Implementing Palliative Wound Care Principles for 4 Patients with Chronic Wounds and Mixed Lower Extremity Disease

Palliative wound care focuses on patient comfort by controlling wound-related symptoms &improving the quality of life(QOL) of persons with chronic wounds.  Two-way communication with patients, families and/or caregivers is critical with goals established by the patient or his/her proxy. These goals often shift from wound closure to symptom management. (Chrisman, 2010; Naylor, 2007; Langemo, 2006; Alvarez et al., 2002). A case series of 4 patients with chronic lower-extremity(LE) wounds is presented using principles of palliative care (G=goals,T=treatment,O=outcomes).

90+female:Co-morbidities of DM &PAD/claudication (ABI rt=0.81) Lives in Senior-living.  Family involved. CoccyxPU &arterial wounds right foot/ankle; pain 6-8/10.

        G:Avoid hospitalization &amputation. Control pain.

           T:PT evaluation. Comfortable wound care. Address incontinence. Protect legs. Nutrition.  Educate family.

        O@8 months: No cellulitis/hospitalizations, decreased pain 0-4/10, remains @home.

85+female:Co-morbidities of DM &PAD (ABI rt=0.61,TcPO2=24). Resides in LTC. Family involved. Ulcers right lateral calf/malleolus/foot.

        G:Avoid amputation, decrease pain &cellulitis, maintain ambulation, return home.

        T:Comfortable wound care. Decrease LE trauma/edema/vascular symptoms. Nutrition.  Staff &family education. Custom shoes.

        O@9 months: Wounds healed, Pain decreased, no cellulitis.

80+female:Stroke/left hemiparesis, dementia, PAD (ABI rt=0.2, lt=0.24), COPD/Oxygen &chronic steroids. BMI=16. Wounds left lateral knee/malleolus. Lives in LTC. FLACC score=6/10.

        G:Decrease pain, prevent additional wounds.

        T:Comfortable wound care. Staff/family education.  Nutrition. Pain control.

        O@8 months: Wounds healed. Pain resolved. Gained 3pounds. FLACC score=0/10.

81+female:Fractures both hips &pelvis, multiple surgeries/hospitalizations. PAD (ABI rt=0.88,lt=0.67). Bilateral heel &coccyx PU.  4 ulcers bilateral toes/dorsal foot. BMI=18. Initially @LTC.

        G:Avoid amputation. Return home. Decrease pain. Heal wounds.

        T:Minimal invasive vascular-angioplasty LLE. Appropriate wound care. Nutrition.  Decrease LE trauma/edema/vascular   symptoms.  Offloading &pressure redistribution. Family &staff education.

        O:@6 months:  Avoided amputation. Wounds healed. Transitioned to home.

Nursing care is traditionally holistic &patient-focused. The general response of these 4 patients was relief when the goals of wound care were re-focused to patient comfort. Implementing palliative wound care principles helped meet their needs.