title: [The adapting of a care plan after Kennedy terminal ulcer diagnosis].
abstract: A 69 year old man was admitted to the Intensive Care Unit (ICU) from the Emergency Department due to severe respiratory failure. Due to unsuccessful non-invasive mechanical ventilation, endotracheal intubation was performed. A category I ulcer in coccyx was detected 48h after admission. Eight hours later, a double erythema (the second one darker than the first one) with displacement between 30-45° over the bony prominence suggested there was a deep tissue injury. The lesion progressed rapidly during the next 24h. The shape and the rapid evolution of the injury lead us to diagnose a Kennedy terminal ulcer (KTU). At 72h after the admission, and once the causes of acute decompensation were ruled out, limitation of life-sustaining treatment was decided. An individualised plan of care was drawn up with the aim of identifying problems in a patient with KTU evolving from a critical to a terminal situation. Our overall objectives (NOC) were to adapt the care plan based on a realistic approach. Nursing interventions (NIC) included actions such as pain management, conservative treatment of the injury, agony care and support to help the family to make decisions.
  
  
  CONCLUSIONS
  The diagnosis of KTU helped the health care team in the decision-making process when they considered limiting the life support, as well as in the adapting of the care plan to the actual situation.
authors.affiliation: Universidad Rovira i Virgili, Departamento de Enfermería, Tarragona, España. Electronic address: alba.roca@urv.cat.
authors.forename: A
authors.initials: A
authors.lastname: Roca-Biosca
authors.affiliation: Universidad Rovira i Virgili, Departamento de Enfermería, Tarragona, España.
authors.forename: L
authors.initials: L
authors.lastname: Rubio-Rico
authors.affiliation: Hospital Universitari Joan XXIII de Tarragona, Servicio de Medicina Intensiva, Tarragona, España.
authors.forename: M C
authors.initials: MC
authors.lastname: Velasco-Guillen
authors.affiliation: Hospital Universitari Joan XXIII de Tarragona, Unidad de Acogida Prequirúrgica, Tarragona, España.
authors.forename: L
authors.initials: L
authors.lastname: Anguera-Saperas
mesh_terms: D000368:Aged; D018450:Disease Progression; D006801:Humans; D008297:Male; D010347:Patient Care Planning; D003668:Pressure Ulcer / Q000175:diagnosis / Q000628:therapy*; D012720:Severity of Illness Index
keywords: Adecuación del tratamiento del esfuerzo terapéutico; Adequacy of treatment of therapeutic effort; Cuidados intensivos; Enfermería; Intensive care; Kennedy terminal ulcer; Nursing; Úlcera terminal de Kennedy