Palliative Wound Care Approaches (Part 2)

VickyRN, MSN, DNP, RN

Palliative wound care is much more than exudate and odor management. Maintaining optimal function and mobility is an important part of symptom control and supportive care as well.

Optimize Function and Mobility

To optimize function and mobility in persons with nonhealing wounds, interventions should be tailored to the needs, comfort level, and desires of the individual patient. The overarching goal is to maintain as much function and independence for as long as possible to improve quality of life.

Pain management should be adjusted to the amount and level of activity. Pain causes limited motion, restricted social interaction, and reduced capacity to conduct normal activities of daily living, such as dressing, bathing, and using the toilet.

Pressure Redistribution

Palliative care patients who are bedridden need pressure redistribution beds with support surfaces to help eliminate pressure, shear friction, and maceration. These devices reduce pressure by conforming to the contours of the body to redistribute the pressure over a larger surface.

Group 1 pressure redistribution devices include pressure pads and mattress overlays composed of foam, gel, or water products, and the least expensive air mattresses.

Group 2 devices include powered pressure reducing mattresses and mattress overlays, therapy beds, and low air loss mattresses to manage the heat and humidity of the skin. The only group 3 device is the clinitron air fluidized bed, where warm filtered air is circulated through silicone coated ceramic beads in the mattress, to evenly distribute an individual's body weight over a large surface.

Infection Prophylaxis

Infection prophylaxis is another important approach to palliative care of non-healing wounds, as it helps to control symptoms and prevent complications. Non-healing wounds, especially open ones, have a potential for serious wound infections that can extend to the underlying tissue and bone, where infectious organisms can enter the bloodstream with spread of infection throughout the body. Infection can make the wound, as well as the distressing symptoms associated with the wound, much worse.

Signs of Infection

Classic signs of wound infection are redness, swelling, warmth, extreme tenderness, increased exudate, purulent drainage, contact bleeding, odor, and fever or chills. A variety of different management strategies may be employed, since the development of a wound infection in a debilitated patient depends on the complex interplay of many factors. Treatment options include diagnostic testing to guide the choice of antimicrobials, antimicrobial topical products, antibiotics, wound bed cleansing, and surgical debridement of necrotic tissue.

Pain

Pain is a characteristic feature of nonhealing wounds and advanced life-limiting conditions. The constant pain can take a toll on quality of life, transforming the time that remains into a miserable existence. Effective pain management, therefore, is paramount for patients with nonhealing wounds at end-of-life. Ways to alleviate wound-associated pain include medicating the patient before dressing changes, moistening dry dressings prior to removal, the liberal use of opioid medications and topical anesthetics such as lidocaine, refrigerating dressings before application, avoiding the use or overuse of tape, and the use of wound gel products such as collagen hydrogel to lessen trauma to the wound bed.

Palliative wound care places great emphasis on symptom management. Maintaining optimal function and mobility, managing wound infections, and controlling pain are all important approaches to help patients with nonhealing wounds and terminal conditions achieve the highest possible quality of life.