What is a Kennedy Terminal Ulcer?
Have you ever heard of a Kennedy Terminal Ulcer? This mysterious and often misunderstood condition can be a critical indicator in nursing home abuse cases. These ulcers appear suddenly in terminally ill patients and are frequently contested in medical and legal discussions. In this week’s episode, nursing home abuse lawyer Rob Schenk welcomes guests Martha Kelso and Karen Kennedy-Evans to talk about the medical and legal implications of Kennedy Terminal Ulcers, shedding light on how they can impact court cases and patient care.
Schenk:
All about the Kennedy Terminal Ulcer. Stick around.
Hey out there, everybody. Welcome back to the nursing home abuse podcast and also happy new year. Hope your 2025 has started swimmingly. We have a fantastic show for you this week. We are talking all about the Kennedy terminal ulcer, but we don’t do that alone. We have a fantastic panel. We have Martha Kelso returning, I think, for her fifth appearance, but we also have the namesake.
All right, everybody, let’s get to the meat and potatoes of the episode. We have, as I mentioned two fantastic guests, Martha Kelso and Karen Lou Kennedy Evans. So Martha Kelso, CEO of a leading mobile wound care group is renowned for her visionary leadership and post acute care with a dedication to advancing wound healing, she excels as a published author, clinical editor, and expert witness for wound litigation.
Learn about the dedicated team and their expertise in wound care management at Wound Care Plus.
Martha’s contributions extend to national advisory boards where her award winning expertise shapes the future of healthcare. And we also have Karen Lou Kennedy Evans, who became the first family nurse practitioner in Fort Wayne, Indiana in 1974 for 25 years, she was the medical clinic manager at Byron health center, a 500 bed hospital.
Long term care facility and there she established one of the first skin and wound care teams. And it was during this time during this period that she and her team identified what would later become the Kennedy terminal lesion, as well as the Kennedy terminal ulcer. And we’ll get into all that good stuff here in just a second.
Martha and Karen, welcome to the show.
Kelso:
Thank you. Thanks for having us. Rob. We’re excited to be here.
What is a Kennedy Terminal Ulcer?
Schenk:
This is the first time I think that I’ve had a panel like I’ve never, I don’t think I’ve had a panel before. And I’m really excited that the panel is the both of you and that we’re talking about today’s topic, which is the Kennedy terminal ulcer.
So again, a lot of us can get into the weeds to get into the weeds, but let’s start from the top. How did this all start?
Kennedy:
This started When I became the very first family nurse practitioner in 1974 in Fort Wayne, Indiana. And in 1979, I started to work at the Byron Health Center, which was a 500 bed, long term care nursing home.
It was a county facility. And there, we did have pressure injuries, and back then, nobody really knew much about pressure injuries. I went to a conference in Indianapolis by Yvonne Fowler. who talked about pressure injuries. And it was very fascinating. So when I went back, I talked to the nurses and said, Hey, how about if we start looking at these I’ll take pictures of them.
We’ll measure them and we’ll make sure that they got the right bed, that we’re doing the right things and that their health is all right. Let’s just keep track of it. So I started probably one of the very first skin and moon care teams in the United States in 1983. And I had five and a half years worth of data of pressure injuries when the very first National Pressure Ulcer Advisory Panel meeting was in 1989.
As we saw the pressure ulcers every week, we started to notice a pattern that some patients develop this thing that just came on suddenly. And because we, went every week. I was starting to notice a pattern that in two weeks I’d go to that same room and the patient wouldn’t be in the bed. I’d go back to the nurse and say, Hey, where’s Mr Smith in 204 B?
And they say, Oh, he died. And I look back and I’m thinking, gosh, Two weeks ago we got this pressure ulcer. So as this progressed over the five year span, I started to see the same thing. I’d go in the room the week later and it would get bigger, and then the week after that, they weren’t in the room again.
And we looked at each other because there were director of nursing and the pharmacist made rounds with us and it’s gosh, this is really weird. And so then when we’d roll somebody over and we’d look at their. Sacral coccygeal buttocks area, and we’d see that presentation, sudden onset, irregular borders, purple, black, or maroon discoloration.
