During palliative care, the primary goal is to ease suffering and help the patient maintain a good quality of life. Wound care is a major part of palliative care and can take various forms depending on the particular needs of the patient. At Three Oaks Hospice, our dedicated team can provide a wide range of palliative care services, including wound care, spiritual care and assistance with other in-home tasks.
Wounds often develop during the course of a severe or terminal illness, either as a direct result of the underlying disease or because the limitations of the disease make it hard to avoid sores and abrasions. Pressure sores, friction wounds and skin tears are common in hospice and palliative care patients, especially those who have limited mobility. Malignant tumors on the surface of the skin, diabetic ulcers and vascular wounds may occur in patients with specific conditions. Surgical wounds after a planned or emergency operation also need specialized care. Different types of wounds require different kinds of care, so a patient’s medical team must assess the wound before determining appropriate care.
Unlike traditional wound care, the goal of palliative wound care isn’t necessarily to heal the wound. Instead, the goal is to manage the symptoms of the wound and make the patient more comfortable. Some chronic wounds, such as those caused by cancer or ulcers, may not be treatable. In other cases, full wound recovery might involve treatments that the patient’s body can’t currently handle, such as surgery. Regular wound assessment by the palliative care team helps track how specific wound care interventions are working.
Any wound can develop an infection, and individuals with a severe or terminal illness may be more prone to them. As the immune system tries to mount a defense against the infection, further damage may occur. To combat infections, a palliative care doctor might prescribe a course of antibiotics. Systemic antibiotics, taken orally, are often used to treat widespread infections and help prevent an infection’s spread. Palliative care patients with a contained infection in a single spot might be prescribed a topical antibiotic, such as a gel or cream solution. In some cases, topical medications for wound treatment are placed directly on a soft bandage and set on the wound to keep the area covered and protected from further exposure to potentially infectious microbes.
Debridement is another type of infection treatment patients might need during palliative care. During this procedure, a doctor or nurse removes dead or dying tissue at the wound site to reveal healthier tissue underneath. After debridement, the exposed skin absorbs topical antibiotics and other medicines more easily.
Wounds often cause pain, and managing this pain is a big part of palliative care. A patient in palliative care may already be on pain medication to manage symptoms of their illness but might need even more treatment for pain during medical procedures or dressing removal.
During dressing removal, a palliative care nurse might wet the area with warm saline to help loosen the adhesive and prevent pain. The medical team might apply topical analgesics to temporarily numb the area undergoing treatment. Many modern wound dressings are crafted to reduce trauma during removal, so these can be used to minimize discomfort.
Wound Odors and Exudate
Some palliative care patients have wounds that exude fluids or produce odors. Exudate from wounds can cause continued damage because these fluids typically contain enzymes that break down skin cells. Bacteria can also build up in wound fluids, which can lead to an increased risk of infection and further breakdown of the skin around the edges of the wound.
Treatment of seeping or malodorous wounds involves reducing the smell and covering the wound with an absorbent material to collect any seepage. Odor-reducing solutions placed into the dressing on top of the wound help eliminate unpleasant smells. These absorbent dressings generally have a non sticky layer that lies directly against the wound to minimize damage when the dressing is removed. Depending on the level of seepage, dressing changes may be required daily or every few days.
Managing Social and Emotional Effects
Wounds have effects beyond just physical pain, infection and reduced mobility. Palliative care patients with wounds may also experience social and emotional difficulties stemming from their wounds. Depression and anxiety over visible wounds may compound existing emotional stress surrounding the initial illness. Patients with visible wounds might feel self-conscious about the way they look, which can lead to social isolation if the patient starts avoiding friends and family. A good palliative care team can help patients maintain a sense of dignity by minimizing the visual appearance of wounds and reducing any odors coming from them.
Because palliative care is designed to treat the whole person, your care team should address these emotional impacts as well as the physical wound symptoms. Palliative care might include counseling to let the patient discuss concerns with a trained therapist, and palliative care practitioners might provide companionship and social interaction for patients in their own homes.
Preventing wounds is just as important as treating them during palliative care. Patients who spend most of their time in bed or in a chair often develop pressure wounds. Frequent repositioning may be required to reduce the risk of this type of injury. Specialty pillows, foam supports and elbow protectors can ease pressure and prevent friction that can lead to abrasions.
Excess dryness or moisture can make the skin more susceptible to wounds. Prevention might involve assessing the state of the skin and applying moisturizers or medicated lotions to the area. Patients who experience excess perspiration may need frequent clothing changes or bed linen changes to prevent moisture buildup that can lead to sores. Palliative care patients with incontinence might be at risk of sores caused by too much moisture and the buildup of feces or urine. Home health aides can help with personal toileting and bathing to reduce the risk of waste buildup and infection.No matter what type of injury is present, palliative wound care helps ease suffering and enhances the quality of life for patients in a hospice or palliative care setting. From initial assessment to wound cleaning and pain treatment, our palliative care team at Three Oaks Hospice makes regular wound care part of your overall care plan.