- 0Jun 12, '10 by SarasLPNAny experience with kennedy ulcers? We've got a resident recently Dx with this and I know it's pretty much part of active dying but most of the literature I find quotes impending death 8-48 hours after finding this type of ulcer. Our resident is really hanging on. What kind of pain management would best be put to use? I personally would like to see comfort measures in place but the family isn't ready to go there yet, this man is a full code bless us and him...Any help advise? Thanks!
- 1Jun 12, '10 by Hospice Nurse LPNSo sad that "the family isn't ready to go there yet". You are correct, death usually occurs within 8 to 48 hours. I'm assuming he is in a LTC facility. Comfort measures would be nice, but if the family in unwilling to agree, you will have to code that poor soul. This link is an interesting read. http://www.kennedyterminalulcer.com/
- 3Jun 12, '10 by happyheatherpOur hospital had a lady in her 50's who came in through the ER with EMS in a code blue. She was resuscitated and survived, then was sent to ICU on the vent. Within a couple of days, her coccyx became reddened, and over the next few days it became a very large ulcer that was very deep. The changes were so fast, and did not respond to any treatment. It ended being diagnosed as a kennedy ulcer. The wound care nurse ended up getting a wound vac ordered, and over time the ulcer healed. The way she explained it was that when she coded she had skin cell death and it caused the ulcer. It was amazing at how fast it occurred, but over time it did heal up. Very interesting I thought!!!
- 0Jun 13, '10 by tewdlesThis is what we commonly refer to as the "butterfly" pattern of pressure ulcer on the coccyx in the my region.
In my experience it is most common in the very elderly bedbound and terminal patients.
However, I have seen rapid onset pressure ulcers on the calf and heel, which certainly meet the criteria of a Kennedy ulcer, in patients of all ages who are debilitated are nutritionally comprimised.
In your instance the best thing I would advise is to establish a good professional trust relationship with this patient, if possible, and the family/DPOA. It sounds like they really need some nursing education from a compassionate and kind soul to help them make good choices for their loved one.
In terms of pain management...you are correct to assume that this would be painful. Are you familiar with the PAINAD? This unfortunate guy may benefit from having an opiate in the dressing/gel applied to the wound assuming it is open.
Good luck...heshe will very possibly be gone to the next adventure by the time you read this...
- 1Jun 14, '10 by SuesquatchRNQuote from Hospice Nurse LPNThanks for that link. We have a poor soul whose family won't let him go and have been having a terrible time keeping him from breaking down - we're not, in fact. His coccyx wound followed the pattern. Got that healed and broke down his hips. Poor thing.So sad that "the family isn't ready to go there yet". You are correct, death usually occurs within 8 to 48 hours. I'm assuming he is in a LTC facility. Comfort measures would be nice, but if the family in unwilling to agree, you will have to code that poor soul. This link is an interesting read. http://www.kennedyterminalulcer.com/