.

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Scenerio

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  1. 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

  2. Surgery & Initial Postop Course • Roux en Y gastric bypass on August 2, 2002 • Initial Postoperative Course • Ventilator dependency • Tracheostomy • Atrial fibrillation • Stroke • Fluid and electrolyte imbalances • Diarrhea from tube feeding • Sepsis from TPN • Acute renal failure • Rashes from plastic allergy and Candida

  3. Operating Room • Access to OR • Size of OR table • Size of instruments • Positioning • Visualizing the operative field • Anesthesia challenges & risks • Longer time

  4. ABCs Airway Breathing Circulation Drugs Post Operative Care

  5. Vital signs Pulse Blood pressure Respirations Temperature Pain Post Operative Care

  6. Mobility & Early Ambulation Bariatric bed Supportive equipment Staff support Preventing Complications Thromboembolic Deconditioning Pressure ulcers Post Operative Care

  7. Wound Care Wound Assessment Dressings Binders Increased risk of infection Post Operative Care

  8. 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

  9. September 3, 2002

  10. September 3, 2002

  11. September 10, 2002

  12. September 17, 2002

  13. September 17, 2002

  14. September 19, 2002

  15. September 19, 2002

  16. September 19, 2002

  17. October 9, 2002

  18. 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

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