Wound Care in Hospice Settings
Mar 24, 2021
Email US
Click to Email Us
Even in the final stages of life, good wound care can contribute to physical, psychological and emotional comfort. Wounds can generate feelings of fear, aversion and suspicion of neglect. Poor wound careor lack of wound carecan be devastating to the patient and familys experience of death.
Pressure Ulcers in Hospice Patients
Pressure ulcers (bedsores) occur in more than 40 percent of hospice patients. Even with aggressive preventive measures, critically ill patients experience compromised healing response due to impacted muscle cell and immune function, among other factors. For these patients, pressure ulcer formation may be a visual biomarker that the critical illness has overwhelmed the body; skin breakdown is neither preventable nor treatable.
Family members of terminally ill patients may view pressure ulcer formation as a failure on the part of the healthcare staff caring for the patientor even as their own failing, if they are responsible for providing care. Their emotional response may lead to requests that compromise the patients comfort-focused plan of care.
However, in general, prevention and treatment should not compromise the hospice philosophy of providing comfort care. Studies show that when patients are more comfortable in one position due to advanced illness, comfort should supersede preventive measures. If hospice staff deem that routine patient turnings contribute to increased pain, turnings may be suspended.
Other Wounds Common in Hospice
Due to the wide variety of patients and conditions treated in hospice care, you may encounter an equally wide variety of wound types:
Arterial insufficiencyOften appears as ulcers with black eschar on the lower leg and foot. The skin surrounding the wound appears to be very thin, shiny and usually hairless. The foot may feel cold and appear dusky red or pale.
Diabetic ulcersTypically on the plantar surface of the foot and the second metatarsal head. They are usually painless.
Venous ulcersOccur in the so-called gaiter area, halfway up the calf and down to just below the ankle. The skin likely feels itchy and appears mottled brown or has black staining and may appear crusty. The legs may become painful with sitting.
Tumors or fungating lesionsOccur most often in cancer of the breast, but may occur with other types of cancers, including head and neck, malignant melanomas and sarcomas. The lesion may be a small crusted area or a large ulcerated area with profuse exudate and capillary bleeding. They are often disfiguring, distressing and isolating. Odor and exudate management may be a particular problem in this type of wound.
Risk Factor Assessment and Prevention
Risk assessment upon admission is crucial and must include a full body check. Pressure ulcers are caused by intrinsic and extrinsic factors, including immobilization, cognitive deficit, inability to verbalize discomfort or numbness, chronic illness, aging and poor nutrition.
Once risk factors are established, preventing wounds from occurring is the best practice. Prevention measures include, but are not limited to, inspecting the skin and monitoring for proper moisture control. Proper positioning, transfer techniques and nutrition are essential for the comfort of the patient.
Avoid pressure on the heels and bony prominences of the body, and use positioning devices whenever feasible. As always, remember to document the condition of the skin after assessment.
Staging Wounds
The following wound stages are established by the National Pressure Advisory Panel:
Stage IThe skin is intact with non-blanchable redness of a localized area. Darkly pigmented skin may not have visible blanching, but its color may differ from the surrounding area. The area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue.
Stage IILook for partial-thickness loss of dermis presenting as a shiny or dry shallow open ulcer with a pink wound bed, without slough or bruising. It may also present as an intact or ruptured serum-filled blister. Stage II does not describe skin tears, tape burns, perineal dermatitis, maceration or excoriation.
Stage IIIIndicates full-thickness tissue loss. Subcutaneous fat may be visible, but bone, tendon or muscle is not exposed. Slough may be present but does not obscure the depth of the tissue loss. There may be undermining and tunneling. The depth of a stage-III pressure ulcer varies by anatomical location.
Stage IVFull-thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. This wound often includes undermining and tunneling. The depth of a stage-IV pressure ulcer varies by location. Stage-IV ulcers can extend into muscle and/or supporting structures, making osteomyelitis possible.
