End of Life Wounds

By Holly Hovan MSN, APRN, CWOCN-AP A fistula is an abnormal opening between two areas that typically shouldn't be connected, or with an epithelialized tract. An example is an opening from the bowel to the abdominal wall, termed enteroatmospheric or enterocutaneous (the terms are sometimes used interchangeably) because this fistula is exposed to the atmosphere, or is open from the abdomen to the skin, and typically needs to be pouched or some type of containment of the effluent.

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.

by the WoundSource Editors Palliative care and hospice care are not the same, but they both share one goal. They both focus on a patient's physical, mental, social, and spiritual needs. Palliative care can begin at diagnosis and treatment or for patients at any stage of their illness. Patients may not want to receive aggressive treatment of non-healing wounds because of underlying diseases, pain, and/or cost.

By Heidi Cross, MSN, RN, FNP-BC, CWON Ms. EB, a frail 82-year-old woman admitted to a long-term care facility, had a complex medical history that included diabetes, extensive heart disease, ischemic strokes with left-sided weakness and dysphagia, dementia, kidney disease, anemia, chronic Clostridium difficile infection, and obesity. Her condition was guarded at best on admission, and she had a feeding tube for nutrition secondary to dysphagia. Despite these challenges, she survived two years at the facility.

By Heidi Cross, MSN, RN, FNP-BC, CWON "It was the best of times, it was the worst of times." – Charles Dicken When Charles Dickens wrote this introduction to his Victorian-era novel, A Tale of Two Cities, his novel was aimed at the brewing French Revolution, but he could have been writing about the best and worst of modern American health care. His novels depicted how life could be pretty miserable during those times, with no social safety net and no real medical care. Fortunately, times have changed, and we have improved social supports as well as, some would argue, the best health care system in the world (although, sadly, not all people in the United States enjoy access to our great health care system, but I digress).

Article Title: Pressure Injury Progression and Factors Associated With Different End-Points in a Home Palliative Care Setting: A Retrospective Chart Review Study Authors: Artico M, D’Angelo D, Piredda M, et al Journal: J Pain Symptom Manage 2018;56(1):23-31 Reviewed by: Arden Harada, class of 2021, Temple University School of Podiatric Medicine

by Emily Greenstein, APRN, CNP, CWON, FACCWS "When I grow up, I want to be a wound care specialist." That's not something you hear kids going around saying. Sure, kids want to be doctors or nurses. But wound care specialist? When you think about it, being a wound specialist is not a glamorous position, unlike being a neurosurgeon. The best quote that I ever heard from a colleague of mine was, "No one wants to do wound care; wound care isn't sexy." This may be true, but what is wound care then? To me it is ever changing, it is learning new things (most of which are not found in text books), and it is about helping patients heal both emotionally and physically from a chronic condition.

By Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS Part 1 in a series on skin failure A few years ago, a panel of experts gathered to evaluate the nature of skin changes at life's end (SCALE) and to discuss the Kennedy Terminal Ulcer (KTU). The panel concluded that there are observable changes in the skin at the end of life and that these situations are complex. It should be noted that the skin is an organ and it can fail. The skin can also demonstrate what is happening internally, such as multisystem organ failure.