CS14-071 Healing a Kennedy Terminal Ulcer: A Case Study

Rhoda Kahn, RN, MSN, CFNP, WCC, Nursing, McLaren Oakland, Pontiac, MI
Healing a Kennedy Terminal Ulcer:  A Case Study

Introduction:  A Kennedy Terminal Ulcer represents skin failure at the end of life.  Once a Kennedy Terminal Ulcer develops some believe healing cannot occur but major organ failure may be reversed with aggressive treatment. It is conjectured that with successful treatment of the underlying causes it may be possible to reverse the course of a Kennedy Terminal Ulcer as well.  Past Management:  Until identified by Karen Lou Kennedy-Evans skin breakdown, particularly to the sacrum, were denoted as pressure ulcers.  Protocol for pressure ulcer treatment was employed for Kennedy Terminal Ulcers.  These ulcers did not respond to treatment and evolved rapidly.  As the people who had KTU were debilitated and near death the goal was often pain management.  Current Approach:  A patient in his early forties was admitted to the hospital in critical condition with pneumonia and meningitis.  He was not oriented to person, place or time and appeared to be grimacing in pain.  After being transferred to a hospital bed the patient was examined by members of the health care team, including wound care.  The patient had a sacral ulcer in a butterfly shape, a presentation often seen with Kennedy Terminal Ulcers.  Although death appeared imminent interventions were immediately begun and the patient very gradually stabilized, although he remained critical and in the ICU for one month.  Wound care included a LAL bed, turning, and a wound healing ointment was utilized. Patient Outcomes:  As the patient’s overall health improved his ulcer began to resolve.  As the wound improved and changed so did the dressings which ranged from ointments, foam, hydrofiber and NPWT.  A team approach addressed the needs of the patient. Conclusions:  In cases where the underlying causes of a terminal condition are reversed a Kennedy Terminal Ulcer can be successfully brought to healing.