This is a pressure ulcer or skin lesion which some patients will develop towards the end of life. It will develop on both sides of the buttocks or the sacrum. (bilateral)It can also develop only on one side of the buttocks or the sacrum(unilateral). The presentation on both sides is called Kennedy Terminal Ulcer(KTU) and the one that develops only on one side is called the 3:30Syndrome.
The Kennedy Terminal Ucler may be difficult to identified because there is no Standard Assessment Tool.
Most healthcare professionals are not aware of this condition. It has irregular shaped, butterfly shaped or pear-shaped.
CAUSES:The Causes remain unknown but some studies have shown that it is due to organ shut down. It develops in the final weeks of life.
It can develop in few hours.( unilateral presentation)Skin may be healthy in the morning but changes in the afternoon.
It should be treated as pressure ulcer.
PROGRESSION: It will start as red,purple or black superficial intact area of the skin that will progress quickly to blister, stage 11,abrasion and will progress quickly to stage 111 or stage 1V.
TRUE TIME FRAME OF DEATH OF KTU AND 3:30 SYNDROME BASED ON EXPERIENCES AND STUDIES.
Kennedy Terminal Ulcer (KTU)is roughly two weeks to months.( Presents itself bilateral buttocks)
3.30 Syndrome about 24hours to 48hours.( Presents itself only on one side)
Treatment should focus on comfort and dignity in the last few weeks of life.
It is very painful ulcers, so pain should be reduced with pain medications, medication for nausea given as ordered.
Monitor fast heart rate.
Patients are usually very fragile.
Reposition for comfort.
MEASUREMENT OF PRESSURE ULCER. Using a wound measuring guide such as the wound measuring tape to measure length, width and depth of wound and document appropriately.
Documentation of findings based on facility policy and procedures.
Documentation of the wound well secured.The depth should be measured and well documented.