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Palliative Wound Care Approaches (Part 2)

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Specializes in Gerontological, cardiac, med-surg, peds. Has 16 years experience.

How do you maintain optimal function and mobility in patients with nonhealing wounds?

This article discusses how 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.

Palliative Wound Care Approaches (Part 2)

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.

VickyRN, PhD, RN, is a certified nurse educator (NLN) and certified gerontology nurse (ANCC). Her research interests include: the special health and social needs of the vulnerable older adult population; registered nurse staffing and resident outcomes in intermediate care nursing facilities; and, innovations in avoiding institutionalization of frail elderly clients by providing long-term care services and supports in the community. She is a Professor in a large baccalaureate nursing program in North Carolina.

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4 Comment(s)

great article, vicky.

and just as a reminder, please change these dsgs as quickly as possible.

it is a very unpleasant experience for the pt.

seeing and smelling their wounds, creates not only physical pain, but a lot of psychological pain...

reminding them of their impending terminality.

more often than not, i've had pts tell me, "that was quick" or, "that wasn't so bad"...

whereas i've seen pts grow increasingly anxious when dsgs are seemingly prolonged.

believe me, the less time it takes, the better the pt fares. :)

leslie

VickyRN, MSN, DNP, RN

Specializes in Gerontological, cardiac, med-surg, peds. Has 16 years experience.

Thank you, Leslie, for a very important point!

A great product for these types of wounds is Enluxtra odor control, pain relief, and the ability to be left on longer if needed with appropriate wound assessment. I have seen two hospice patient's heal out with just dressing. The bandage does not have any lidocaine additives it simply works by optimizing wound environment controlling inflammatory cycle most patients pain relief is seen at first application and within 10minutes.

leslie 😄 said:
great article, vicky.nd

and just as a reminder, please change these dsgs as quickly as possible.

it is a very unpleasant experience for the pt.

seeing and smelling their wounds, creates not only physical pain, but a lot of psychological pain...

reminding them of their impending terminality.

more often than not, i've had pts tell me, "that was quick" or, "that wasn't so bad"...

whereas i've seen pts grow increasingly anxious when dsgs are seemingly prolonged.

believe me, the less time it takes, the better the pt fares. 🙂

leslie

NC29mom, ASN, LPN, RN

Specializes in Hospice, Geriatrics, Wounds. Has 10 years experience.

If you were creating a wound/dressing formulary for a hospice, what items would you insist be on the list? (Simple, yet adequate formulary).

I purchased a few boxes of the self adaptive dressings (ouch!!expensive! !) However, i haven't had the opportunity to use just yet....