Page 26 - Wound Care at End of Life Content: A Guide for Hospice Professionals - DEMO

WOUND TREATMENT GRID: Pressure Ulcers Stage 3 & 4
Wound Care Need Pressure Ulcer Stage 3 or 4 Comments
Bleeding Dressing strategies:  Consider checking: platelet count, PT/INR,
 Calcium alginate (silver alginate is not vitamin K deficiency.
hemostatic)  Ask: Is transfusion appropriate? Is patient
 Non‐adherent dressing on warfarin?
 Coagulants: gelatin sponge, thrombin  Use topical vasoconstrictors only when
Topical/local strategies: bleeding is minimal, oozing, or seeping
 Sclerosing agent: silver nitrate
 Antifibrinolytic agent: tranexamic acid
 Astringents: Alum solution, sucralfate
 Vasoconstrictive agents: topical
oxymetazoline (Afrin®) , topical
epinephrine
Support Surface Group 2 Support Surface: Any patient with •Group 2: Dynamic. Powered air flotation
partial to full thickness ulcers already present. beds & pressure reducing air mattress, non‐
Group 3 Support Surface: Patient must have powered advanced pressure reducing
large or multiple stage 3 or 4 pressure ulcers mattress
on trunk or pelvis, be bedbound, and all •Group 3: Dynamic. Air‐fluidized bed
alternative measures have failed (criteria to
receive Medicare reimbursement).
Pain •Topically:  Allow procedural time‐outs.
‐ 2% lidocaine or EMLA® cream 30‐60  Use moisture‐balanced dressing.
3
minutes before dressing change;  Use appropriate irrigation force.

‐ Morphine in hydrogel (only for  Avoid adherent dressings.
4
open/inflamed wounds)  Use warm saline irrigation to remove
•Systemically: dressing.
‐ Pre‐medicate 30‐60 minutes prior to  Use contact layer to protect wound bed.
dressing change with appropriate agent for  Complementary therapies, such as music,
anxiety and/or for pain.
relaxation, aromatherapy, visualization,
‐ Neuropathic pain (burning, stabbing, meditation, can be helpful.
stinging, shooting pain): tricyclic
antidepressant, anticonvulsant.
‐ Nociceptive pain: appropriate opioid or
corticosteroid

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