Bariatric Mattress Case Study

Clinical Problem

A 24 year old unemployed, 624lb male was admitted to the acute care facility for bariatric weight loss surgery. The patient has a long history of sleep apnoea and hypertension, although no other cormorbidities. Postoperative course was expected considering the patient's size and subsequent challenges in mobility. However, the patient was reluctant to accept the specially designed oversized equipment that was offered post-operatively. Exacerbating mobility-related complications, by post-operative day 33, the patient had developed full-thickness pressure ulcers over the right and left buttock. Presenting to the WOCN was the challenge of managing numerous pressure ulcers while the patient refused both a support surface and an extra-wide bed that would allow him to reposition itself.

Description of Past Management

The first 8 days post-operatively, the patient was in the intensive care unit because of respiratory difficulties. Once transferred to the surgical unit, the patient grew increasingly reluctant to reposition himself in the bed, refusing a wider bed low air loss therapy or rotation therapy. Post-operative pain also interfered with activity to a lesser extent. Sharp debridement was initially performed at the bedside, which the patient tolerated poorly. Surgical debridement was necessary, which revealed three stage IV pressure ulcers over the right and left buttocks, a stage III pressure ulcer in the buttock cleft, and a stage III over the waist area.

Current Clinical Approach

A 39" wide frame with a support surface which provided continuous full body lateral rotation therapy (CFLRT) was employed on the 34th post-operative day. By day 35, this was readily accepted by the patient. Ancillary equipment was added as the patient became more willing to transfer, ambulate, and grow increasingly independent. Daily local treatment was continued by the WOCN.

Patient Outcome

Because of the surface area and depth of wounds involved and the threat of deterioration of the wound based on the risk factors such as immobility, an interdisciplinary team was actively involved with prevention and intervention modalities. Objective outcomes include: full resolution of the pressure ulcers in 120 days, at which time the patient had lost 128lb, and had become increasingly independent in activities of daily living. Subjective outcomes include: increased patient comfort, dignity and confidence with specially designed oversized equipment which included a means for relieving pressure and promoting independence.

Conclusion

Prevention is a cost effective alternative to treatment. Although this particular patient was reluctant to accept prevention modalities, this would likely prevent the adverse therapeutic, cost and satisfaction outcomes associated with numerous pressure ulcers. Daily local treatment, CFLRT and ancillary oversized equipment was provided throughout the hospitalization. The patient continues to lose weight at home, has not had a recurrence of the pressure ulcers, and is adapting to his new body.

Financial assistance provided by Sizewise, Kansas City, Missouri

Reference; Big Turn, continuous full body lateral rotation therapy, Sizewise, Kansas City, Missouri