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Ask the treatment expert
Ask the treatment expert
We have seen an increased number of bariatric patient admissions to our facility. What are some key issues we should consider in our care planning for skin integrity?

Bariatric or obese residents are not only subject to pressure ulcer development from the same risk factors as average-sized patients, but they also can develop ulcers in atypical locations, such as skin folds. Tubes and catheters can burrow into skin folds and lead to tissue erosion. Moisture may collect in skin folds and lead to maceration of the axilla, under breast tissue, thighs, knees, neck, and the abdominal fold. Microorganisms thrive in these moist environments and can contribute to skin breakdown. 

Pressure ulcers can result from constant contact that positions an obese resident against an ill-fitting bed, stretcher, side rails, or armrests in a wheelchair that is too small. Excess body weight increases friction and shear forces when an obese resident is moved up or across bed surfaces.
With this in mind, skin care plans should include these provisions:

• Use properly sized equipment.

• Ensure proper hygiene.

• Skin folds should be inspected regularly by lifting the skin to evaluate underlying skin condition.

• Sprinkle plain cornstarch lightly in rash-free folds to decrease friction and moisture.

• Use skin sealants and protective ointments to protect intact skin.

• Apply soft bath blankets between skin folds to decrease moisture as needed.

• Assess all tubes frequently. 

• Utilize a low-air-loss mattress to help decrease moisture and provide pressure reduction.

• If the patient has a large abdominal apron, or pannus, it should be repositioned frequently enough to prevent pressure injury to the underlying abdominal tissue.

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