FOURTEENTH ANNUAL EUROPEAN PRESSURE ULCER ...

Thursday September 1st
Proceedings of the 14th Annual European Pressure Ulcer Meeting
Oporto, Portugal
Care of Pressure Ulcers in Palliative Care Individuals
Diane Langemo, PhD, RN, FAAN 1* , Joyce Black, PhD, RN, CPSN, CWCN, FAAN 2
1* University of North Dakota College of Nursing, Grand Forks, ND, USA, dianelangemo@aol.com
2 University of Nebraska Medical Center, Omaha, Nebraska, USA
Introduction
Pressure ulcers occur all too frequently throughout the
world, as do fungating wounds, particularly among
palliative care individuals, and are painful, expensive
to treat, and diminish quality of life. Individuals in
palliative care are at increased risk for pressure ulcer
development related to their frail, deconditioned state.
Sufficient informed clinical consensus exists in the
literature to support the management of a pressure
ulcer in individuals in palliative care, inspite of the
ethically understandable absence of randomized
controlled trials comparing various management
approaches. [1] “Within palliative care, it is never going
to be possible to eradicate pressure [ulcers] because
of the multiple risk factors experienced by the
patients.” [2] Palliative care individuals are also at risk
for development of a fungating wound, and these
types of wounds are difficult, at best, to manage.
Methods
This presentation will focus on up-to-date pressure
ulcer and fungating wound prevention and treatment
strategies in individuals in palliative care. The 2009
NPUAP-EPUAP Pressure Ulcer Prevention and
Treatment Guidelines [3] as well as the most up-todate
literature will provide a framework for the
presentation related to pressure ulcers. [4] The most
current up-to-date literature related to treatment of
fungating wounds will frame this section. Patient
scenarios will be addressed and analyzed.
Results
Specific guideline recommendations for prevention
and treatment of pressure ulcers in palliative care
individuals will be provided for attendees. Specific care
recommendations, based on current literature and
practice, will be presented for fungating wound care in
palliative care individuals.
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Discussion
Prevention and treatment of pressure ulcers and
fungating wounds in palliative care individuals includes
patient and risk assessment; management of
pressure, shear and friction; positioning and
repositioning; nutrition and hydration; care of the skin;
care of the pressure ulcer and fungating ulcer; pain
assessment and management; and assessment of
resources for the palliative care individual. All will be
discussed along with patient care scenarios.
Clinical relevance
The number of palliative care individuals with pressure
ulcers and/or fungating wounds is growing yearly.
Ensuring quality care individualized to these
individuals is of utmost importance.
Acknowledgements
We appreciate the work of the NPUAP-EPUAP
Guideline Development Group work on the 2009
Pressure Ulcer Prevention and Treatment Guidelines.
Conflict of Interest
There is no conflict of interest for either author that is
relevant to this presentation.
References
[1] Langemo DK, Black J. Adv Skin Wound Care.
2010;23(2):59-72.
[2] Walding M, Andrews C., Professional Nurse. 11(1):
33-38, 1995
[3] National Pressure Ulcer Advisory Panel and
European Pressure Ulcer Advisory Panel. Prevention
and treatment of pressure ulcers. 2009
[4] Langemo DK., et al. Adv Skin Wound Care. 19(3):
148-154
[5] Langemo D, Brown. Skin Fails Too: Acute, Chronic
& End Stage Skin Failure, Adv Skin Wound Care.
2006;1994):206-211.
[6] SCALE Panel (includes D Langemo). SCALE: Skin
Changes at Life’s End. WOUNDS, 21(12):329-336.
[7] Langemo DK (2011). Palliative Wound Care, In:
Wound Care Essentials: Practice Principles, 3 rd Ed.
Baranoski S, Ayello EA (Eds). Philadelphia: Lippincott,
Williams & Wilkins.
Copyright © 2011 by EPUAP