Even in debilitated and bed bound patients wounds are likely to heal, including chronic wounds
Goals of Palliative Wound Care
- Preventing new wounds
- Stabilize current wounds
- Addressing symptoms while wounds are healing
Aspects to Consider
- Assessing nutrition, as needed:
- Encourage PO intake
- Increasing protein
- Supplement Vitamin C or Zinc if low
- Determine cause and treat appropriately
- Pressure ulcer? --> off-loading and proper positioning
- Venous stasis? --> compression bandages/stockings, elevation
- Arterial insufficiency? --> dependent positioning, stent to revascularize
- Malignancy? --> wound dressing +/- abx to address odor & exudate
- For all: DME as needed
- For all: consider debridement, topical lidocaine, zinc oxide, etc
- Manage symptoms including pain, pruritis, odor, exudates, and bleeding
- Skin wounds are unlikely sources of systemic infection
- Rule out respiratory, urinary, and GI sources first
Selected References
- Wound Care in Home-Based Settings chapter of Geriatric Home Based Medical Care textbook (Ch. #10)
- Incorporating wound healing strategies to improve palliation (symptom management) in patients with chronic wounds
- The Braden Scale for Predicting Pressure Sore Risk <-- awaiting permissions --> AAFP Wound Management Articles:
- Pressure Ulcers: Prevention, Evaluation, and Management
- Diagnosis and Treatment of Venous Ulcers
- Diabetic Foot Ulcers: Pathogenesis and Management