Ask the treatment expert ... about bariatric residents

Rosalyn Jordan, RN, BSN, MSc, CWOCN, WCC
Rosalyn Jordan, RN, BSN, MSc, CWOCN, WCC

How do you care for a resident who weighs more than 300 pounds?

These bariatric residents require special care related to pressure ulcer prevention and treatment, along with safe practices to prevent injury to both the resident and staff during caregiving activities.

Pressure ulcers are likely to develop over bony prominences but also can develop in skin folds or areas of adipose tissue pressing against other tissue. Along with pressure in the areas of heavy skin pressing on other areas of skin, additional issues of maceration, inflammation and general tissue necrosis add to pressure ulcer development. 

Maceration, or the over-hydration of the skin, along with the added pressure of the heavy skin, can introduce more pressure, friction and shear in particular areas.  

Both routine and additional interventions are advised. 

Routinely assess all skin surfaces and skin folds. Several areas to inspect include breasts, and the skin under the arms and breast, and around the abdomen, the thighs, and any other skin folds. If an area is noted that as moist, discolored or blistered, seek additional assistance to differentiate dermatitis from a pressure ulcer.

Policies and procedures, along with adequate equipment and personnel to manage the turning, repositioning and transfer of the resident, should be available for the safety of the resident and the staff.  Bed frames, mattresses, support surfaces and other equipment that accommodate the weight of the resident (and the girth) are necessary to provide safe resident care. Many companies are now making products specifically for the bariatric long-term care population.

Nutritional assessment and support are other necessities.