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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

Malignant Wound Management

By:

Peter Hancock, CN Cancer Nursing Professorial Precinct and RBWH Radiation Treatment Unit

learning outcomes
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
what is a malignant wound
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?
issues for consideration
Issues for consideration
  • Wound Assessment: size, location, exudate
  • Pain
  • Odour
  • Psychosocial
pathophysiology of malignant wounds
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
pathophysiology of malignant wounds1
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
occurrence
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%
references
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.
references1
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.