Deep-Tissue InjuryA purple or maroon localized area of discolored intact skin, or a blood-filled blister due to damage of the underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue.
UnstageableFull-thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed. Until enough slough and/or eschar is removed to expose the base of the wound, the true depth, and therefore stage, cannot be determined.
Basic Principles of Wound Care
The first step in determining a successful wound plan of care involves establishing the patients prognosis, condition and potential for wound healing. For instance, a less aggressive approach will be necessary for someone in the final days of life, or when it is evident that healing is not realistic.
Its important to set appropriate goals based on the prognosis, condition and potential for healing. Goals for hospice patients may include:
Preventing complications of the wound, such as infection or odor
Preventing additional breakdown of the skin
Minimizing harmful effects of the wound on the patients overall condition
When developing a care plan for a patient, it is important to factor in their status and desires. Interventions should be re-evaluated every two weeks to determine whether the plan is still appropriate. A wounds failure to heal does not necessarily imply that other measures are more appropriate, or that all possible approaches should be attempted. Instead, focus on developing the best option for the patient based on their present condition and their desires.
A basic wound care plan will incorporate these elements:
Cleansing debris from the wound
Possible debridement
Absorbing excess exudate
Promoting healing
Treating infection
Minimizing discomfort
In hospice care, the pain, appearance, odor and perceived implications of wounds can be incredibly distressful for the patient and family. To stay in alignment with hospices mission of comfort care, the entire hospice team must operate with vigilance, assessing and documenting wounds and condition changes in detail, maintaining proper preventive measures and developing plans of care that consider the patients needs and desires.
By reducing the occurrence and severity of wounds and mitigating their effects, the hospice team contributes to quality of life and facilitates a peaceful death experience for both patient and family.
Submitted and Written By: Vitas Healthcare - click here for more information
Other Articles You May Like
Cherishing Our Seniors: Exploring the Heart of Senior Care
As we age, it's essential to prioritize the well-being and comfort of our seniors. At A Call to Order Professional Organizer, we believe in cherishing our seniors and providing them with the care and support they deserve. In this blog post, we'll delve into the heart of senior care, exploring the ways in which we can honor and uplift our elders.Understanding the Importance of Senior CareSenior care encompasses a wide range of services and support designed to enhance the quality of life for older adults. From assisting with daily tasks to providing companionship and emotional support, senior care plays a vital role in ensuring that seniors can age with dignity and independence.The Heart of Senior CareCompanionship and Connection: One of the most significant aspects of senior care is providing companionship and fostering meaningful connections. Many seniors experience feelings of loneliness and isolation, especially if they live alone or have limited social interactions. Caregivers and family members can offer companionship by spending time with seniors, engaging in conversations, and participating in activities together.Promoting Independence: While it's essential to offer support to seniors when needed, it's equally important to promote their independence and autonomy. Encourage seniors to maintain as much independence as possible by involving them in decision-making processes and respecting their preferences and choices. Simple tasks like meal preparation, household chores, and personal care activities can help seniors feel empowered and capable.Ensuring Safety and Comfort: Creating a safe and comfortable environment is paramount in senior care. Evaluate the senior's living space for potential hazards and make necessary modifications to enhance safety, such as installing grab bars, improving lighting, and removing tripping hazards. Additionally, ensure that the home is comfortable and conducive to the senior's needs, considering factors like temperature control, seating options, and accessibility.Health and Wellness: Prioritizing seniors' health and wellness is fundamental to their overall well-being. Encourage regular medical check-ups and screenings to monitor their health status and address any concerns promptly. Promote healthy lifestyle habits, including nutritious eating, regular exercise, and adequate sleep. Additionally, consider incorporating holistic wellness practices such as meditation, yoga, or tai chi to promote physical and mental wellness.Supporting Emotional Well-being: Seniors may face various emotional challenges as they age, including grief, loss, and anxiety. It's essential to provide emotional support and create a nurturing environment where seniors feel valued and understood. Listen actively to their concerns, validate their feelings, and offer reassurance and encouragement. Encourage participation in social activities and hobbies that bring joy and fulfillment.Planning for the Future: As seniors age, it's crucial to plan for the future and make arrangements for their care and well-being. Discuss topics such as advanced care directives, estate planning, and long-term care options to ensure that their wishes are honored and their needs are met. Involve seniors in decision-making processes and provide them with the necessary support and resources to plan for the future with confidence.At A Call to Order Professional Organizer, we believe in cherishing our seniors and providing them with the care and support they deserve. Our team is dedicated to promoting the well-being and independence of seniors through compassionate care and personalized support. With our heart-centered approach to senior care, we strive to create meaningful connections, ensure safety and comfort, and empower seniors to live their best lives. Let us be your partner in cherishing and honoring the seniors in your life.