We’d look at each other and say, do you think this is like the other ones? And so we started to see a pattern. So it became known as a Kennedy terminal lesion, which morphed into Kennedy terminal ulcer. Now, the irony of this is people say, Oh, you made this up. This is just, this really isn’t true.
Access detailed discussions on the Kennedy Terminal Ulcer in this 2009 article.
But the irony of this is that Dr. Charcot, who is a French neurologist, and this is an interesting story. In Paris, France, he worked in the same hospital that Lady Di was in. Came to as a patient when she was in that automobile accident. So Dr. Charco had a ward that had a thousand patients in over time, because when people, they didn’t have any family, they didn’t have any place to go.
They went to this ward, his thousand patient ward. And during his time as a French neurologist, he started to see patients over time. Like I was seeing patients over time for five years, he started to see changes. He came up with the first to describe Parkinson’s disease, first to describe Lou Gehrig’s disease, and 30 other diseases.
And on the streets of New York, by Dr. Levine, found a textbook written by Dr. Charcot. In that textbook, in the pictures, there’s a picture of Lou. Of the two presentations that I described, the bilateral presentation, which what on one is what on the other side or the unilateral presentation.
So in 1887, Dr. Charcot, a French neurologist, describe this. And it would seem to me that if his textbook hadn’t got lost in history, this wouldn’t be a problem because we know it exists. We know it happens. And so this is the same thing that I was seeing with my 500 patients in the county facility over 25 years.
Explore a scoping review of Kennedy Terminal Ulcers and their clinical implications in this Journal of Hospice and Palliative Nursing article.
How did the Kennedy Terminal Ulcer get its name?
Kelso:
So Karen, who named it the Kennedy Terminal Ulcer?
Kennedy:
The medical director at the time was Dr. Glassley and we were going to present this data. How many pressure ulcers do you have? Nobody knew. Here I had five years worth of data at the Byron Health Center. So I was invited to speak and I said, we should call this something.
And I said, why don’t we call this the Byron ulcer or the Glassley ulcer? And he said, and he’s the one who named it the Kennedy terminal ulcer.
Schenk:
What is, in y’all’s definition and estimation, a Kennedy terminal ulcer?
Kennedy:
A Kennedy terminal ulcer or lesion is an area of skin discoloration. Usually it’s on the buttocks or the sacrococcygeal area.
It comes on suddenly. Often the nurse says, or the caregiver says, Oh my gosh, that wasn’t there yesterday, or that wasn’t there the last time we turned him. The color, the discoloration can be purple or black or maroon. And it often has irregular borders and it progresses rapidly. and can turn into a skin ulceration.
Kelso:
And Rob, it’s usually a sign, Rob, it’s usually a sign of skin failure or somebody failing, whether it’s multi organ system dysfunction or organ failure. And so it’s a symptom of other underlying pathophysiology going on in the human body.
Understand the treatment of skin tears among the elderly in this research study available on ScienceDirect.
What is the difference between a Kennedy Terminal Ulcer and a pressure injury?
Schenk:
And why typically do we have a conversation about the Kennedy terminal ulcer and pressure injuries at the same time, what is the difference between those two?
Kennedy:
We originally had the Kennedy terminal ulcer, it presented differently and we can go into that in a little bit, but it presents differently, but it can end up looking like a pressure injury. Pressure ulcer. And so it fell into that category. However, with current testing and information, we find that it doesn’t have the same etiology, the same cause.
It’s not really from pressure. We think that it’s from a micro circulation issue.
Schenk:
I see. If I understand correctly, when we’re talking about the Kennedy terminal ulcer, we’re talking about an ulceration, meaning like a wound that opens up. But the cause of this is not necessarily or not at all based on pressure.
It’s more based on, I think you said, microscopic circulation issues related to the dying process. Is that kind of
Kennedy:
It can be related to the dying process, it can be related to hypotension, it can be related to how ill and sick the patient is. Now, I think what you said, you talked about an ulceration, but in the very beginning of this presentation, and in my opinion, this is where the magic is, whether this is a pressure ulcer or whether this is a Kennedy terminal ulcer or lesion, we tend to see the differences in the very beginning of the presentation.
