Page 24 - Wound Care at End of Life Content: A Guide for Hospice Professionals - DEMO

WOUND TREATMENT GRID: Pressure Ulcers Stage 1 & 2
Wound Care Need Pressure Ulcer Stage 1 or 2 Comments
Bleeding Dressing strategies:  Not applicable to Stage 1; skin is intact.
 Calcium alginate (silver alginate is not  Consider checking: platelet count,
hemostatic) PT/INR, vitamin K deficiency
 Non‐adherent dressing  Ask: Is transfusion appropriate? Is
 Coagulants: gelatin sponge, thrombin patient on warfarin?
Topical/local strategies:
 Sclerosing agent: silver nitrate
 Antifibrinolytic agent: tranexamic acid
 Astringents: Alum solution, sucralfate
Support Surface Float heels • Group 1: Static. Mattress, pressure pad
Group 1 Support Surface (prevention) or foam or gel overlays.
Group 2 Support Surface (stage 2 ulcers • Group 2: Dynamic. Alternating and low
present) air loss mattress
Pain •Topically:  Allow procedural time‐outs.
‐ 2% lidocaine or EMLA® cream 30‐60  Use moisture‐balanced dressing.
minutes before dressing change; 3  Avoid adherent dressings.

‐ Morphine in hydrogel (only for  Use warm saline irrigation to remove
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open/inflamed wounds) dressing.
•Systemically:  Use contact layer to protect wound bed.
‐ Pre‐medicate 30‐60 minutes prior to  Complementary therapies, such as
dressing change with appropriate agent for music, relaxation, aromatherapy,
anxiety and/or for pain. visualization, meditation, can be helpful.
‐ Neuropathic pain (burning, stabbing,
stinging, shooting pain): tricyclic
antidepressant, anticonvulsant.
‐ Nociceptive pain: appropriate opioid or
corticosteroid

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