Wound Care in the Palliative Setting. By: Eleanor Bardgett RN BScN MClSc(WH) CETN(C)

Transcription

1 Wound Care in the Palliative etting By: Eleanor Bardgett RN BcN MClc(WH) CETN(C)

2 OCCURRENCE RATE! 5 10% OF PATIENT WITH METATATIC CANCER WILL DEVELOP A MALIGNANT WOUND!!

3 OCCURRENCE RATE! CANADIAN CANCER TATITIC 2012 INDICATED 186,400 new cases of cancer would develop in 2012 (excluding non-melanoma skin cancer) Potential for ,640 malignant wounds

4 COMMON ITE BREAT HEAD/NECK BACK/TRUNK/ABDOMEN GROIN/AXILLA GENITAL

5 PATHOPHYIOLOGY econdary to invasion of primary tumour or metastasis from a distant site may initiate as inflammation with induration, redness, heat, and/or tenderness, skin has a peau d orange appearance kin infiltration along tissue planes, blood and lymph capillaries may initiate as nodules firm or rubbery, deep red to brown-black (usually painless) eeding of malignant cells i.e. during surgery

6 PATHOPHYIOLOGY APPEARANCE OF LEION Tumour mass extends above the skin surface with a fungus or cauliflower-like appearance Erosive and Ulcerative forms shallow craters with or without a sinus tract or fistula Nodules and atellites raised or flat; single, clustered or diverse; vesicular or papular: encrusted with drainage

7 MALIGNANT WOUND

8 MALIGNANT WOUND

9 MALIGNANT WOUND

10 GOAL OF WOUND CARE

11 MANAGEMENT BEGIN WITH: AEMENT Physical wound characteristics location, size, depth, shape, exudate, odour, type of tissue present, signs and symptoms of infection, pain, bleeding, condition of surrounding skin Psychological - Assessment of patient s feelings and reactions to the wound and the disease (include family members) potential isolation and social ostracism

12 PALLIATIVE WOUND PAIN ODOUR 4 KEY YMPTOM BLEEDING EXUDATE

13 PAIN Cause Pressure from tumour on nerves and blood vessels; dermal exposure; trauma from dressing change Treatment Options Pre-procedural pain medication oral, subcutaneous, parenteral (20 30 min) oaking dressings with saline before removal Topical pain preparations: morphine gel 0.1%, methadone powder mixture, ibuprofen foam dressing Nonadhesive dressings i.e. silicone foams and meshes, hydrogel sheets, skin sealants Infrequent dressing changes while still managing the wound microenvironment

14 ODOUR Cause Tissue degradation, tissue necrosis, aerobic and anaerobic bacteria colonization - presence of infection Treatment Options Topical Metronidazole flagyl powder, metrogel 0.75%, irrigation preparation (addresses anaerobes binds DNA) ilver Dressings, Iodosorb ung (gram +ve cocci and gram ve rods pseudomonas) Charcoal Dressings, Pouching systems, debridement with select cases only

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16 EXUDATE Cause Infection, secretion of vascular permeability factor (vessels more permeable to plasma colloids and fibrinogen), inflammatory reaction (histamine releases from wounded cells plasma leaks from blood vessels) Treatment Options Absorptive products foams, alginates, hydrofibers, extra absorbent pads Wound management pouching systems Barrier products to protect periwound skin

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18 BLEEDING Cause Traumatic dressing removal, tumour erosion into vessels, decreased platelet count, infection Treatment Options Nonadherent dressings - hydrogel, silicone or vaseline mesh, silicone foams oaking dressings with saline before removal Topical hemostatic products gelfoam, surgifoam, surgicel, AgN0 3 sticks, alginate dressings

19 OUTCOME MEAURE Odour is diminished or non existent No leakage from dressings and frequency of changes has decreased Bleeding has been controlled Pain is managed by topical treatment and supportive medications Achievement of comfort, general psychological well-being atisfactory level of physical functioning

20 KEY POINT 1. Most malignant wounds will increase in size and deteriorate. 2. Outcome measures are not based on healing but the ability of the treatment to meet the goals. 3. Dressings must be comfortable, easy to apply and must remain in place without interfering with physical function. 4. Patient and caregiver education is essential for ongoing management. 5. Quality of life can be improved through symptom management.

21 RADIATION Received by as many as half of patients with cancer Used as primary, adjunctive or palliative intervention kin reactions - severity based on dose delivered, volume treated and time exposed (no. of treatments) Effects are cumulative irritation can start after 2 weeks, late effects can develop over several months or years Bony prominences, skin folds, under the breast, the axillae, the neck, the perineum, and the groin are at greatest risk of reaction

22 RADIATION KIN REACTION TAGE DEFINITION PREENTATION tage I Inflammation, slight edema Pink and dusky, mild edema, burning, itching, mild discomfort tage II Dry Desquamation Partial loss of dermis, dry, itching, scaling, hyperpigmentation tage III tage IV Moist Desquamation and blistering Epilation and suppression of sweat glands Blister or vesicle, nerve exposure and pain, serous drainage Pigment changes, permanent hair loss, atrophy, ulceration British Columbia (BC) Cancer Agency. Radiation skin reactions, 2006.

23 RADIATION KIN CARE Prevention Cleanliness, hydration, avoid perfumed products, avoid astringents, alcohol products and adhesives Loose non-binding clothes and jewelry Use electric razor Avoid extremes of heat or cold, protect skin from direct sunlight and wind exposure Avoid chlorinated pools

24 RADIATION KIN CARE Hydration and/or Inflammation Apply lotions or creams 2 3 times per day (one week prior to, during and 2 weeks after treatment) Avoid petroleum only products and alphahydroxy acid (AHA) products Use prescribed corticosteroid creams sparingly

25 RADIATION KIN CARE Topical Care of Damaged kin Non adherent dressings, avoid tapes Antibacterial or antifungal products as indicated Absorptive products for increased exudate Follow treatment options outlined for malignant wounds based on symptoms

26 QUETION