Kennedy Terminal Ulcer

Cathy Wogamon's picture

By Cathy Wogamon, DNP, MSN, FNP-BC, CWON, CFCN

Many questions arise and confusion develops when wound care providers mention Kennedy terminal ulcers (KTUs). Because these wounds are not frequently seen, and because they develop rapidly and observation ends abruptly with the death of the patient, wound care providers may have never observed a KTU, even in a long career in wound care. Although the literature reveals that there is a lack of knowledge regarding the exact cause of a KTU, let’s look at the facts currently known from published resources.

WoundCon Faculty's picture

By: Mary Brennan, RN, MBA, CWON, Karen Lou Kennedy-Evans, RN, FNP, APRN-BC, and Diane Krasner, PhD, RN, CWCN, CWS, MAPWCA, FAAN

What is the best way to differentiate between a Trombley-Brennan terminal tissue injury (TB-TTI) and deep tissue injury (DTI)?

Mary: This is the most challenging because these injuries resemble one another. The difference is that a TB-TTI does not evolve as a DTI does. There may be an increase in surface area but no change in the appearance or type of tissue. A TB-TTI will look the same in color and appearance on day 3 or 5 as it does on day 1.

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Heidi Cross's picture
Risk Factors for Unavoidable Ulcers

by Heidi H. Cross, MSN, RN, FNP-BC, CWON

According to the Agency for Healthcare Research and Quality, more than 17,000 lawsuits related to pressure ulcers (PUs) are filed annually in the United States, second only to wrongful death lawsuits. One of the greatest gifts to defense attorneys was when the Centers for Medicare & Medicaid Services (CMS) published F-Tag 314, finally acknowledging that some ulcers can occur despite best care. The facility essentially can maintain, “Hey, we did everything we were supposed to, and despite that, the patient developed that pressure ulcer”—that is, the ulcer was unavoidable. To prove unavoidability, proper documentation (proof) of best care needs to be in place, as well as documentation that all proper prevention and treatment measures were implemented.

Heidi Cross's picture
Skin Changes at Life's End

by Heidi H. Cross, MSN, RN, FNP-BC, CWON

"If a patient is cold, if a patient is feverish, if a patient is faint, if he is sick after taking food, if he has a bed sore, it is generally the fault not of the disease, but of the nursing." —Florence Nightingale

Ouch! What an indictment of nursing and, by extension, the facility in which the nurse works. We have a lot to thank Florence Nightingale for—a brilliant woman considered to be the founder of nursing and nursing standards and the first to ever put statistics to health care, among other valuable contributions.

WoundSource Practice Accelerator's picture
Palliative Care

by the WoundSource Editors

Pressure Injury/Ulcer Risk Management in Palliative Care and Hospice

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.1

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Jeffrey M. Levine's picture

By Jeffrey Levine MD

Please join me Thursday, November 16 from 3:00-4:00pm EST for a free webinar presented by myself and Elizabeth A. Ayello, PhD, RN, ACNS-BC, CWOCN, ETN, MAPWCA, FAAN sponsored by the National Pressure Ulcer Advisory Panel (NPUAP), entitled, Unavoidable Pressure Injuries, Terminal Ulceration, and Skin Failure: Where Are We and Where Are We Going?

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Jeffrey M. Levine's picture
medical community discussion

By Jeffrey M. Levine MD, AGSF, CWS-P

As Co-Chair of the NPUAP Education Committee it is my pleasure to invite all clinicians to the NPUAP Biennial Conference in New Orleans from March 10 to 11, 2017. Featured topics will include best practices for staging and treatment, pressure injury recidivism, and pressure injury as a quality measure. In addition to these timely topics, NPUAP will host a full day featuring national experts who will discuss terminal ulceration, skin failure, and unavoidable pressure injury. Attendees are invited to submit cases that illustrate these lesions, and a select number of submissions will be presented for discussion with the group.

Rick Hall's picture
documenting wounds

By Rick Hall, BA, RN, CWON

Wound care documentation is a hot topic with overseeing agencies dealing with the medical industry. Good documentation is imperative to protect all those giving care to patients. Documentation should be Legible, Accurate, Whole, Substantiated, Unaltered, Intelligible and Timely. If these components are not incorporated into your wound care documentation, you could end up in a LAWSUIT.

Aletha Tippett MD's picture

By Aletha Tippett MD

I recently had a patient encounter that reminded me of the difference between palliative and curative wound care. In my role as a hospice medical director with a specialty in wound care, I am often asked to see wounds in our hospice patients. I was asked to see this particular patient because of a wound on her coccyx. I had already approved the nurse’s order of medicated hydrogel covered with a foam dressing, changed every three days. This seemed like a reasonable treatment plan; simple and straightforward. I also gave instructions to provide adequate support surface on her mattress, static air if possible.

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Lindsay Andronaco's picture

By Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS

In the past two blogs I have discussed a controversial topic, skin failure. We all have strong feelings on this topic and have experienced different cases in our practice. Dispute the controversial feelings on KTUs and skin failure; I would like to now just address the viewpoint of the family and how to approach these difficult conversations.

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