As wound care clinicians, one among the primary steps we tend to take when meeting our patient and assessing their wound is distinctive our treatment goals. very similar to managing a complex medical drawback, we want to identify if our goals of care are curative or palliative. this is often necessary with all wounds, not simply those present at end of life. There are several patients with vascular disease, diabetes, or different co-morbidities that will need to require a palliative approach versus aggressive debridement or amputation. you will have detected the term, “keeping it dry and stable.” this will work on times, however like any wound, we want to keep a watch out for signs of a lively infection and confirm if/when we want to additional intervene. Wounds will and do resolve with a palliative approach, however, it’s important to grasp, and notify our patients, the distinction.
Palliative Wound Care?
Palliative wound care emphasis on comfort, dignity, managing pain, odor, preventing infection, and taking a holistic approach to managing the wound. Though prevention of pressure injuries is often a treatment goal, even at end of life, our treatment goals and focus amendment in a palliative setting. Treatment selections ought to be supported the wound presentation… consider merchandise that may stay in place for over each day, manage bioburden, managing odor, and facilitate with pain (this is particularly vital with application and removal of dressings). additionally to the particular product that goes on or into the wound, it’s vital to spot different variables that impact healing: seating surface (if appropriate), bed surface, repositioning tools and tools used to stop friction and cutting (slings, wedges, pillows), offloading of heels (think floating, heel offloading boots, foam dressings, skin barrier film), hydrating skin (emollients), protective skin from fecal or incontinence (barrier creams), managing pain (before, throughout and once dressing changes) and nursing employees education on the expectations and goals of a palliative pressure injury prevention and treatment program.
It is vital to recollect that additionally to distinguishing a treatment that meets the patient’s wants, we’d like to continue routine pressure injury prevention measures as listed on top of, most significantly, routine turning (every two hours at a minimum and as required for comfort). Alternative variables that are vital and may impact the success of a palliative wound program embody regular assessment of the injuries and change treatments as needed; this can be done best with a team approach (nursing, management/leadership, physician, dietitian, activity expert/physical therapist as needed). A homogenous team is useful as they get to understand the patients and their wants and are able to change the arrange of care consequently. occupational therapists and physical therapists are vital resources who will facilitate with seating assessments, braces, wedges, and merchandise to dump tough spots like elbows and typically heels.
To recap palliative wound care objectives:
1. Identify the type of wound and treatment goals (palliative vs. curative)
2. Discuss treatment options with the interdisciplinary team and patient/caregiver
3. Implement a treatment based on the principles of palliative wound care discussed above
4. Frequent (at least weekly) rounding on patients and change treatments as required with input from the multidisciplinary team
5. Highly important: remember to continue routine pressure injury prevention measures such as offloading, turning, appropriate seating and bed surfaces, moisture management, prevention of friction and shear, etc.
6. Continued education to nursing staff regarding expectations and treatment goals
To conclude, it is vital to recollect that palliative wound care doesn’t mean we tend to quit on the wound or that we don’t offer the most effective treatment possible. I actually have seen several palliative wounds resolve within the past and still see them resolve. On the opposite hand, there are palliative wounds that don’t resolve, however, are well managed in order that the patient is in a position to possess the most effective quality of life attainable without the wound having an enormous impact on their quality of life.
Continued follow-up, assessment and re-assessment, and education of nurses is essential to the success of a palliative wound treatment program. as the saying goes, “there’s continuously more than one way to treat a wound.” This positively holds true within the discussion of palliative wound care; the goal is to seek out what works best for your patient.
In future blogs, I hope to a lot of specifically discuss treatments, particularly those geared toward controlling odor and managing pain.
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