Ask the Treatment Expert about... palliative ulcer care

Rosalyn Jordan, RN, BSN, MSc, CWOCN, WCC
Rosalyn Jordan, RN, BSN, MSc, CWOCN, WCC

I am treating a resident who is receiving palliative care with a Stage III pressure ulcer on the right trochanter and a Stage IV pressure ulcer on the sacrum. How should I treat these pressure ulcers?

This question related to pressure ulcer care is not asked frequently enough. When providing palliative care, the goal is to provide comfort measures rather than treatment leading to a cure. 

The expected outcome is improvement in the resident's quality of life. The major focus is relief of pain, resident and family support and measures to support dignity. Appropriate wound care is essential to goals of palliative care.

Residents at the end of life experience skin failure just as they do with other organ failure. The development of individualized goals for wound or pressure ulcer care must be based on the individual's and family's decisions. The physician should also be included.

Wound and pressure ulcer healing is not the prominent goal because this is frequently not attainable. Instead, goals to consider include: pain control, stabilization of the wound, use of dressings that address the resident and family concerns, infection management, and protection of the skin surrounding the wound.

Pain management may be necessary to medicate the resident prior to dressing changes. Use dressings that can remain in place for a longer period of time safely. Dressings should keep the wound bed moist and protects the periwound area from moisture. 

Odor control preserves self-image, dignity and quality of life of the palliative care resident with wounds. Many dressings have a charcoal component specific to odor control. External methods of odor removal are also available.