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In long-term care, it is common to encounter sores and ulcers, the most common being pressure and Kennedy ulcers. While the two conditions have similar characteristics, each has distinct traits and underlying causes. Here we will discuss both in great detail. 

What are Kennedy ulcers?

A geriatric patient has a Kennedy ulcer on a leg.
A Kennedy ulcer is a skin lesion that emerges in geriatric patients during the last stages of their lives.

A Kennedy ulcer, also known as a “Kennedy Terminal Ulcer” (KTU) or a “Kennedy wound”, is a skin lesion that typically emerges in geriatric patients during the last stages of their lives. The exact cause of Kennedy terminal ulcers is uncertain. 

Some experts believe they occur in terminal patients because their bodies are shutting down, leading to a decline in their internal organs. The skin, of course, is the body’s largest organ, comprising approximately 10% to 15% of a person’s body weight. It uses around 25% to 33% of the blood pumped around the body. And like other organ systems, when the skin experiences dysfunction, this reflects signs of illnesses.

The signs and traits of a Kennedy ulcer

When examined closely, Kennedy ulcers have several key features that set them apart from pressure ulcers. Understanding these characteristics is essential for accurate diagnosis and effective care management. 

Unlike pressure ulcers, a Kennedy ulcer can occur suddenly on the skin, often in the shape of a pear. It is seen as a sign of impending death and a natural part of the dying process. These ulcers manifest within a very short timeframe, typically between three to eight hours, and are predominantly found in the sacral region. Recognizing their unique appearance is pivotal in diagnosis.

Initially, Kennedy ulcers manifest as minor superficial skin damage but can progress into a dark necrotic wound (3:30 syndrome) as the patient’s condition worsens. The rapid deterioration of a Kennedy ulcer reveals the severity of the injury, indicating the patient’s terminal status. Caregivers should familiarize themselves with the different stages of Kennedy ulcers to provide appropriate care.

Some typical signs and symptoms to look for include:

  • Inflammation
  • A break in the skin or tissue
  • Necrosis (death of cells or body tissue)
  • Skin discoloration
  • Black or purple color
  • Pear-shaped or another irregular shape
  • End-stage skin failure

Caregivers must understand the varying degrees of pain, discomfort, and stages associated with Kennedy ulcers, allowing them to address and provide appropriate care to terminal patients.

How do Kennedy ulcers differ from pressure ulcers?

Dissimilar to a Kennedy ulcer, pressure ulcers are skin or soft tissue injuries caused by extended pressure on the skin. They usually occur due to caregiver negligence and are common among residents in long-term care facilities who are bedridden or have mobility issues.

When pressure ulcers are found, swift and immediate treatment is essential, as failure to address these injuries can lead to life-threatening complications. The primary focus of treatment includes reducing the pressure around the affected area. However, the specific treatment will differ depending on the stage and severity of the pressure ulcer.

Common symptoms of pressure ulcers include:

An older adult is distressed because she has a Kennedy terminal ulcer on her leg.
A Kennedy Terminal Ulcer is a distressing condition that emerges in the final stages of life for older adults with terminal illnesses.
  • Discolored areas of skin that remain unchanged even when pressure is applied, typically appearing red on fair skin or purple or blue on darker skin tones
  • The area of the skin may feel warm, spongy, or hard
  • The skin region may experience pain sensations or itchiness

While most pressure ulcers usually develop over a stretch of time, they can sometimes appear over a few hours, leading to blisters or open wounds. If left untreated, they will worsen and eventually reach the deep skin, muscle, and bone layers.

In the upcoming sections, we will explore the challenges, ethical considerations, and treatment options when caring for older adults in long-term care with Kennedy ulcers. 

Kennedy Terminal Ulcer  Treatment and Ethical Dilemmas

It is now clear that a Kennedy Terminal Ulcer (KTU) is a distressing condition that emerges in the final stages of life, particularly in older adults with terminal illnesses. The cause and appropriate treatment of a Kennedy ulcer are subjects of intense debate within the medical community due to the sudden onset and appearance of these ulcers. 