5 Reasons Why Respite Care Is Necessary
Caring for a loved one can be both rewarding and challenging, especially when youre responsible for their well-being on a daily basis. The demands of caregiving can often lead to exhaustion and burnout, which is why respite care plays a crucial role in providing much-needed relief. In this blog post, we will explore five reasons why respite care is necessary for caregivers and how it benefits both the caregivers and their loved ones. Physical and Mental Well-being:Caregiving can take a toll on a persons physical and mental health. Constantly attending to the needs of another person without taking time to care for oneself can lead to exhaustion, stress, and even depression. Respite care offers caregivers an opportunity to take a break, recharge, and focus on their own well-being. Whether its a few hours, days, or even weeks, respite care allows caregivers to rest, engage in self-care activities, and maintain their overall health.Preventing Caregiver Burnout:Caregiver burnout is a real and significant issue. When caregivers are overworked and overwhelmed, their ability to provide quality care decreases, leading to potential negative consequences for both the caregiver and the person receiving care. Respite care acts as a preventive measure, providing caregivers with the much-needed time off to relax, rejuvenate, and maintain a healthy work-life balance. By preventing burnout, respite care ensures that caregivers can continue to provide the best possible care for their loved ones.Enhanced Quality of Care:When caregivers are exhausted or stressed, it can impact their ability to provide optimal care. Respite care allows caregivers to recharge and return to their caregiving role with renewed energy and focus. This break from caregiving responsibilities can help improve their patience, empathy, and overall caregiving skills. Additionally, respite care providers are trained professionals who can offer specialized care and support tailored to the unique needs of the individual, resulting in an enhanced quality of care.Socialization and Independence:For individuals receiving care, respite care can provide an opportunity to engage in social activities and interact with others. Social isolation is a common concern for both caregivers and care recipients. Respite care programs often offer group activities, outings, and opportunities for socialization, fostering a sense of community and promoting emotional well-being. Moreover, respite care can encourage the independence of the care recipient by exposing them to new experiences and enabling them to develop relationships outside their usual caregiving environment.Strengthening Family Relationships:Caregiving can sometimes strain family relationships, as the demands and responsibilities can become overwhelming. Respite care can help alleviate this strain by providing family members with time to reconnect and nurture their relationships. By sharing the caregiving responsibilities, family members can work together more effectively, ensuring that the burden doesnt fall solely on one person. This shared experience of respite care can strengthen family bonds and promote a supportive and collaborative environment.Respite care is not only necessary but also invaluable for caregivers and their loved ones. It provides a much-needed break for caregivers to prioritize their own well-being, prevent burnout, and maintain the quality of care they provide. Furthermore, respite care offers care recipients an opportunity to socialize, engage in activities, and foster their independence. By recognizing the importance of respite care, we can support and empower caregivers while ensuring the overall well-being of both the caregiver and the care recipient.
