What the Kennedy Terminal Ulcer Can Tell Us

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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.

The Kennedy Terminal Ulcer as a Sign of What's to Come

I thought that I might share a positive story. I received a phone call one day from one of our CNAs located in southeastern Kansas. She stated she had a gentleman who was just released from the hospital to our hospice service. When he got home he became unresponsive. The CNA reported that when she turned the gentleman over, he had a dark purple area in his coccygeal sacral area. She said, "I am sure this is a KTU, can you come down here and verify it?"

I advised our CNA that I would be down in the morning. I met her at our office and we rode to the patient's house together. When we turned him to his side, there was a KTU. The CNA stated it had gotten bigger since the preceding day.

After assessing and measuring the KTU, I met with the wife of our patient and revealed my findings. I asked her if there were any family members who needed to be notified; I did not think her husband was going to make it through the weekend. She said they had a daughter several hours away. I suggested she contact her daughter and ask her to visit her mom and dad.

The daughter came down the next morning and spent the weekend with her parents. Her father passed away the next day. This daughter and mother were so appreciative of the information which led her to her father's bedside so she could say goodbye. It is unfortunate that KTUs develop, but it can be used to help us prepare for the inevitable.

Educating Caregivers and Family About SCALE

I later received another phone call from the same area. A daughter had been taking care of her mother. One day she turned her mother and found a KTU on her left buttock. She immediately called her hospice nurse, who in turn called me. I went down the next day.

When we turned her mother during my assessment, there was what looked like five fingers marks. They were purple/red, not open, and much larger than fingers. The daughter tearfully told me her brother was coming in from the east coast and she was afraid he would think she slapped her. After we shared some tears and a hug, I explained to her what I believed the marks to be, and that it was nothing she did in caring for her mother. I further explained this was a sign of what was happening inside of her mother as a skin change that happens at life's end. After an hour she felt better, but still had some lingering guilt.

Informing caregivers and family about what the development of a KTU means, and what changes occur when their loved ones are experiencing SCALE may help in preparing them for what's to come. Educating family and caregivers about why these end of life changes occur may also help alleviate some of the feelings of anger and guilt that may surface during this challenging time of transition.

About the Author
Rick Hall is a wound and ostomy educator and consultant for Kaiser Permanente.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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