End-of-Life Skin Changes: Make Sure You Know What They Mean, a Case Study

Abstract

Skin is the largest organ of the human body. Skin changes can result from natural ageing, as well as from acute or chronic diseases and failure of body systems. Various types of wounds are identified in Palliative Care, and terminal pressure ulcers are often incorrectly classified. This case study highlights the importance of recognizing skin ulcers in patients’ last hours and days of life as a diagnostic indicator for impending death. The first focus of nursing care was pain management and maintaining skin integrity. On the 20<sup>th</sup> of December 2023, a pressure ulcer was identified on a patient in the sacral region with unknown further characteristics. A skin modification was observed three days later in the neck area, with intense redness and no heat felt. Approximately ten minutes later, several minor purple-type discolorations, like small bruises, appeared on the chest area as a symmetrical mirror image. This change suggested a Trombley-Brennan Terminal Tissue Injury. The patient died 14 hours after the first skin change was observed on the neck. After examining this case study, it becomes clear that it is essential to expand knowledge and actively involve nurses in the accurate assessment and classification of skin changes, especially regarding Kennedy Terminal Ulcers or Trombley-Brennan Terminal Tissue Injuries, as they are indicators of death’s proximity.