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A 43-year-old African American female with a body mass index (BMI) of 49 was admitted to the hospital yesterday for elective bariatric surgery. She was scheduled to have a laparoscopic Roux-en-Y gastric bypass, but the surgical procedure was changed to an open Roux-en-Y during the operation due to her large abdominal pannus. Notable medical history includes hypertension, obstructive sleep apnea, bilateral knee osteoarthritis, diabetes mellitus, and gastroesophageal reflux disease (GERD). Preoperative medications included nonsteroidal anti-inflammatory drugs, metformin, and insulin. Prior to admission, the patient was able to walk limited community distances without an assistive device. She was limited by bilateral knee pain. She has been using a continuous positive airway pressure (CPAP) device for approximately 4 years for treatment of obstructive sleep apnea. She has brought her CPAP device with her to use at night during her hospital stay. The physical therapist is asked to evaluate and treat the patient before she is discharged to her single-level home, where she lives alone. The bariatric surgeon stated that she must follow “abdominal precautions” and wear an abdominal binder whenever she is out of bed.

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What are the examination priorities?

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What are the most appropriate physical therapy interventions?

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What are possible complications interfering with physical therapy?

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What is her rehabilitation prognosis?

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  • ABDOMINAL PANNUS (PANNICULUS): “Apron” of excess skin and subcutaneous fat in the lower abdominal area of morbidly obese individuals
  • BARIATRICS: Branch of medicine specialized in providing healthcare for individuals with excess weight, variously defined as those with: body mass index > 30 kg/m2, body weight > 300 lb, or overweight by more than 100 to 200 lb
  • BODY MASS INDEX (BMI): Weight in relation to height (weight/height2); common clinical measurement that has been adopted as a valid proxy for body fat
  • CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEVICE: Machine that provides compressed air into a mask over the nose or nose and mouth in order to keep the airway open and prevent sleep apnea
  • LAPAROSCOPIC SURGICAL PROCEDURE: Surgeon makes several small incisions and uses small instruments and a camera to guide the surgery
  • OBSTRUCTIVE SLEEP APNEA (OSA): Repetitive lapses in breathing during sleep caused by obstruction of the upper airway; risk factors include older age, male sex, obesity, and increased neck circumference
  • OPEN SURGICAL PROCEDURE: Surgeon makes large incisions that enable direct access and visualization of the structures involved

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  1. Identify classifications of obesity and the guidelines for choosing eligible bariatric surgery candidates.

  2. Understand the two broad categories of bariatric surgical procedures (restrictive and/or malabsorptive) and recommended postoperative dietary and exercise guidelines.

  3. Define abdominal precautions given to patients after open abdominal surgery.

  4. Identify short-term (e.g., vomiting) and long-term (e.g., weight regain, nonadherence to diet and exercise) complications after bariatric surgery and strategies to mitigate these problems.

  5. List the long-term benefits of ...

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