Pressure Ulcer or Kennedy ulcer staging question

[trayp33]

Hi all! I am a QAPI nurse with a home based hospice and responsible for the staging of our wounds. I need some advice on a scenario and would love to hear from wound experts!

Patient developed a stage one on her coccyx early June,5 weeks later it had prgoressed to a stage 2. it remained a slowly growing stage 2 until 2 weeks ago where it developed slough and a stage 3. Yesterday the nurse told me it now looks like a necrotic kennedy ulcer. I am told it has the classic kennedy ulcer shape. What i have read defines a kennedy ulcer as a rapid onset/deterioriation. This wound has been around for awhile. I believe the wound is deteriorating as the patient is dying but have a hard time thinking it was not originally a plain old pressure ulcer-stage 2 on 7/22 to stage 3 on 9/9 just dosent seem that rapid to me. I am unable to find information to clarify this and want to code accurately.

Any thoughts?

[mommy.19, MSN, RN, APRN]

Kennedy ulcers are generally, as you said, rapidly deteriorating and represent the decline of the skin (organ failure, since the skin is an organ). If you believe the etiology is pressure, whereas in Kennedy ulcers this is not the postulated cause. However, what I have read about them directs me to understand that the treatment is no different whether a PU or KTU. http://www.kennedyterminalulcer.com/

Hope this helps!

Sent from my iPhone using allnurses.com

[TammyG]

Kennedy ulcers typically go from intact skin to stage IV in a few days, followed by or a sudden decline in the patient. But I have also seen existing ulcers that had been healing well suddenly take a bad turn -- infection, odor, increased exudate -- at the same time as a patient starts to transition to EOL. Based on your description, it does not seem to be a Kennedy ulcer. But, as the other poster points out, the treatment is the same anyway. You often don't know it is a Kennedy until the patient dies.

[Turtle in scrubs]

You often don't know it is a Kennedy until the patient dies.

So why would it be any clearer once the patient has died? Just curious. Thanks!

[TammyG]

Just that it explains why the patient would all of a sudden have a severe and rapid skin breakdown.