And as I said, this has a sudden onset. It comes on suddenly and it ends up being an area of discolored skin and it’s not necessarily open in the beginning. It can be, but often it is superficial discoloration of intact skin that as it progresses can open up. And when it starts, it can be a larger area.
Review comprehensive discussions on skin integrity and pressure injuries in this document from Academia.edu.
What I’ve noticed in my experience, sometimes like in a nursing home, you can have the initial discoloration about the size of a quarter or the size of 50 cent piece and a lot of times in I. C. U. Patients in the hospital. And this is supported by a study that was that we did in 2000 that was published in 2000.
20 and 2023. It showed that the initial presentation of the discoloration of the skin was a larger area, more like almost the size of a name tag. And the borders of this discoloration are irregular. So if you traced around the edges, you’re not going to get around or an oval area like you would probably get with a pressure injury.
You get more of a jagged edge. Irregular edge. And so the edges are significant and it can progress to open up and as it progresses along the pathway, if the patient doesn’t die, it can progress to what looks like a pressure injury.
Schenk:
Okay. So there can be a Kennedy terminal lesion or ulcer. And I don’t know if those are synonyms or not, but it starts with discoloration and the discoloration typically follows a different pattern than how maybe a pressure injury would start.
And this is me as a lay person, but so the pressure injury. The discoloration is happening due to either the lack of nutrients getting to the tissue because of the obstruction or perhaps some other issue, diabetes or some reason why the nutrition can’t fall in the blood plus the pressure is causing that initial discoloration.
Is there any way that without, and again, this is, I want the lay person to understand, is there any way that we can talk about why that would happen with the Kennedy terminal if it’s not pressure doing it?
Kennedy:
There were a lot of things in there. And so if I can back up to the beginning, one of the original things that you ask is the difference between a Kennedy Terminal Ulcer and a Kennedy terminal lesion.
The original article was published in 1989 and called it a Kennedy terminal lesion. So with more science, what we’re using is we’re using the term Kennedy terminal lesion for the discoloration of intact skin. We’re using the Kennedy Terminal Ulcer. For the discoloration of the skin that starts to ulcerate.
Okay? So it’s a matter of progression. So let’s just say on day one, when you have the initial presentation, you more than likely will have intact skin. Now you can have a very minor, very superficial area that’s starting to peel, but as it progresses through the timeline and. Which kind of goes to, as a rule, most of the time with a Kennedy Terminal Ulcer or lesion, these people die, because it is, it can be a sign of something’s really bad going on with the patient.
Now, not all people die with a Kennedy Terminal Ulcer or lesion. Most people do, but some don’t. In the study that we did in 2023, on is a small study on 10 patients in an I. C. U. Two of them, I believe, died in 24 hours. One died like in 12 days. And then actually one patient died in over a year, a little over a year.
Discover essential information on Kennedy Terminal Ulcers and their identification in nursing homes at Nursing Home Law Center.
So from onset to death can vary and often you’ll see if they didn’t die in 24 hours or 48 hours or two weeks, it’s not a Kennedy Terminal Ulcer. That’s not necessarily true because what’s happening to cause this, we think, is the patient is going through this process of significant illness. Often it is accompanied by hypotension, and especially the people in ICUs with a low blood pressure, they’re on vasopressors. And when they get this they can die, but occasionally, if you can fix what’s going on with the patient that’s making them so ill, that they have the skin discoloration, if you can reverse that, then, and the patient will live.
What the Kennedy Terminal Ulcer is really showing is, I’m really sick, bad things are happening, and something definitely needs to be done.
Kelso:
I do want to say, oftentimes we use the word progression with these wounds, or lesions, but it’s really an evolution. So it’s not that, Somebody’s failing to do something, and therefore the wound continues to get worse because of failure.
The wound’s getting worse because it’s evolving, because the underlying tissue is already damaged through hypoperfusion or tissue ischemia, or the inability to perfuse the area adequately, whether that’s nutrition, hydration, adequate blood pressure support, et cetera. And so I typically use the word evolve.
Instead of devolving or progressing, Rob.
