Bariatrics Flashcards
final content
what is bariatrics
the branch of medicine relating to the study and treatment of obesity
what are the risk factors for bariatrics?
Increased Risk: DM II, heart disease, HTN, Stroke, apnea, osteoporosis
BMI > 30
what is a BMI
BMI is an inexpensive, quick, easy tool used to screen for a weight category
Based on height and weight
The most commonly used method today for classifying obesity is based on the BMI
The BMI Formula to calculate Body Mass Index: BMI. To calculate your BMI (Body Mass Index), take your weight (in kilograms), and divide by your height (in meters) squared.
what are the ranges for BMI
underweight:
normal weight:
overweight:
obese:
extreme obesity:
Underweight: <18.5
Normal weight: 18.5 – 24.9
Overweight: 25 – 29.9
Obese: 30.0 – 39.9
Extreme Obesity: 40.0 or greater
what are the bariatric surgeries
gastric bypass
larproscopic gastric banding
gastric sleeve
intrgastric balloon
duodenal switch
what is the gastric bypass diet look like?
Up to 6 weeks➔ liquid or soft diet; solids added gradually
Pts work with dietician to plan healthy meals balanced in macro & miconutrients
Life-time supplement of vitamins & minerals
Immediately after surgery ➔ Pts likely feel ‘full’ with a couple sips of water
Bowel movements not regular after surgery ➔ avoid constipation & straining
Dumping Syndrome ➔ stomach empties food into SI too quickly➔ faint, lightheaded, shaky
High Sugar foods
Patients advised: no liquid during meals, before and after meal (once on solids), eat slowly, 5-6 small meals
panniculus grading
Grade 1- Covers hairline of mons pubis but not the genitalia
Grade 2- Extends to cover the genitalia
Grade 3- Extends to cover the upper thighs
Grade 4- Extends to cover the mid thighs
Grade 5- Extends to cover the knees and beyond
what are some challenges to moving a patient that is bariatric?
Panniculus (pannus)
Movement patterns ➔ ADLs, bed mobility, transfers, ambulation
Locations of adipose tissue➔ Adipose Folds ➔ impacts movement
Location of feet ➔ LE mechanics➔ impacts movement
what are the co morbidities of bariatric patients
DM 2
HTN
liver disease
reproductive disorders
heart disease
mood disorders
cancer risk
dyslipidemia
what are the Dionnes bariatric body types
Apple Ascites
Apple Pannus
Pear Abduction
Pear Adduction
Gluteal Shelf
what is the apple ascites Dionnes body type
High waist to hip ratio with forward abdominal region
Cardiopulmonary intolerance to flat postures
Supine to sit ➔ roll supine to sidelying, progress to sit at edge of bed
what is the Dionne shape of apple pannus
High waist to hip ratio demonstrating an inferior abdominal drift
Intolerant to supine position
Supine to sit: flat spin to
Perpendicular ➔ Then progress to
full sitting ➔ caution edge of bed
Logroll to side lying careful➔ a little
Risker due to potential to roll off edge of bed
what is the pear abduction Dionnes body type
Low Waist to hip ratio
Hip abduction movement pattern
Supine to sit: Avoidance of rolling, tend to go from supine to long sitting then short sitting
Sit to stand: knee extension,
Followed by trunk extension
what is the pear adduction shape
Low waist to hip ratio but able to achieve full femoral condyle contact
Hip adduction movement pattern
Supine to sit: May use log rolling
or long sitting techniques for supine to sit
W/C foot pedals challenging to fit ➔ wide WC seat and narrow foot rest needs
what is the gluteal shelf shape?
Person who demonstrate excessive asymmetrical posteriorly directed tissue at the level of the gluteal region. May have either high or low waist to hip ratio
Supine may be uncomfortable
W/C seating may need to be adapted for back support
what should a bariatric physical therapy examination include?
Social History: Home set up & Family Support
PMH
Strength
ROM, Flexibility
Sensation
Skin integrity, folds, infection
Balance
Pain
Mobility ➔ bed mobility, transfers, gait
Movement Patterns
Mental Health
what are some exam considerations around the topic of home set up, family support and medical history
Where do they live?
Do they have help at home?
Stairs
Prior level of function/techniques of mobility
Assistive devices➔ walkers, wheelchair, cane
Activity habits➔ do they exercise/leave home?
Co-morbidities
what are some exam considerations for rom and flexibility
Are there acute or chronic impairments?
ROM may be limited by excess tissue
Is ROM functional for ADL’s?
Can they reach areas necessary for ADL’s or skin inspection?
Are there restrictions from surgeries?
what are the exam considerations for a bariatric patient when it comes to strength?
Are they strong enough to move their body?
Are they strong enough to move their limbs?
Are their strength issues acute or chronic?
May need to adjust hand placement for any MMTs
Patient may not be able to lie flat
Patient may try to use muscle substitution due to difficulty achieving test positions
what are the exam considerations for sensation
Do they have dermatomal deficits?
Do they have neuropathy due to co-morbid conditions of diabetes or peripheral vascular disease?
May have poor blood supply or peripheral nerve injury as a result of impingement by fatty tissues
what are the considerations for bariatric patients when it comes to skin integrity and integumentary systems?
Skin integrity & integumentary system
Do they have DM?
Do they have ulcers?
Can they examine their own skin?
Can they reach all areas necessary for hygiene?
Skin fold inspection
Edema
Attention to reducing shear and friction with bed mobility
Is their skin being pinched by lifts, bedrails, or wheelchairs?
what are examination considerations for bariatric patients when it comes to balance?
Test in sitting and standing
Posture may be affected by excess tissues, affecting center of mass
Pear abducted body types may have abducted femurs
Pear adducted body type may have adducted femurs
Apple pannus body types may have increased lumbar lordosis
Apple ascites body types may have a flexed trunk
what are examination considerations for bariatric patients when it comes to pain?
Will this affect treatment or examination?
How does the excess weight affect long-term stress on weight-bearing joints?
Pain score & location
what are examination considerations for bariatric patients when it comes to behavior?
What are their personal goals?
Consider psych history
Be aware of your biases
what are examination considerations for bariatric patients when it comes to mental health?
Are they motivated to participate?
what are examination considerations for bariatric patients when it comes to mobility?
When was the last time they mobilized?
How did this mobility occur?
Do they use physical assist, or assistive device at baseline?
Independent or level of assist
Egress Test by Michael Dionne, PT
(1) Patient clears hip 1-2 inches from bed and returns to seated position. If successful then,
(2) Two reps of sit to stand are then performed. If successful then,
(3) Patient stand and marches in place 3 reps, if successful then,
(4) Patient steps forward and back with one leg then the other
Hospital No Lift Policy: use mechanical lift
Hannah Williams is a 28 y.o. female with PMH significant for extreme morbid obesity with BMI 54 (5’4”, 314 lb), grade II panniculus, HTN, HLD, and obesity hypoventilation syndrome who was initially admitted for cellulitis, now transferred to the MICU for Bipap therapy and sleep study d/t obesity hypoventilation syndrome and chronic hypoxic respiratory failure. what might you use to mobilize this patient?
Ezlift
ARJO (near weight limit)
Hoyer lift
Sarah lifter
ultralift
what equipment options do you have for bariatric patients
EZlift -1,000lb limit
ARJO- 350lb limit. Sling-420lbs
Hoyer -600lbs
Trans Aid-600lbs
Sarah lifter-350lbs
Ultralift-600lbs
lifts and slings might be different
