Skin Problems In Palliative Care Flashcards
List the 4 stages of pressure injuries
- Non-blanchable erythema
- Partial thickness skin loss with exposed dermis
- Full thickness skin loss
- Full thickness skin and tissue loss
Examples of skin damage and wounds in palliative care (7)
- Pressure ulcers
- Moisture lesions
- Skin tears
- Dry, irritated skin
- Malignant fungating wounds
- Fistulae
- Blistering skin conditions
List 5 Assessment Scales for Wound Care
- Toronto Symptoms Assessment System for Wounds
- Schulz Malignant Fungating Wound Assessment Tool
- Wound Symptoms Self-Assessment Chart
- TELER System
- Hopkins Wound Assessment Tool
5 Core Symptoms of Wounds
- Odour
- Pain
- Exudate
- Itching
- Bleeding
3 Keys to good skin care
- Cleansing (use cleanser that doesn’t strip oils, avoid soap and water).
- Moisturizing and Hydrating (emollients, lotions)
- Protecting (barrier products like creams)
3 Ways to Prevent Pressure Wounds
- Identify those at risk
- Repositioning on pressure redistribution devices
- Test cap refill to determine skin with pressure damage
List 4 general management strategies for pressure ulcers and moisture lesions
- Pressure relief and management of friction and shear forces.
- Good skin care
- Wound management
- Continence and fistula management
4 ways to manage moisture wounds
- Disposable pads and close fitting underwear
- Urinary catheters
- Anal or stoma bags
- Fecal management systems
3 treatment strategies for fungating malignant wounds
- Control tumour growth with anti cancer tx
- Control bleeding
- Promote wound closure if possible
What lab values distinguishes NMS from SS (5)
- Elevated CK
- Elevated AST
- Elevated LDH
- Elevated WBC
- Low serum iron level
What three considerations make up the framework of wound management?
- Management or palliation of underlying cause of the wound.
- Management of wound-related symptoms.
- Management of the wound and peri-wound skin.
How do fungating malignant wounds cause skin damage? (5)
- Tumour growth
- Loss of local blood supply with subsequent loss of tissue viability
- Local infections
- Colonization with aerobic and anaerobic bacteria causing exudate and potential for further tissue damage.
List 4 key components of local wound management.
TIME
- Tissue management
- Infection and inflammation management
- Moisture balance
- Edge of wound (in terms of how this advanced inwards to cover the broken area)
List 6 methods for wound debridement of necrotic tissue and one example of each.
- Autolytic (hydrogel dressing)
- Biological (larval therapy)
- Mechanical (ultrasound and water irrigation devices)
- Surgical and sharp debridement (scalpel, scissors, forceps)
- Chemical (active dressings, medical grade honey)
- Enzymatic (collagenase agents)
Under what circumatances would you promote scab formation in wound care?
- Short life expectancy
- Multiple wounds over body
- H&N wounds
How do you manage a wound with granulating tissue?
Promote and protect fragile granulating tissue by applying semi-occlusive, non-gauze based dressings.
How do you manage a wound with epithelializing tissue?
Protect epithelializing tissue by applying low-adherent moisture conserving primary dressings.
List two treatment strategies for an infected wound? (2)
- Debride dead tissue harbouring bacteria, unless scab formation is indicated.
- Treat with appropriate antimicrobial (includes application of an antimicrobial dressings and solutions to remove bacteria).
List 4 topical anti microbials for wound care.
- Medical grade honey
- Polyhexamethylene biguanide impregnated dressings
- Metronidazole gel
- Silver impregnated dressings.
List 3 wound management strategies for wounds with high fluid output.
- Two layer dressing system (low adherent primary dressing and secondary absorbent dressing or super-absorbent pad).
- Low adherent foam dressing.
- Topical negative pressure device.
What are two things to monitor around the edge of a malignant wound?
- Epithelialization of the edge of the wound to cover granulation tissue.
- Edge of wound free of non-viable tissue and debris in non-healing wounds.
Define a fistula
A tract between two hollow organs.
List 4 causes of fistulae.
- Surgery
- Infection
- Radiation
- Progressive malignant disease
List 5 principles of fistula management
- Prevention of skin excoriation with barrier products.
- Collection of effluent in closed stoma devices or wound management devices.
- Management of odour in a closed device.
- Nutrition and fluids to maintain a balance between intake and loss.
- Supportive care to protect pts sense of self, autonomy and ability to socialize.
List two non-pharm management strategies for pruritic skin irritate caused by wounds.
- TENS
2. Clothing and linens that wick away hear and moisture.
List 4 ways to manage malodour in malignant sounds.
- Systemic antibiotics
- Topical antimicrobials
- Debridement of dead tissue
- Adsorption of volatile malodorous chemicals by charcoal cloth
List three reasons to apply a dressing to an infected wound.
- Contain infection and prevent contamination to and from the wound.
- Keep anti-microbial agents in contact with the wound.
- Contain exudate and odour
List 8 ways to reduce incidence of minor wound bleeding.
- Careful dressing application and removal techniques.
- Maintenance of humidity at the wound/dressing interface.
- Radiotherapy to control spontaneous bleeding.
- ECT
- Topical TXA
- Topical adrenaline
- Hemostatic sponges
- Sucralfate suspension
Clinical indicators for superficial wound infection.
NERDS Non-healing or deterioration Exudate Red wound bed (hypergranulation) Debris in wound Smell
Clinical indicators for deep wound infection
STONES Size of wound increased Temperature increased Os (palpable exposed bone) New areas of breakdown Exudate, erythema, edema Smell
