Pacjenci bariatryczni to grupa szczególnie narażona na występowanie ostrych ran, odleżyn, owrzodzeń żylnych, cukrzycowych zmian w obrębie stóp, a także na powikłania w leczeniu ran chirurgicznych. Z tego powodu istotne jest, by w opiece terapeutycznej nad tymi pacjentami uwzględnić działania prewencyjne.
Uszkodzenia skóry to poważny i częsty problem w grupie pacjentów bariatrycznych. Zwiększone ryzyko powstawania ran ma u nich związek z wieloma czynnikami.
Czynniki ryzyka uszkodzeń skóry u pacjentów z otyłością
Tkanka tłuszczowa u pacjentów cierpiących na otyłość jest niewystarczająco ukrwiona, co wpływa na jej niedotlenienie. Ważnym czynnikiem ryzyka jest także zwiększona potliwość. Wilgotna skóra jest częściej podrażniona, bardziej podatna na uszkodzenia, a ponadto łatwiej mogą się na niej rozwijać bakterie i grzyby.
Ze względu na znaczny rozrost tkanki tłuszczowej i powstawanie fałdów skórnych u pacjentów bariatrycznych mogą występować problemy z prawidłową higieną. Skóra w fałdach bywa zawilgocona i zanieczyszczona, co stwarza ryzyko maceracji i zakażeń. Skóra ulega też ciągłemu tarciu i uciskowi, co prowadzi do podrażnień, stanów zapalnych, wyprzeń skórnych i odparzeń.
Ograniczona mobilność ruchowa u pacjentów z otyłością zwiększa ryzyko odleżyn. Znaczenie ma także nieodpowiednia dieta, która często nie dostarcza składników odżywczych i witamin, które są konieczne do sprawnej regeneracji tkanek.
Ponadto po wystąpieniu rany ze względu na zmniejszone unaczynienie skóry oraz obniżoną perfuzję tkanki tłuszczowej proces gojenia jest u pacjentów z otyłością wydłużony I utrudniony.
Zapobieganie ranom u pacjentów bariatrycznych
Opieka terapeutyczna nad pacjentami z otyłością wymaga multidyscyplinarnego podejścia, znacznych kompetencji ze strony personelu, a także zastosowania specjalistycznego sprzętu.
Zmienianie pozycji
Pierwszy ważny aspekt to regularne zmienianie pozycji i obracanie pacjentów z ograniczoną mobilnością ruchową. Repozycjonowanie pacjenta stanowi ważny element profilaktyki odleżyn. Do wykonywania tej procedury w bezpieczny i prawidłowy sposób powinno być zapewnione specjalistyczne wyposażenie, takie jak maty i płachty do obracania pacjenta, podnośniki sufitowe, pionizujące i podłogowe, nosidła. Wykorzystanie tego rodzaju sprzętu pozwala zminimalizować ryzyko wystąpienia uszkodzeń skóry i związanych z nimi powikłań.
Higiena skóry
Ze względu na znaczne ryzyko wystąpienia uszkodzeń w fałdach skóry, bardzo istotne jest dbanie o regularną i dokładną higienę tych obszarów. Powinno się unikać produktów na bazie alkoholu i o silnych właściwościach myjących. Podstawową zasadą jest utrzymanie skóry czystej i suchej.
Nawodnienie i dieta
Ważną rolę odgrywa także stosowanie u pacjenta odpowiedniej diety, bogatej w składniki odżywcze, minerały i witaminy, które sprzyjają utrzymaniu skóry w dobrej kondycji i usprawniają jej regenerację. Równie istotne jest nawadnianie, które także ma wpływ na stan skóry i zmniejsza ryzyko powstawania uszkodzeń.
Regularna kontrola
Ostatnim ważnym aspektem opieki nad pacjentem bariatrycznym w zakresie profilaktyki uszkodzeń skóry jest stałe monitorowanie stanu skóry. Należy regularnie sprawdzać, czy nie dochodzi do powstawania uszkodzeń, szczególnie w obszarach szczególnie na to narażonych, takich jak pośladki, wewnętrzna strona ud, fałdy skórne, okolice genitalne, a u kobiet także przestrzeń pod piersiami.
Źródła: https://www.woundsource.com/
Przeczytaj także: Postępowanie w dniu zabiegu operacyjnego pacjenta z cukrzycą
Przeczytaj bezpłatnie pokrewny artykuł w czasopiśmie „Pielęgniarstwo w Anestezjologii i Intensywnej Opiece”:
Pacjent bariatryczny w oddziale intensywnej terapii – opis przypadku
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