Skin Changes At Life's End (SCALE) - page 2
The skin is the largest organ of the body and can become dysfunctional at life's end, with loss of integrity, just like any other vital body system, with reduced ability to utilize nutrients and... Read More
May 20, '16Nursing is and always will be a fascination of new ideas, studies and theory. I have a 40yr hx of CCU,ER, Geri-care, Med-Surg and many certs and took a lot of classes. My 93 old Mother is in a NH, and was called by the DON and her case worker. To be informed that my Mother had developed a Kennedy Ulcer. I will always admit when I have no idea of a subject, especially something nursing related, and this stage of decubiti I was not aware of. Yes I have worked with StgIV ulcers in my past. But I never heard of this Kennedy Ulcer. I can remember times when we had pts who were turned and repositioned and still developed an ulcer. In those days I even recall nurses blaming the NA or other shifts for these progressive and devastating wounds. So after speaking with the nurses I went to All Nurse and the internet to seek more info. Like any other medical mystery there was many lawyers and such who actually denied the existence of this ulcer. But with my prior knowledge and basic A&P I knew there had to be some intrinsic factor involved R/T to ischemia in a debilitated pt that could cause rapid and extreme skin breakdown. So now we have a name for this syndrome and it all make sense to me. I will now be on my way to see my Mother with more acceptance of her condition and the inevitable outcome. Along with sympathy for my Mother but also empathy towards her care takers and the medical staff. I am thankful for the All Nurses site and all the participation of the other nurses. I am retired but still feel like a nurse, and as always it tends to be true that as long as we try to stay humble. There is always something new to learn....
May 20, '16You are a very caring and loving daughter who took care your mother at home rather than turning her over to a nursing home. My mother is 90 and stays with my youngest sister most of the time with monthly weekenders with me. If I was retired, I would care for her more. I dread the time I see these ulcers appear, if ever. We plan to have hospice care for her when the time arrives.
May 20, '16Prmenrs,
You are a very caring and loving daughter who took care your mother at home rather than turning her over to a nursing home. My mother is 90 and stays with my youngest sister most of the time with monthly weekenders with me. If I was retired, I would care for her more. I dread the time I see these ulcers appear, if ever. We plan to have hospice care for her when the time arrives.
May 21, '16When I worked on a vent floor in a LTACH we saw them all the time. The patients were trying to die as hard as they could and we kept yanking them back. Lots of anasarca with the orange peel skin as well, since they ended up with CVL's on IVF or TPN once they stopped tolerating enteral feeds. IVF+anasarca+ KTU = puddles of interstitial fluid. Real, honest-to-goodness puddles.
One poor fellow ended up developing KTU's from the pressure of the linens, and even across the bridge of his nose from his glasses. We continued to pump in the fluids, adjust the vent to (sort of) compensate for lungs that were like stiff leather sacks, and mop up puddles of fluid while his kids stood in the hallway, arguing over who was going to get his house. He wasn't "allowed to die" until they were satisfied that each of them would get their fair share of his estate. I believe TPTB finally intervened during my 3-day weekend off.
May 21, '16Kennedy Terminal wounds are a big indicator of impending death, as has already been pointed out. The phenomenon was named after the Hospice nurse who first put two and two together and described the correlation between appearance of the wound and death within two weeks (my experience with them has been death within 48-72 hours, but I do know of some Hospice nurses who had patients who followed the two week scenario).
Ms. Kennedy first described the phenomenon in the early 80s, but because of the prevailing thought that "all pressure wounded are due to negligence", it took awhile before the medical community even started to turn their thinking around, and the State agencies still haven't, for the most part (I have run into a few enlightened inspectors recently).
Most of my patients are in facilities, and as they decline, staff and family education regarding skin issues is imperative. If they have foreknowledge that skin issues will happen, I have found that they are even more diligent with skin care.
The "7-3" phenomenon is generally the most distressing part, and that is when I work hard to nip the gossip in the bud.
When my mom was in ICU, she developed a Kennedy wound in just a few hours. The nurse was upset and almost in tears. I wound up giving an impromptu inservice about skin health at EOL in general and Kennedy wounds in particular to the staff, including a few docs who were sitting nearby lol. I suspect a few visitors also listened in. Not one staff member had heard of them, and they thanked me for the information. My mom was admitted to Hospice that day.
May 22, '16It's widely accepted that at the end of life the heart, kidneys, etc are likely to fail but many, including intelligent healthcare staff still have a hard time grasping that the skin, the largest organ of the body, can also fail rapidly as death nears. We can see it - which makes it so devastating to watch.
May 24, '16I've had a few patients with sudden and quickly worsening wounds. Not all were sacral though. The first was actually her heels. I did a full skin assessment in the morning and was called back in the afternoon to by the aide to find both heels had large black areas. I don't recall them being butterfly shaped though. She was gone by morning.
Another was a gentleman I saw in the afternoon who had several existing wounds. I noted blanchable redness to both hips. He was being repositioned frequently and the care was good. When I came back in the morning both hips had large black areas. He was gone within the week.
In both cases I had heard of Kennedy ulcers and believed that was what I was seeing. My supervisor had never seen one. I have seen other cases, but those two stand out in my mind. It is an interesting phenomenon and definitely needs more attention in literature and education programs.