Literature Review of Kennedy Terminal Ulcers: Identification, Diagnosis, Nursing Goals, and Interventions

Abstract

Although not greatly researched, the paucity of available literature theorizes that Kennedy Terminal Ulcers (KTUs) are clinical indications of skin failure. Through a review of the literature, the topics of: (1) methods of KTU identification, (2) how to make a proper nursing diagnosis, and (3) suggested nursing interventions will be discussed. Included in this literature review are anecdotal articles written by experienced healthcare professionals working in the hospice and palliative care fields. Case studies which focus on the development and treatment of KTUs incurred by end-of-life patients receiving hospice or palliative care services are also presented. The available literature corroborates that there are five characteristic wound criteria that serve to identify and diagnose KTUs. Though clinical professionals have different approaches on how to treat KTUs, the current literature concurs that nursing interventions should include: adequate pain control, hemorrhage prophylaxis, effective wound dressings, exudate management, infection prophylaxis, effective debridement methods, and odor control. Limitations encountered by the clinicians studying the development and treatment of KTUs include ethical dilemmas (i.e. inducing patient fatigue, inflicting emotional distress, or occupying the patient's valuable time as they approach end of life) and limited awareness of the existence of KTUs. Further research is needed to raise awareness of the existence of KTUs and how they are indicative of skin failure, for they must be identified, diagnosed, and treated accordingly so nurses are able to better advocate for the patient and ensure quality comfort care is provided as the patient approaches end of life.