Kennedy:
That’s a good point. It evolves.
Read about the latest studies and guidelines on pressure injuries from the National Pressure Injury Advisory Panel.
How is a Kennedy Terminal Ulcer treated differently from a pressure injury?
Schenk:
That I guess that would be to piggyback off that. Then how is it? How other than treating whatever the underlying clinical condition is, how is it treated? How do you treat the chemity, how do you treat the Kennedy Terminal Ulcer, Kennedy Terminal Lesion, other, if you can, other than treating the underlying problems that the patient has?
Kelso:
We treat it based on wound characteristics. So if the wound has moderate to heavy drainage, you pick a dressing to absorb moderate to heavy drainage. If the lesion’s intact, you pick a dressing to support the skin and manage moisture and all those good things as best you can. But it’s not the treatment of the lesion that keeps it from getting worse or keeps it from developing.
It’s The underlying medical issues with the patient that ultimately make all the difference in the world and it’s why CMS decided October 1st, 2023, to clearly differentiate that pressure ulcers. are pathophysiologically different than Kennedy Terminal Ulcers or skin failure at life’s end. The skin failure lesions are not the same thing as pressure.
And to Karen’s point, pressure wounds, if they’re true pressure, generally look like whatever object or thing The body part was laying on that was causing pressure. So did they lay on a bedpan and they now have the outline or the shape of a bedpan? Did they lay on a catheter tubing and you now have this imprint of the catheter tubing?
Did they have friction or shearing and you can see the shearing forces of the skin or tissue? And so it’s why CMS has embraced and supported Karen Kennedy’s research and showing that it clearly is. A different underlying pathophysiology feature than pressure and congratulations to Karen, too.
Listen to our podcast episode on the different types of ulcers, including pressure, diabetic, vascular, and Kennedy ulcers.
Schenk:
I think that, for me, that would be a big deal that CMS is citing my research that they’re changing regulations for or updating.
I should say updating regulations based on my work. So congratulations to you. That’s amazing. Um, very rarely I got, true rock stars in the show. I don’t want to say that’s demeaning to all the other hosts, but it’s your head and shoulders above some others.
But anyway, in terms of if you’re a nurse or a physician or you’re the provider at bedside, the idea is, You want to understand whether you’re dealing with a pressure injury or dealing with a Kennedy Terminal Ulcer because the treatment might vary. So for example, like it might not matter if there’s a, if you have determined that there’s a Kennedy terminal ulcer where we’re at the process where you’re at ulceration.
Then pressure, whether or not you relieve pressure from that area is irrelevant. You want to treat whether it’s the, whatever the sickness is versus the actual wound, wound itself. Or am I wrong about that?
Kennedy:
You would still need to do what you need to do for any normal person in that situation.
And you certainly want to make sure that you have all your preventative measures in, in line so that they don’t get a pressure entry.
Kelso:
People with Kennedy Terminal Ulcers, Rob, or the underlying organ dysfunction that can lead to Kennedy terminal ulcers are at higher risk of pressure ulcer development because the underlying tissue is not as strong.
It’s not as resilient to the effects of pressure. And Karen and I and others are very clear that Kennedy Terminal Ulcers are not a get out of jail free card and one of the differential diagnostics to show that the wound is a kennedy terminal ulcer is showing that you had adequate pressure support relief interventions to help the skin stay intact has to be in place.
From the beginning or from at least to be able to show it’s not contributing to the wound development. And so if you have the appropriate things in place and then wounds still develop, you can then look at the underlying criteria that meets or matches the Kennedy Terminal Ulcer to arrive at the correct diagnosis.
Schenk:
Which I can imagine at bedside is a difficult thing to do for a practitioner, especially if The KTU for short is in a pressure spot. Because if you prematurely diagnosed it as a KTU, it’s game over for that wound because you’re not treating it as a pressure injury.
You’re treating it as something else. Because if I understand correctly, the treatments can be different.
Kelso:
And I may, I agree with what you’re saying, but I also want to reverse the lens and say, it’s the same with pressure. If you’re prematurely calling it a pressure wound when it is a KTU, the message that we’re communicating to the family is also wrong, where the family may be thinking they’re going to heal.
