Page 31 - Wound Care at End of Life Content: A Guide for Hospice Professionals - DEMO

WOUND TREATMENT GRID: Arterial or Ischemic Ulcers
Wound Care Need Arterial Ulcer/Ischemic Ulcer Comments
Bleeding Dressing strategies:  Consider checking: platelet count, PT/INR,
 Calcium alginate (silver alginate is vitamin K deficiency.
not hemostatic)  Ask: Is transfusion appropriate? Is patient on
 Non‐adherent dressing warfarin?
 Coagulants: gelatin sponge,
thrombin
Topical/local strategies:
 Sclerosing agent: silver nitrate
 Antifibrinolytic agent: tranexamic
acid
 Astringents: Alum solution,
sucralfate
Support Surface N/A. Only pressure ulcers determine use  Medicare reimbursement is based on
of support surfaces presence of pressure ulcers, not other
wound types.
Pain  Pain is often severe‐even at rest  Allow procedural time‐outs.
 Elevation of extremity may increase  Use moisture‐balanced dressing.
pain; dangling legs over side of bed  Avoid adherent dressings.
may relieve pain  Use warm saline irrigation to remove
 Consider antiplatelet agents: cilostazol dressing.
(Pletal®)  Complementary therapies, such as music,
 Pre‐medicate with appropriate agent relaxation, aromatherapy, visualization,
for pain and/or anxiety prior to meditation, can be helpful.
dressing change  Cilostazol (Pletal®) is contraindicated in
 Neuropathic pain (burning, stabbing, patients with heart failure ‐ any level of
stinging, shooting pain): tricyclic severity.
antidepressant, anticonvulsant
 Nociceptive pain (gnawing, throbbing,
tenderness): opioid or corticosteroid
Other  Characteristics: minimal exudate;  Do not use hot water bottles, heating pads
infection common, including gangrene, or other thermal devices.
 Pulses may or may not be present  These ulcers are also known as LEAD‐Lower
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 Thin, fragile skin Extremity Arterial Ulcers.
 Ulcer is due to occlusion of one or  Calciphylaxis associated with end stage renal
more arteries disease (ESRD) see Special Topics, page 47.
 Use lamb's wool or foam toe sleeves to
prevent interdigital friction

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