Guidelines for a Palliative Approach in Residential Aged Care

6.10.1 Oedema of the limbs
Assessment
The limbs should be examined for any signs of swelling. Residents and their families can also
indicate if they perceive that any limbs seem more swollen than normal. Assessment should
include investigations to determine low albumin levels, which are associated with loss of protein.
Management
Oedema of the limbs can cause the resident, family members and carers concern, but there is
sometimes little that can be done to resolve the swelling. Support for the family might include
providing them with information on the causes of the oedema, as well as involving the family
in using techniques that may yield some relief. Some of the suggested options could include [230]
(Level EO):
• elevation of the swollen limbs;
• daily or more frequent washing (only if necessary);
• minimal handling;
• a bed cradle;
• pain relief;
• leaving limbs uncovered on water-resistant non-stick disposable sheets to protect bed linen
(from weeping that may occur from the tissues in extreme cases);
• massage (if the oedema is not extreme), as this might provide some relief for the resident
— this can be provided by the family or a massage therapist; and
• dietary interventions — depending on albumin levels, stage of the resident’s illness and/or
ageing, and their preferences.
6.10.2 Wound care
Assessment
Careful assessment when dressings are changed is essential to identifying infection early. Other
areas of assessment relevant to wound care should also be considered, such as pain. (See also
Section 6.2, ‘Pain management’, for a brief discussion of incident pain and recommended use
of analgesia for wound care.)
Management
Wound care specialists fulfil an important role as part of a multidisciplinary team as part of a
palliative approach in RACFs. They can be consulted for their expertise; however, their services
are generally limited to the more populated or metropolitan areas and hence they may be
unavailable in rural and remote facilities.
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