They’re going to get up. They’re going to walk. They’re going to go home. They’re going to be great. When in fact, it could be a KTU end of life or, severe organ dysfunction where this person may not live.
Schenk:
And that’s the analogy that I give to families. Cause I feel it a lot of phone calls from folks and after they tell me the litany of clinical conditions, I’m like, look, some people you can put in space, the skin is an organ.
And they’re at a position in their life where the skin is going to break down now. And that, and I’m not saying that’s not impossible. So I guess it sounds like it’s a situation where you know it’s tough, but it sounds like there is a distinction in these two in, in these two conditions the pressure wound in the Kennedy Terminal Ulcer.
What should families know about Kennedy Terminal Ulcers?
Schenk:
Okay. So let me ask this then. What should families know Karen and Martha like that are that might be watching this show? Maybe they’re going through this process. What would you want to tell them about the Kennedy Terminal Ulcer? Like what? What should they know? What are the basics?
Kennedy:
In my opinion, I think this is very important to be very open with the family because this is very devastating.
This is very devastating to a family member because often this person is ill or becoming more ill. What we see in long term care is a lot of these people have 18 to 20 years of experience. Over 20 diagnoses, some of them are on more than 18 medications, and I see a low serum albumin, a low hemoglobin, a low total lymphocyte count, whether they’re diabetic or not, often their blood sugar will start to go up, they have unintentional weight loss, they’re losing weight for no particular reason, and they’re kinda just going downhill, and a lot, and as we said, this is a sudden onset.
So the family is hit with something new, and the reason is why? Why? What did you do to cause this? And, pressure ulcers can be bad care, but the Kennedy terminal lesion is something that’s physically going on with the patient. So I think to talk with a family member and to say, we think this might be a Kennedy Terminal Ulcer or lesion because of the sudden Irregular borders it progresses rapidly and this may turn into an ulcer.
And this has to be not from the care that they’re being given or not given, but from what’s really going on with your family member. And I think then, Also, just having the family go home and look up the Kennedy Terminal Ulcer or lesion on the internet is very helpful. I just got a call from a doctor that I consult with who is in hospice.
Explore the critical role of staging in the care of pressure injuries in our podcast episode, What Role Does Staging Play in Pressure Injury Care?.
And he said for the first time in history, he had, in fact, the doctor just called me two days ago and said, the Husband just called and said, Hey, my wife has been in hospice for six months and she got one of those Kennedy things. And so I think it’s very important for families to understand that this may be part of the dying process.
Now, can we reverse this or can we not? And with that, as Martha talks about, CMS, the federal government, coming up in October 1st of 2023, saying this is no longer considered pressure. It’s part of the dying process. And so I think to let family members know that this may be a bad sign, and this may not turn out well, and this may be what’s really going on with the patient.
Kelso:
Yeah. On my end, I, by the way, Karen, that was beautiful. I couldn’t have said it better. I also believe we have to educate the clinicians. Doctors oftentimes don’t realize KTUs exist or even some of the underlying factors. Same with nurse practitioners and other bedside nurses. And so some of the things that I would encourage them to analyze or point to.
Aside from the criteria Karen set forward, are there two or more major organs that have underlying dysfunction or failure? Are they in congestive heart failure and in stage COPD, do they have stage three chronic kidney disease or worse and in stage brain failure? from Alzheimer’s dementia.
So when you start looking at two or more major organs with severe dysfunction or failure, the chances are when the major organs of the body are failing, the largest organ of the body may also fail. Because in order for the skin to stay alive, my heart has to have adequate perfusion. My lungs have to have adequate oxygen.
My kidneys have to be filtering toxins out of my body adequately. My liver has to be, producing and filtering at the same time. And so that’s one of the easiest things for clinicians, doctors, and even family members to understand. If my major organs are dysfunctional and or failing, my largest organ, the skin,
Are there particular parts of the body more susceptible to Kennedy Terminal Ulcers?
Schenk:
So let me ask this then, is there a particular part of the body then that is perhaps more susceptible to a KTU? Is it happening somewhere? Is the shoulder, the forehead like where is this more likely to happen?
