Pressure Ulcers at End of Life: An Overview for Home Care and Hospice Clinicians
Myra Nenna RN, BN, CHPN, WCC

Home Healthcare Now
June 2011 
Volume 29  Number 6
Pages 350 - 365
  PDF Version Available!

PRESSURE ULCERS are often seen in end-of-life patients when care typically focuses on comfort measures. Multiple comorbidities as well as age, malnutrition, compromised mobility, and the patient and family's right to make informed choices about care may present clinicians with significant challenges to prevent or heal these wounds.Prevention is the best strategy whenever possible, but there are circumstances when unavoidable pressure ulcers may develop. This article introduces clinicians to assessment tools to assist in identifying patients who are at greater risk for developing unavoidable pressure ulcers as well as those whose wounds are unlikely to heal.Developing agency policy and procedures to reflect a holistic integrated approach to palliative wound management for this population, centered on patient and family goals, can promote quality of life for the patient, while maintaining wound bed stabilization.Pressure ulcers are defined by The National Pressure Ulcer Advisory Panel as localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction (NPUAP, 2007). Sustained pressure on areas that support the body leads to restricted blood flow, and lack of oxygen eventually leads to ischemia, cell death, and tissue necrosis of the skin and underlying structures (Pieper, 2007). Pressure ulcers are classified in stages defined by the visible layers of tissue damaged from the surface toward the bone, and in 2007, NPUAP added 2 more stages: deep tissue injury and unstageable (Figure 1).Incidence and prevalence rates vary by patient population and clinical setting and exact figures are unknown. Surveys performed between 1990 and 2000 found the prevalence of pressure ulcers among the hospice population ranged from 14% to 28% (Cuddigan et al., 2001).Severe wounds can be significantly more expensive to manage and may require more frequent skilled nursing visits and impose a significant

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