Understanding Diabetes in Seniors: Symptoms, Signs, and Care
As we approach our golden years, the likelihood of developing diabetes rises significantly. In fact, according to the National Institutes of Health (NIH), one-third of seniors have diabetes, and one-half have prediabetes. These numbers underscore the unfortunate reality that many older adults face daily as they navigate this condition. In this blog, well delve into the types of diabetes, symptoms to watch out for, and practical tips for managing it to help ensure that you or your loved one continues to live a healthy and fulfilling lifestyle.What is diabetes?At its core, diabetes is about the bodys struggle with managing glucose, which is a vital source of energy for our cells. When this process breaks down, it can lead to various forms of diabetes, such as:Type 1 Diabetes: An autoimmune condition where the bodys defense system mistakenly attacks insulin-producing cells in the pancreas. This type of diabetes affects millions, including a significant number of adults.Type 2 Diabetes: Predominantly observed in adults, type 2 diabetes develops when the body becomes resistant to insulin or fails to produce an adequate amount. Lifestyle factors, including diet and exercise, play a significant role in its onset.Prediabetes: Think of this as natures warning bell. Blood sugar levels are elevated but not high enough to be classified as type 2 diabetes. Alarmingly, 26.4 million seniors are in the prediabetic stages.Understanding these forms of diabetes is crucial, particularly as experts predict that the number of seniors with diabetes will double for those between 65 and 74 years old and quadruple for those older than 75 within the next couple of decades.Recognizing the warning signsSome diabetes symptoms can be subtle and easily mistaken for normal signs of aging. Being aware of these signs can lead to early diagnosis and better management:Frequent urination: This could be your bodys way of trying to flush out excess sugar.Excessive thirst: High blood sugar can lead to dehydration, making you feel thirstier than usual.Unexplained weight loss: When your body cant use sugar for energy, it starts burning fat and muscle, leading to weight loss.Fatigue: High sugar levels can make you feel tired and worn out, even after a full nights sleep.Blurred vision: High blood sugar can cause the lenses in your eyes to swell, altering your ability to focus clearly. If left untreated, this symptom can worsen rapidly and lead to permanent low vision complications.Slow-healing wounds: High blood sugar affects your blood flow and causes nerve damage, making it difficult for your body to heal wounds.Frequent infections: Diabetes tends to weaken the immune system, making you more susceptible to infections.Lifestyle tips for navigating diabetesManaging diabetes is a team effort, involving you, your loved ones, and your healthcare providers. Heres how to play your part:Diet: Food is fuel. Opt for foods that stabilize blood sugar, like whole grains, lean proteins, and colorful vegetables. These not only nourish but also ensure steady energy.Exercise: Gentle exercises like walking can boost mood, tai chi can improve balance, and swimming offers a full-body workout without stressing the joints.Regular Check-ups: Stay informed about your health. Regular monitoring can help tailor your management plan and catch potential issues early.Medication: Sometimes, diet and exercise might not be enough. Medications or insulin can help bridge the gap. Always consult with your doctor about your medication options.Living with diabetes day-to-day can be challenging, especially for seniors. Thats why weve created a free, easy-to-follow Trusted Tips guide to help you or your loved one navigate these challenges with greater ease and effectiveness. Download it today.Potential complications with diabetesDiabetes, if left unchecked, can open the door to other health challenges such as: Heart disease Kidney disease Vision problems Diabetic Neuropathy But heres the good news: proactive management can significantly reduce these risks. Regular check-ups, a balanced diet, and consistent exercise are your best friends when it comes to keeping the effects of this condition in check or preventing its onset entirely.Managing diabetes with supportNavigating diabetes in your golden years requires a delicate balance, but fortunately, you dont have to go through it alone. Use these insights to help you recognize early signs and cultivate healthy habits, empowering you or your loved ones to lead fulfilling, healthy lives.At HomeWell Care Services, we specialize in providing personalized care that simplifies diabetes management for seniors. Our services encompass everything from efficient medication management to ongoing symptom monitoring, all designed to support your health or that of your loved one on a daily basis. If youre seeking a care solution that adapts to the unique needs of living with diabetes, contact us today.