Kennedy:
Over the years, the majority of them happen on the sacral coccygeal area. And in the study that we did in 2023 of the 10 patients in ICU, 80 percent of them were on the sacral coccygeal area.
They also can be. But not near as often in other areas, such as the heels, posterior calf muscle, the arms and the elbow. But the mo, the majority of ’em are on the sacral, al and some people call it the buttock area.
Understand the legal aspects of suing a nursing home for bedsores in our detailed discussion, Suing a Nursing Home for Bedsores.
How can clinicians differentiate between a Kennedy Terminal Ulcer and a pressure injury?
Schenk:
And I guess that would be if I was a, if I was a nurse, if I was a, a medical provider, that would be concerning because those are all pressure points.
And so in my mind, it would seem to me. And please correct me if I’m wrong, that you would want the default, if you’re just diagnosis, not talking about treatment or previous treatment, but from a diagnosis perspective, wouldn’t it be safe to say, okay, let’s treat this as a pressure injury until otherwise the symptoms point otherwise.
Kennedy:
Yes, you treat it just like you would anything else that looks like that, but to your former statement, this is confusing and because they are on a prominent area where people get pressure ulcers, once again, the things that you look at that may indicate that this is a Kennedy Terminal Ulcer, Kennedy terminal lesion, end of life, skin changes that life said, it’s the sudden onset.
These come on suddenly. As I said, the caregiver will say, Oh, my gosh, that was not there the other day. They have a sudden onset of discoloration of intact skin. It’s the size of a nickel or a dime or a quarter or even. And it’s like, how in the world can that possibly come on that quickly? When you look at it, it has irregular borders, and some people may even say jagged edges.
It progresses rapidly. It can have the colors in initial presentation of purple, maroon or black. And as it evolves, the colors can change when it opens up. It can be yellow or red. And so those are some of the things in my opinion that are very important. The initial onset is different than a pressure ulcer, sudden onset, irregular borders, skin discoloration and progresses rapidly.
Kelso:
And Rob, I would even say they have to have appropriate pressure relieving interventions in place as part of the differential diagnostics. But, about 60 percent of wounds have mixed etiology. And again, Kennedy Terminal Ulcers can also occur when there is a pressure component. The tissue is not as resilient to the effects of pressure.
And sometimes With Kennedy Terminal Ulcers, they may have them on appropriate support surfaces, but due to the underlying issues with their organ dysfunction, the tissue is not as resilient to the effects of pressure. And so sometimes even getting them up, in a sling, a Hoyer lift, you’ve got the sling putting pressure on that spot for a very short period of time, but because their body is already failing, pressure can still occur.
In short periods of time, but then it’s the ongoing progression or evolution of these wounds. If you take pressure off of it, pressure is not going to continue damaging the underlying tissue. The pressure is gone. Then, if these wounds continue to distract and be damaged in the presence of appropriate pressure relief.
While having system malfunction or organ dysfunction, we need to be looking at these end of life or Kennedy terminal type lesions or ulcers. But I know Karen’s done research with objective tools or equipment that can clearly define. Now, not everybody has access to the tools, but we know this information and equipment is coming.
So I’ll let Karen take over from there.
Kennedy:
Yeah. Thank you, Martha. Leads right into what I wanted to say. So when you talk about a pressure injury, you’ve got damage down to the bone and you’ve got destruction of tissue. When you talk about the initial 24 hour presentation of the discoloration, there’s a device out there called a thermographic image.
It’s like a camera and it measures temperature on the body. When you use this, And in the study that we did in the 10 ICU patients in three different hospitals, when the wound nurse decided that this was a Kennedy Terminal Ulcer or Lesion because it met the criteria, they came in with this thermographic image camera and took the temperature reading and picture of that discoloration.
And what they found with that. Is that the temperature of the discoloration, even if it may have been black or purple, that temperature of the skin was the same temperature as the surrounding skin temperature. There was no temperature difference. And what we know with pressure injuries, when you use that same thermographic camera on a pressure injury, The temperature will either be higher or be lower than the normal surrounding tissue.
