wound care in eol patients

P_RN, ADN, RN · Nov 2, 2006

I am not a hospice nurse, but I did find some articles referencing your question.

One is http://www.findarticles.com/p/articles/mi_qa3929/is_200506/ai_n13643129

The problem with algorithms is they are often too narrowly construed. What is EOL.....1 day, 1 month, 1 year. My aunt was given several months to live, she lived 3 days. My friend was given 5 months at the most (breast ca) and here 4 years later is back at work. What is EOL?

nurselearner · Nov 16, 2006

What would you recommend for a good resource book, course, or company providing info on wound care -to help set up treatment plans

leslie :-D · Nov 16, 2006

the only thing i feel strongly about is in the last few days of life, wound care should be secondary to comfort.

if a dsg change proves to be too invasive at the end, i will omit the painful steps (irrigating/debriding) and keep the wound clean, loosely packed with alginate dsgs, and ensure odor is controlled.

if repositioning is too uncomfortable, then weight shifts will do.

often there are many extra pillows for support.

priorities change during the terminal phase of dying.

leslie

doodlemom · Nov 16, 2006

I am not a hospice nurse, but I did find some articles referencing your question.
One is End of Life Care: Every Nurse's Business Alberta RN - Find Articles
The problem with algorithms is they are often too narrowly construed. What is EOL.....1 day, 1 month, 1 year. My aunt was given several months to live, she lived 3 days. My friend was given 5 months at the most (breast ca) and here 4 years later is back at work. What is EOL?

I think that you can use your own judgement on this and should not rely on algorithms (which are narrowly construed, as you said.) If you have a patient that is bed bound and no longer eating, it would not make sense to put them through complicated wound care. Most people that still have a good quality of life do not have wound care needs. It is usually the patient that has been incapacitated with decreased or little food intake who needs wound care. If we are talking about fungating wounds, there is not a lot to be done except comfort measures and keeping the wound clean and infection free. It is not an uncommon occurrence for us to have patients that are referred to us whose doctor has given them a few months and looking at them from our standpoint, they may have a few days to a few weeks. It sounds like either your aunt died suddenly and unexpectedly or the doctor was very dishonest.

nurselearner · Nov 18, 2006

For patients who are not in the last few days of life, who may have months to live, who have infected wounds or stage 3 wounds - or chronic wounds.................

what are you using, doing etc

doodlemom · Nov 18, 2006

For patients who are not in the last few days of life, who may have months to live, who have infected wounds or stage 3 wounds - or chronic wounds.................
what are you using, doing etc

I think it really depends on what kind of wound it is. I had a patient that had a chronic infected wound that he had been treating himself - for years! He lived on our service for about 5 months. We treated it with a silver dressing to keep the bacterial load down. Near the end we just cleaned it daily and put lots of flagyl powder on it and kept it covered to keep the smell down - it was the nastiest wound I've ever had to deal with. For decubitus ulcers, for a stage 2, we sometimes will put duoderm on it or we'll use a barrier cream and place a foley to keep urine out (of course turning and repositioning.) I really don't like using duoderm anymore - they seem to cause more damage than good at times. If the area is kept clean and dry, it will usually heal. You could just use some antibiotic ointment and cover it with a dry dressing. For stage 3-4, if they are draining a lot - we will use some calcium alginate packing - maybe put some flagyl pawder in it to keep it from being infected and cover with a dry dressing. There are so many different kinds of wounds and different treatment options. I am not a wound specialist - but if I come across a wound that I am not sure how to deal with I will get a wound consult.