Palliative Wound Care

Rick Hall's picture
hospice patient

by Rick Hall, BA, RN, CWON

I have been encouraged to continue with my discussion on Skin Changes at Life's End (SCALE) and the Kennedy Terminal Ulcer (KTU). I have addressed the negatives about SCALE and the KTU, including the legal implications and documentation challenges surrounding the care of patients at the end stages of life.

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Rick Hall's picture
medical research

by Rick Hall, BA, RN, CWON

Those of you who have been following my blog know that I believe the phenomenon we call the Kennedy Ulcer is a form of lividity prior to death, not due to pressure. I find it curious since the publication of SCALE - Skin Changes at Life's End, by the SCALE panel in 2009 and the presentation of this subject throughout my blog series, there has not been much dialogue on the changes we observe in our actively dying patients, especially with the concept of lividity prior to death.

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Rick Hall's picture

by Rick Hall, BA, RN, CWON

Contrary to popular myth, not all pressure ulcers are avoidable. The Skin Changes At Life's End (SCALE) panel concluded that our current understanding of the complex skin changes which occur at life’s end is limited and additional research and expert consensus is necessary.

As a hospice nurse for over six years, I observed many changes in our patients' skin. In the final weeks of life, the body begins to change. Skin temperature may fluctuate. Mottling, a bluish color, may appear on the extremities...

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empty bed

by Rick Hall, BA, RN, CWON
As is often the case in wound care, health care professionals cannot fight what they can't see. In the case of Skin Changes At Life's End (SCALE) and Kennedy Terminal Ulcers (KTUs), education is the first step towards effective management and documentation. Presentations offered to long-term care facilities and other organizations in the states of Kansas and Missouri have made them aware of SCALE and KTUs.

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Patient Care

by Rick Hall, BA, RN, CWON

Treatment of Skin Changes at Life's End (SCALE) and Kennedy Terminal Ulcers (KTUs) is the same as any other ulcer: moist wound therapy if the skin is open, protect and offload the area if the skin is closed. Continue to turn the patient for comfort and alleviate any undue pressure on the already compromised skin. When the patient is in the active phase of dying, caregivers have a tendency not to turn the patient because it may be painful.

Mary Ellen Posthauer's picture
patient centered care

by Mary Ellen Posthauer RDN, CD, LD, FAND

Recently there have been numerous articles and webinars focusing on the methods health care professional can employ to effectively communicate and engage in end of life conversations with patients receiving palliative and/or hospice care.

Rick Hall's picture
elderly hands

by Rick Hall, BA, RN, CWON

Series Note: Dying patients experience a variety of skin changes, including pressure ulcers, as part of the natural dying process. While this phenomenon has been recognized in the health care literature for centuries, the explanations and etiologies have yet to be fully elucidated. In this blog series, I will be discussing key concepts related to Skin Changes At Life's End and the Kennedy Terminal Ulcer from the perspective of a hospice wound care nurse. Suggestions for clinical practice and a case series with discussion will also be presented in future posts.

Aletha Tippett MD's picture
Aletha Tippett demonstrating Maggot Therapy

by Aletha Tippett MD

There is lots in store for the new year, and a great many wound care conferences just chock-full of information. There is one conference this year that you may not know about—small, quiet, highly informative and productive. That is the 2015 Palliative Wound Care Conference that will be held in Orlando, Florida, in May this year.

Aletha Tippett MD's picture
grief

by Aletha Tippett MD

The topic of grief and bereavement is near to my heart right now as I just lost my beloved therapy dog, Barney, suddenly to hemangiosarcoma after years of service. He was an important and valued part of our healing community and will be mourned for a long time.

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Diana Gallagher's picture

by Diana L. Gallagher MS, RN, CWOCN, CFCN

While watching the CBS news show, Sunday Morning, my attention was captured by a piece offered by Steve Hartman. I admit that I am a fan of Steve Hartman. I always enjoy his sense of which stories are really important. Today's news is filled with turmoil, tragedy, and drama; a lot like life but on a much larger scale. There simply has to be something positive trapped in the midst of so much overwhelming negative information. Once again, Steve Hartman found that thread of optimism in the midst of tragedy. It is that invisible thread and hope that there is something positive to reap out of overwhelming tragedy that serves as a lifeline to so many of us.

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