Long-term care facilities, nursing homes and hospice centers take care of some of the most vulnerable residents. These individuals go through many changes as they progress through the end stages of life.
One of the challenges that is typically associated with end-of-life scenarios in particular is a Kennedy terminal ulcer (KTU). These are often mistakenly identified as pressure ulcers, but they’re quite different.
Understanding Kennedy terminal ulcers
KTUs are a type of pressure ulcer that develops suddenly in patients who are actively dying. They develop rapidly and can progress from unnoticeable to severe in a matter of hours. They are a telltale sign that the body is shutting down and usually occur 24 to 48 prior to death.
Pressure ulcers typically develop due to prolonged pressure on a specific are of the body and aren’t associated with the death process. KTUs, on the other hand, can develop even if there isn’t constant pressure on the affected area because they’re a sign that the skin is breaking down due to lack of oxygen and other factors related to organ failure that occurs in death.
Characteristics and identification
One of the hallmark characteristics of KTUs is their distinctive appearance. They often show up as a pear, butterfly or horseshoe shape and have a reddish, black or purple color. Typically, they are found on the sacrum, coccyx or heels, which are areas of the body where skin breakdown occurs most frequently in bedridden patients. Their rapid onset and progression sets KTUs apart from other pressure ulcers.
Implications for care
The appearance of a KTU is a significant indicator that the patient may be nearing the end of their life. It necessitates a shift in care priorities, focusing on comfort and quality of life rather than aggressive treatments aimed at healing the ulcer. Management strategies include regular repositioning, providing supportive bedding surfaces and meticulous skin care to minimize discomfort and prevent further skin breakdown.
The development of a KTU isn’t necessarily a reflection of poor care, but rather an indication of a patient’s terminal phase of life. Still, failure to manage a KTU and provide suitable comfort measures can be a sign of elder neglect, which may lead to legal action by a patient’s family.
