Yaşam sonunun uyarıcı işareti: Kennedy terminal ülseri
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Date
2019-09-16
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Bursa Uludağ Üniversitesi
Abstract
Karen Lou Kennedy tarafından 1989 yılında tanımlanan, uzun süre bakım alan terminal hastalarda görülen Kennedy Terminal Ülseri (KTÜ), cilt dolaşımı yetersizliği nedeniyle hastanın ölümüne yakın saatler veya günler öncesinde ortaya çıkmakta ve hızlı bir şekilde ilerlemektedir. Ölüm sürecinin parçası olarak ortaya çıkan ve kaçınılmaz bir cilt krizi olarak nitelendirilen KTÜ, 2009 yılından bu yana Ostomi Yara Yönetimi (Ostomy Wound Management) tarafından tanınmıştır. Ayrıca 2009 yılında uzmanlardan oluşan Yaşamın Sonunda Cilt Değişikliği konulu bir panelde (Skin Changes At Life’s End-SCALE), bu ülserin genellikle koksiks veya sakrumda görüldüğü ancak diğer anatomik bölgelerde de meydana geldiği ve genellikle ölüme yakın bir sürede görülme ile ilişkili olduğu bildirilmiştir. Bu özel sınıflandırmaya, 2014 yılında The Centers for Medicare & Medicaid Services (CMS) Uzun Süreli Bakım Hastanesi Kalite Programı Kılavuzu kapsamında da değinilmiştir. Klinik uzmanlar KTÜ'lerin nasıl tedavi edileceği konusunda farklı yaklaşımlara sahip olsalar da, mevcut literatürde multidisipliner ekip yaklaşımının benimsenmesi gerektiği ve bu ekip içindeki yer alan hemşirelerin spesifik bakım müdahalelerinin önemi konusunda hemfikirdir. Bu derlemede sağlık profesyonellerinin KTÜ'lerin varlığına yönelik farkındalığı arttırmak, hastaya daha iyi destek verebilmeleri ve kaliteli bakım hizmeti sağlayabilmeleri için tanılanma ve tedavi seçeneklerini tartışmak amaçlanmıştır.
The Kennedy Terminal Ulcer (KTU), defined by Karen Lou Kennedy in 1989 and seen in long-term terminal patients, appears and progresses rapidly and shortly before the death of the patient due to failure of skin circulation. The Kennedy Terminal Ulcer, which has been described as an inevitable skin crisis that has emerged as part of the death process, has been recognized by Ostomy Wound Management since 2009. In 2009, a panel of experts “Skin Changes At Life’s End – SCALE” reported that this ulcer was usually seen in the coccyx or sacrum, but was reported in other anatomical sites and was often associated with near time of death. This special classification was also addressed in 2014 in Long-Term Care Hospital Quality Reporting Program Manual. Assessment Record and Evaluations Data Set (CARE) of The Centers for Medicare & Medicaid Services (CMS). Although clinical experts have different approaches to how to treat KTUs, they agree that the multidisciplinary team approach should be adopted in the current literature and the importance of the specific care interventions of nurses within this team. In this review, it is aimed to raise awareness of health professionals and nurses about the presence of KTUs, to discuss the definition and treatment options in order to provide better support to the patient and provide quality care services.
The Kennedy Terminal Ulcer (KTU), defined by Karen Lou Kennedy in 1989 and seen in long-term terminal patients, appears and progresses rapidly and shortly before the death of the patient due to failure of skin circulation. The Kennedy Terminal Ulcer, which has been described as an inevitable skin crisis that has emerged as part of the death process, has been recognized by Ostomy Wound Management since 2009. In 2009, a panel of experts “Skin Changes At Life’s End – SCALE” reported that this ulcer was usually seen in the coccyx or sacrum, but was reported in other anatomical sites and was often associated with near time of death. This special classification was also addressed in 2014 in Long-Term Care Hospital Quality Reporting Program Manual. Assessment Record and Evaluations Data Set (CARE) of The Centers for Medicare & Medicaid Services (CMS). Although clinical experts have different approaches to how to treat KTUs, they agree that the multidisciplinary team approach should be adopted in the current literature and the importance of the specific care interventions of nurses within this team. In this review, it is aimed to raise awareness of health professionals and nurses about the presence of KTUs, to discuss the definition and treatment options in order to provide better support to the patient and provide quality care services.
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Keywords
Kennedy basınç ülseri, Yaşam sonu, Terminal dönem, Kennedy terminal ulcers, End of life, Terminal period
Citation
Erbay, Ö. ve Erarı, G. (2019). "Yaşam sonunun uyarıcı işareti: Kennedy terminal ülseri". Uludağ Üniversitesi Tıp Fakültesi Dergisi, 45(3), 335-338.