Skin Changes At Life’s End (SCALE) - page 2

by VickyRN Asst. Admin

25,284 Views | 12 Comments

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 other factors necessary to sustain... Read More


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    I have seen many Kennedy Ulcers form, usually just hours before death. It was a big indicator for me to inform families. Almost always the shape of a butterfly.
    tewdles and VickyRN like this.
  2. 3
    Had a patient one time who was actively dying. She did have previous skin breakdown from before I worked there. It was healing though, after I came and took over her wound care. But the night she died, she went from not a mark on her hip to a full scale stage 4, all the way to the bone: Overnight! I knew this would be her last day of life and she didn't want to be turned anymore after I looked at it so I let her be comfortable. There was no point preventing the ulcer from worsening, she was gone that afternoon. The PU was shaped kinda like a bow/butterfly, same description you describe here. She had no previous issues in that area and had a low air loss mattress and lots of positioning, I religiously turned her every 2 hours when she was not actively dying, and her one skin breakdown area was improving. Until 2 days before, when it started to deteriorate (I was told) then the night I came back to work she was actively dying. I wanted to turn her off that spot as soon as I saw it was red, but she said it hurt to lay on the other side (she had always preferred one side) so I didn't force her. I could see in her eyes her mind was slowing and then her breathing changed, then she was in and out of consciousness and then the terminal secretions started, I did oral care, swabbed with a few drops of water, used the atropine, everything. Oxygen for comfort, morphine for pain and to slow respirations when she seemed to start getting uncomfortable. I felt guilty as could be that when they released her body that she would go off to the funeral home with that horrible wound. I am glad to know that it was something that is expected and not just a mistake on my part. I prayed with her and her family. My first patient death.
    tewdles, sunny3811, and VickyRN like this.
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    Nice. We have known about this in home care and hospice for a while, but glad to see that you are getting the word out. You feel so guilty when this ulcer shows up!
    VickyRN and tewdles like this.


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