I have a patient who had a failed mesh placement and a panniculectomy and who has developed at least three separate fistulas with a very large amount of output (3-4 L/24 hrs). Any suggestions? I am using an Eakin wound management pouch hooked up to wall suction.
Body Composition: How to Tell the Lean from the Fat
- Thu, 8/19/10 - 11:27am
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25 How often have you seen the politically correct term well-nourished used in a medical chart to describe an overweight or obese person? Although a person with excess body fat may appear to be well-nourished on the outside, inside his body habitus may be hiding the truth. A person who is overweight may be suffering from depleted visceral protein stores and sarcopenia, which may lead to decreased immune function, increased risk for infection, delayed wound healing, decline in mobility, and overall increased morbidity and mortality risk.
Consider the following scenario: a long-term care resident has experienced some health-related setbacks over the past several months but remains overweight. You notice the registered dietitian (RD) has requested a high-protein medical nutritional supplement. You may think the RD is misguided but this dietitian is keenly aware that body weight does not provide a complete picture of a person’s nutritional status. Malnutrition may be masked by the presence of excess body fat. A person can weigh exactly the same as he/she did 6 months previous and may even have gained weight, but during that time inactivity, chronic disease, and bouts of critical illness may have eroded muscle or lean mass. A scale cannot tell the difference between a pound of muscle and a pound of fat. Former Surgeon General, C. Everett Koop, once said, “Body fat percentage will become a new standard for health in adults.” His prediction was on target as we learn more and more about the role body composition plays in health and well-being.
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