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Integ Final > BARIATRICS: > Flashcards

BARIATRICS: Flashcards

1
Q

Bariatrics =

A

the branch of medicine relating to the study and treatment of obesity

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2
Q

What raises the risk of overweight and obesity?

A

Lack of physical activity

Unhealthy eating behaviors

Not getting enough good-quality sleep

High amounts of stress

Genetics

Medicines

Your environment

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3
Q

Increased Risk:

A

DM II, heart disease, HTN, Stroke, apnea, osteoporosis

BMI > 30

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4
Q

Body Mass Index (BMI)

A

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

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5
Q

The BMI Formula to calculate Body Mass Index:

A

take your weight (in kilograms)
and divide by your height (in meters) squared

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6
Q

Underweight:

A

<18.5

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7
Q

Normal weight:

A

18.5 – 24.9

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8
Q

Overweight:

A

25 – 29.9

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9
Q

Obese:

A

30.0 – 39.9

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10
Q

Extreme Obesity:

A

40.0 or greater

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11
Q

Bariatric Surgeries

A

Gastric Bypass

Laproscopic Gastric Banding

Gastric Sleeve

Intragastric Balloon

Duodenal Switch

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12
Q

Gastric Bypass Diet

A

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

Patients advised: no liquid during meals, before and after meal (once on solids), eat slowly, 5-6 small meals

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13
Q

Dumping Syndrome ➔

A

stomach empties food into SI too quickly➔ faint, lightheaded, shaky

High Sugar foods

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14
Q

Panniculus Grading

A

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

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15
Q

Bariatric Movement challenges

A

Panniculus (pannus)

Movement patterns ➔ ADLs, bed mobility, transfers, ambulation

Locations of adipose tissue➔ Adipose Folds ➔ impacts movement

Location of feet ➔ LE mechanics➔ impacts movement

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16
Q

Bariatric comorbidities

A

type 2 diabetes
dyslipidemia
cancer risk
mood disorders
heart disease
reproductive disorders
liver disease
hypertension

***patient education

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17
Q

Dionne’s Bariatric Body Types


A

Apple Ascites
Apple Pannus
Pear Abduction
Pear Adduction
Gluteal Shelf

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18
Q

Apple Ascites

A

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

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19
Q

Waist-to-hip ratio (WHR) norms - males

A

excellent: <0.85

good: 0.85-0.89

average: 0.90-0.95

at risk: >0.95

20
Q

Waist-to-hip ratio (WHR) norms - females

A

excellent: <0.75

good: 0.75-0.79

average: 0.80-0.86

at risk: >0.86

21
Q

Apple Pannus

A

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

22
Q

Pear Abduction

A

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

23
Q

Pear Adduction

A

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

24
Q

Gluteal Shelf

A

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

25
Q

Waist to hip vs bmi

A

High waist to hip & high BMI
High BMI
Low waist to hip & high BMI

26
Q

High waist to hip & high BMI

A

high WHR (above 0.9 for men and 0.85 for women) suggests more abdominal (visceral) fat, which is associated with a higher risk of metabolic conditions like heart disease and diabetes

high BMI (above 25 is considered overweight, above 30 is obese) measures overall body weight in relation to height, but it does not distinguish between muscle and fat or fat distribution

Someone with both a high WHR and a high BMI likely has significant fat accumulation around the abdomen, posing a high risk for cardiovascular diseases, type 2 diabetes, and other metabolic issues.

27
Q

High BMI (with normal or low WHR):

A

high BMI indicates that the person is overweight or obese

normal or low WHR suggests that fat is not primarily located in the abdominal region but may be more distributed in areas like the hips or thighs

fat distribution (e.g., more around the hips and thighs) is considered less harmful metabolically

28
Q

Low waist to hip & high BMI

A

ow WHR suggests that body fat is stored in a healthier distribution, primarily around the hips and thighs rather than the abdomen

high BMI still indicates an overall excess of body weight

person has a higher BMI, the risk for metabolic diseases may be somewhat lower due to the healthier fat distribution

29
Q

Physical Therapy Examination

A

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

30
Q

Home Set Up, Family Support & Medical History

A

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

31
Q

ROM and Flexibility

A

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?

32
Q

Strength

A

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

33
Q

Sensation

A

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

34
Q

Skin integrity & integumentary system

A

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?

35
Q

Balance

A

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

36
Q

Pain

A

Will this affect treatment or examination?

How does the excess weight affect long-term stress on weight-bearing joints?

Pain score & location

37
Q

Behavior

A

What are their personal goals?
Consider psych history
Be aware of your biases

38
Q

Mental Health

A

Are they motivated to participate?

39
Q

Mobility

A

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

Hospital No Lift Policy: use mechanical lift

40
Q

Egress Test by Michael Dionne, PT

A

Patient clears hip 1-2 inches from bed and returns to seated position.

If successful then,
Two reps of sit to stand are then performed.

If successful then,
Patient stand and marches in place 3 rep

If successful then,
Patient steps forward and back with one leg then the other

41
Q

Lifts:

A

EZlift -1,000lb limit

ARJO- 350lb limit. Sling-420lbs

Hoyer -600lbs

Trans Aid-600lbs

Sarah lifter-350lbs

Ultralift-600lbs

Weight Capacities:
Check both the lift and the sling as they may be different

42
Q

Beds / Bed features:

A

Bari Kare ®
Bari Maxx beds ®

43
Q

Equipment options

A

Hover Matt®

HoverMatt® Single-Patient Use (SPU) Air

Transfer System - YouTube

Tilt table

Chairs
Wheelchairs
Walkers

Commodes

Body-weight support slings for transfers, standing, walking

Repositioning strap

Turning/Limb Support Straps

Body-weight support harnesses attached to ceiling lifts

44
Q

Mobility Options/Techniques

A

Guarding techniques
Hand holds
Gait Belt
Utilization of aides and/or assistants
Methods for transferring
Pre-gait/gait
Stairs

45
Q

Assessment Considerations

A

PT and Patient goals

Intervention & plan

D/C planning➔ barriers

Environmental barriers

Available assistance at home

Patient anxiety & fear

Need for other rehab services ➔ OT, nutrition, medical psychology

Integ Final (16 decks)

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