And quite honestly, when I got my camera a little bit before COVID, and we had a patient who had discoloration on his sacral area. So I went in with a thermographic image, and took the image of his sacral area thinking, Oh, my God, this is black. It’s gonna light up like a whatever. And when I took the image, there was no color differentiation in the temperature.
And so I actually took the image thing and I went like that and I beat it because I thought this isn’t working. It was working. But what we didn’t know was is that in the initial presentation, it’s superficial and it doesn’t make a temperature change in the skin until it may evolve later. Now, we only have research on the first 24 hours of this discoloration.
We don’t have any research. After that, and that’s what we’re working on. So we know that in the initial presentation, it’s not like a pressure injury, which would have damage further down.
Learn about bedsores, their prevention, and treatment in nursing homes in our podcast episode, What Is a Bedsore and How Are They Prevented?.
Schenk:
But I’m assuming like, obviously y’all are working hard on the research, but I’m assuming more research would need to be done to really, thread that needle.
Kennedy:
Further research needs to be done so that we can understand the progression of this, the onset and how this differentiates from a pressure injury. Absolutely. And
Kelso:
I think more research needs done on pressure injuries too, but that’s just me.
What clinical conditions are often associated with Kennedy Terminal Ulcers?
Schenk:
Okay, let me okay, so we’ve been going for a minute. So let me ask this one question and then I’ll let you guys go. Are there any, in your research, are you finding any particular clinical condition, whether it’s in the stage renal disease, type two, uncontrolled diabetes, whatever it is that are typically are more likely riding along with or being the root cause of a KTU?
Kelso:
I don’t, I’m not involved in Karen’s research, but as a bedside clinician, the, and I’ve, I’ve been practicing 30 years, Rob, I’ve been in advanced wound care for more than 20. The times that we or my team have seen Kennedy terminal ulcers, it’s the major organs that are either failing or dysfunctional.
And cardiac, end stage heart. Failure or, pulseless electronic activity where they’ve actually coded and, kidney dysfunction or, brain dysfunction, heart dysfunction, thyroid dysfunction. People don’t always realize the small intestine can fail and. One of the criteria for small intestine failure is they end up with malnutrition, even in the presence of adequate caloric intake.
And we see that oftentimes in end stage Alzheimer’s dementia, where the brain is failing and the small intestine is failing, so they’re not absorbing adequate caloric intake. And so really just looking to see which organs and oftentimes it’s three or four or six organs that are dysfunctional. But for sure, if you have two major organs that are not functioning properly, it’s a possibility that they may end up with skin failure or a Kennedy Terminal Ulcer.
And it’d be ideal if more research is elicited and we can start to predict when skin failure may occur. So we can start having conversations with families as early as possible, but the science isn’t quite there yet. We’re working on it.
Kennedy:
And when you ask what particular diagnosis is, it can be a lot of them.
And as I said the typical person that comes into The nursing homes that I worked at have at least 18 diagnoses. And some of the cases that I’ve reviewed, I’ve had as many as 45 different diagnoses. So as Martha said, these are people with multiple issues that, don’t really have solutions to a lot of them.
Schenk:
Well said. Ladies I really very much appreciate you guys coming on the show and talking to me about this. It’s I’ve learned a lot and I hope the audience has learned a lot. So thank you so much.
Discover practical methods for treating pressure ulcers effectively in nursing homes through our podcast, Practical Methods for Treating Pressure Ulcers.
Kelso:
Thank you for having us.
Schenk:
Folks. I hope that you found this episode educational and perhaps entertaining.
If you did, please let me know if you have any ideas of any guests that you want to see in the future, any topics you want me to cover, please let me know that as well. New episodes of the nursing home abuse podcast come out. Every week on Monday. I think we have a very good lineup for 2025 lined up for you.
Yeah, I’m excited about that, but at any rate I hope that your 2025 is fantastic and that you live up to all of your new year’s resolutions. And with that folks, we’ll see you next week.
Guest Info:
- Martha Kelso on LinkedIn
- Karen Kennedy-Evans on LinkedIn
- Wound Care Plus
- Wound Care Plus on LinkedIn