Q: How do acute and chronic wounds appear with worsening of acute or terminal illness?
A: Almost 95% of adults older than 65 years of age have at least one chronic medical condition, including heart disease, type 2 diabetes, cancer, and chronic obstructive pulmonary disease. The challenges for these adults are medication management, declining immune systems, lack of social support and coordination of specialty care. Acute-on-chronic conditions, if not controlled, often lead to compromised health, including system failure or death.
Rapid deterioration of the skin can occur within 24 to 48 hours of worsening acute illness. Skin changes like Kennedy terminal ulcers, and sudden onset of other deep tissue injury around bony prominences and heels can happen rapidly. Skin should be assessed daily with appropriate lighting.
A Kennedy ulcer is a deep tissue injury that develops around the sacral area within a few hours instead of days or weeks like other acute or chronic wounds. Its appearance is anywhere from triangular- , pear- or butterfly-shaped, dark-colored with shades of red, purple, blue, black and even yellow. Kennedy ulcers represent sudden onset of skin failure that is a part of system failure.
Acute wounds can appear quickly around the bony prominences like gluteal areas, bilateral ankle, and prominences of the spine and heels.
Chronic wounds can worsen quickly with signs of inflammation or infection. Daily surveillance of the skin for such patients is essential for early identification of acute deterioration, and system failure that can lead to an acute or terminal condition.
Accurate and timely documentation is necessary, without exceptions, for patients’ care, their safety and avoidance of lawsuits. After all, what is not documented is considered not done.
Please send your wound-related questions to Dr. Naqvi at [email protected].