Unfortunately, Kennedy terminal ulcers are often misunderstood and commonly misdiagnosed as pressure ulcers. This confusion often leads to aggressive care and poor patient outcomes, causing psychological and emotional distress to patients and their family members. Therefore, the materialization of a Kennedy ulcer poses particular ethical challenges for healthcare providers and caregivers. 

One ethical dilemma is determining the validity of a Kennedy ulcer on terminal patients and whether they died from a Kennedy ulcer or a pressure wound. There have been cases in which a nursing home hides the malpractice and labels the pressure wound a Kennedy ulcer.

This ambiguity raises legal concerns about the quality of care provided. Healthcare providers and caregivers may face legal repercussions if they are perceived to have neglected proper wound care or failed to adequately document the patient’s condition and care plan. Indeed, thorough documentation of the ulcer’s progression, interventions, and discussions with the patient and their family is crucial to protecting the patient’s well-being and the healthcare provider’s reputation.

Another ethical concern revolves around communication and consent between the long-term care provider, the patients, and their families. Should a Kennedy ulcer develop, an appropriate care plan must be created that involves the patient’s preferences on treatment options, potential discomfort, and care goals. 

Holding open and honest conversations between all involved parties will ensure the patient’s wishes guide decision-making and that they reach the end of their lives with appropriate pain management, comfort, dignity, and support for the family.

Long-term care facilities can avoid legal disputes related to these ulcers by implementing effective long-term care software that ensures thorough documentation, compliance, and accountability in patient care. This step will ultimately lead to providing the best possible care and support for patients with Kennedy terminal ulcers while enhancing their comfort and dignity during the last stages of their lives.

Contact us here if you would like to test drive our user-friendly long-term care software.

How To Manage a Kennedy Wound during End-of-Life Care 

While a Kennedy wound presents clinical challenges and ethical dilemmas for healthcare providers, for the patient, a Kennedy ulcer indicates the final stages of life. Therefore, care is best focused on effective wound care management, pain relief, comfort, and providing dignity to the patients. Below, we will discuss Kennedy ulcers: what they mean, and how to cope so that caregivers can provide better care and support for patients and their families. 

When the skin begins to fail and the sudden emergence of a Kennedy terminal ulcer develops, afflicted patients will have a tailored care plan in place to provide supportive care. Likely, they will already be undergoing palliative treatment to enhance their comfort to alleviate the different Kennedy terminal ulcer stages and symptoms.

An older man is feeling pain from the Kennedy wound on his elbow.
A Kennedy wound presents clinical challenges and ethical dilemmas for healthcare providers and patients.

Due to the wound’s rapid development and telltale signs of the patient’s imminent demise, physicians will prioritize preventing wound infection over attempting to heal the wound. Some steps to manage Kennedy ulcer wounds include:

  • Meticulous dressing changes
  • Repositioning the patient regularly
  • Cleansing the wound with saline solution
  • Continuous monitoring of the wound 
  • Tending to the wound

Additionally, caregivers will also use palliative care approaches to treat Kennedy ulcers. This ensures appropriate care is given to provide comfort and alleviate suffering while enhancing the patient’s quality of life

Some palliative care measures for Kennedy ulcers include:

  • Maintaining cleanliness
  • Applying a skin barrier cream
  • Placing cushions under the ulcers
  • Utilizing pressure relief techniques 
  • Applying suitable support surfaces, such as a mattress, bed, or special cushions to protect vulnerable skin
  • Preventing infections with proper wound care management
  • Managing pain 
  • Managing wound exudate and odors

By implementing these treatment measures and approaches to each patient’s unique needs and wishes, long-term care providers and caregivers can provide compassionate care while addressing the condition’s complexities. 

Providing Kennedy Ulcer Patients With Compassionate Care

The complexities associated with providing care for a Kennedy ulcer patient in a healthcare facility necessitate a deep understanding of this condition and a compassionate approach to caregiving. Kennedy ulcers pose challenges on account of their unique characteristics and sudden appearance. And they serve as poignant reminders of the delicate balance between medical care and ethical considerations, especially in end-of-life care. 

In managing Kennedy ulcers, staff will need to ensure accurate diagnosis, thorough documentation, and open communication with patients and their families. Through these measures, long-term care providers and caregivers can ensure they provide the best possible care while maintaining the dignity and comfort of the patients.

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