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Malignant Wound Management

Malignant Wound Management. By: Peter Hancock, CN Cancer Nursing Professorial Precinct and RBWH Radiation Treatment Unit. Learning Outcomes. Describe Malignant wounds Gain ability to adapt and plan patient care as required

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Malignant Wound Management

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  1. Malignant Wound Management By: Peter Hancock, CN Cancer Nursing Professorial Precinct and RBWH Radiation Treatment Unit

  2. Learning Outcomes • Describe Malignant wounds • Gain ability to adapt and plan patient care as required • Increase knowledge base surrounding nursing interventions for malignant wounds • Recognise incorrect product applications and provide appropriate remedies

  3. What is a Malignant Wound? • A mass of malignant tissue that has infiltrated the epithelium and broken through the skin surface • Often associated with palliative treatment trajectories • Malignant wounds are defined as an uncontrolled proliferation of cells within the skin bed that encompass the supporting blood vessels and structures • Why is it important to understand the care of these wounds?

  4. Thinking... Thinking....

  5. Issues for consideration • Wound Assessment: size, location, exudate • Pain • Odour • Psychosocial

  6. Pathophysiology of Malignant wounds • Malignant wounds spread like an electrical current, using the pathways of least resistance • This includes tissue structures and anatomy, circulatory systems and lymphatic channels

  7. Pathophysiology of Malignant wounds • They present as multiple non painful nodules of varying colours and consistencies such as pink, violet-blue, brown or black • They rapidly develop into papulous lesions which then form shallow craters complicated with sinus tracts or fistulas

  8. Pathophysiologyof Malignant wounds

  9. Pathophysiology of Malignant wounds

  10. Pathophysiology of Malignant wounds

  11. Occurrence • occur across all tumour streams • 62% of all malignant wound occurrences can be associated with breast primaries • Head and neck cancer accounts for approximately 24% of wound sites • Genitalia account for approximately 3% of wound sites • all other regions account for the remaining 8%

  12. Management of Malignant Wounds

  13. Wound Management Table

  14. Why is it important to chose the correct products and procedures?

  15. Patient Outcomes

  16. Thinking...Thinking...

  17. References • Adderley, U. (2010). Managing wound exudate. Nursing & Residential Care, 12(5), 228. • Adderley, U. J., & Smith, R. (2007). Topical agents and dressings for fungating wounds. Cochrane Database of Systematic Reviews(2). • Alexander, S. (2009a). Malignant fungating wounds: managing malodour and exudate. Journal of Wound Care, 18(9), 374. • Alexander, S. (2009b). Malignant fungating wounds: managing pain, bleeding and psychosocial issues. Journal of Wound Care, 18(10), 418-425. • Alexander, S. J. (2010). An intense and unforgettable experience: the lived experience of malignant wounds from the perspectives of patients, caregivers and nurses. International Wound Journal, 7(6), 456-465. • Benbouzid, M., Gaveriaux-Ruff, C., & Yalcin, I. (2008). Delta opioid receptors are critical for tricyclic antidepressant treatment of neuropathic allodynia. Journal of Biological Psychiatry, 63(6), 663-666. • Benbow, M. (2009). Fungating malignant wounds and their management. Journal of Community Nursing, 23(11), 12. • Bergstrom, K. J. (2011). Assessment and management of fungating wounds. Journal of Wound, Ostomy & Continence Nursing, 38(1), 31-37. • Botney, M. (1983). Amitriptyline potentiates morphine analgesia by a direct action on the central nervous system. Annals of Neurology, 13(2), 160-164. • Burns, J., & Stephens, M. (2003). Fungating wounds. Palliative wound management: the use of a glycerine hydrogel. British Journal of Nursing (BJN), 12(6), S14. • Carmel, J. (2008). Management and challenges of fungating wounds... Scientific and clinical abstracts from the 40th Annual Wound, Ostomy and Continence Nurses Annual Conference. Journal of Wound, Ostomy & Continence Nursing, 35(3S), S9-S9. • Chrisman, C. A. (2010). Care of chronic wounds in palliative care and end-of-life patients. International Wound Journal, 7(4), 214-235. • Collier, M. (2000). Tissue viability. Management of patients with fungating wounds. Nursing Standard, 15(11), 46. • Davies, A. (2003). Wound care. Nursing a patient with a malodorous fungating non-healing wound. Nursing Times, 99(13), 58. • Davies, P., & Rippon, M. (2008). Evidence review: the clinical benefits of SAFETAC technology in wound care. Journal of Wound Care, 4-31.

  18. References • De Gandarias, J., Echevarria, E., Acebes, I., Silio, M., & Casis, L. (1998). Effects of imipramine administration on mu-opioid receptor immunostaining in the rat forebrain. Arneimittel-Forschung, 48(7), 717-719. • Devita, V., Lawrence, T., & Rosenberg, S. (2008). Cancer Principles & Practice of Oncology (8th ed.). Philadelphia, PA 19106 USA: Lippincott Williams & Wilkins. • Dowsett, C. (2002). Malignant fungating wounds: assessment and management. British Journal of Community Nursing, 7(8), 394. • Doyle, J. (1996). Effects of calcium alginate on cellular wound healing processes modeled in vitro. Journal of Biomedical Material Research 32(4), 561-568. • Draper, C. (2005). The management of malodour and exudate in fungating wounds. British Journal of Nursing (BJN), 14(11), S4. • Edwards, J. (2001). Product focus. Use of Exu-Dry in the management of a variety of exuding wounds. British Journal of Nursing (BJN), 10(12), 815. • Eroglu, C., Allen, N., Susman, M., Michael, W., O'Rourke, N., Chang, Y., et al. (2009). Gabapentin Receptor α2δ-1 is a neuronal thrombospondin receptor responsible for excitatory CNS Synaptogenesis. Cell, 139, 380-392. • Fenton, S. (2011). Reflections on lymphoedema, fungating wounds and the power of touch in the last weeks of life. International Journal of Palliative Nursing, 17(2), 60-66. • Gethin, G. (2009). Specialist care was important for helping patients with cancer to live positively with malignant fungating wounds. Evidence Based Nursing, 12(3), 94-94. • Granger, P. (1995). Modulation of the gamma-aminobutyric acid type A receptor by the antiepileptic drugs carbamazepine and pheytoin. Journal of Molecular Pharmacology, 47, 1189-1196. • Grocott, P. (1999). The management of fungating wounds. Journal of Wound Care, 8(5), 232-234. • Grocott, P. (2000a). Clinical management. The management of malignant wounds. European Journal of Palliative Care, 7(4), 126-129. • Grocott, P. (2000b). Palliative management of fungating malignant wounds. Journal of Community Nursing, 14(3), 31. • Grocott, P., Browne, N., & Cowley, S. (2005). Psychosocial aspects in wound care. Quality of life: assessing the impact and benefits of care to patients with fungating wounds. Wounds: A Compendium of Clinical Research & Practice, 17(1), 8-15. • Hampton, S. (2004). Managing symptoms of fungating wounds. Journal of Community Nursing, 18(10), 20-28.

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