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Malignant / Fungating Wounds - Wound Care Nurses

Malignant / FungatingWoundsA Clinical PerspectiveF. Alex Khan, APRN ACNS-BC MSN2018 Email: Wounds are caused by the metastatic spread from a Malignant tumor. Cancerous cells cause massive damage to the localized tissue, through a combination of proliferative growth, ischemia and ulceration. These Wounds are non-healable due to co-existing untreatable medical life limiting WoundsMalignant WoundsMALIGNANT / Fungating WOUNDS2018 Malignant WoundsMalignant WoundsMALIGNANT / Fungating WOUNDSP rimary skin cancer such as a squamous or basal cell carcinoma and Malignant melanoma can develop into a Malignant fungatingwound if left untreated. The most common Malignant / fungatingwound sites include breast 62%, head and face 24% and groin and genitals 3%.2018 StatisticsMalignant WoundsMALIGNANT / Fungating WOUNDSM alignant Wounds are usually polymicrobic, containing both aerobic and anaerobic bacteria causing foul odor and purulent drainage from the tissue necrosis.

and purulent drainage from the tissue necrosis. Anaerobic bacteria emit putrescine and cadaverine, which results in foul odors and some aerobic bacteria such as Proteus and Klebsiella can also produce foul odors. Each wound is unique but pain, foul odor, bleeding, and tissue necrosis is common in malignant wounds . 2018 Characteristics ...

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Transcription of Malignant / Fungating Wounds - Wound Care Nurses

1 Malignant / FungatingWoundsA Clinical PerspectiveF. Alex Khan, APRN ACNS-BC MSN2018 Email: Wounds are caused by the metastatic spread from a Malignant tumor. Cancerous cells cause massive damage to the localized tissue, through a combination of proliferative growth, ischemia and ulceration. These Wounds are non-healable due to co-existing untreatable medical life limiting WoundsMalignant WoundsMALIGNANT / Fungating WOUNDS2018 Malignant WoundsMalignant WoundsMALIGNANT / Fungating WOUNDSP rimary skin cancer such as a squamous or basal cell carcinoma and Malignant melanoma can develop into a Malignant fungatingwound if left untreated. The most common Malignant / fungatingwound sites include breast 62%, head and face 24% and groin and genitals 3%.2018 StatisticsMalignant WoundsMALIGNANT / Fungating WOUNDSM alignant Wounds are usually polymicrobic, containing both aerobic and anaerobic bacteria causing foul odor and purulent drainage from the tissue necrosis.

2 Anaerobic bacteria emit putrescineand cadaverine, which results in foul odors and some aerobic bacteria such as Proteus and Klebsiellacan also produce foul odors. Each Wound is unique but pain, foul odor, bleeding, and tissue necrosis is common in Malignant Wounds .2018 CharacteristicsMalignant WoundsMALIGNANT / Fungating WOUNDS2018 Radiation TherapyMalignant WoundsMALIGNANT / Fungating Wounds As a result of radiation therapy (3) three types of skin problems are commonly seen: Erythema (Redness) Dry Desquamation MoistDesquamation Skin Ulcers 2018 Radiation TherapyMalignant WoundsMALIGNANT / Fungating WOUNDS2018 Radiation TherapyMalignant WoundsMALIGNANT / Fungating WOUNDSP rimary SiteMetastatic Cutaneous SitesLung and BreastHead, neck, anterior chestGastrointestinalUpper abdominal wall,suture linesGenitourinaryLower abdominal wall andexternal genitalsStomachUmbilicus, suture linesMelanomaExtremitiesOral CavityFace2018 Malignant DegenerationMalignant WoundsMALIGNANT / Fungating WOUNDSC hronic Wounds mayexhibit chronicinflammation that canundergo malignanttransformation.

3 A Marjolinulcer maydevelop in an area ofchronic WoundsMALIGNANT / Fungating WOUNDS2018 Kennedy Terminal UlcerMalignant WoundsMALIGNANT / Fungating Wounds A pressure ulcersome peopledevelop at end onset Associated withimminent death Pear, butterfly, orhorseshoe shaped Often on coccyx orsacrum Skin Failure: Occurs when skin and underlying tissue develops necrosis due to lack of tissue perfusion associated with severe dysfunction or failure of other organ StrategiesMalignant WoundsMALIGNANT / Fungating WOUNDSIn some Malignant /fungatingwounds; treating oncologist can perform palliative radiotherapy, which can reduce drainage and bleeding. Further, Chemotherapy can be used to reduce the size of the tumor, reduce pain, and bleeding. Hormone therapy can be used to reduce the symptoms associated with hormone responsive tumors such as breast cancers.

4 Surgical excision of the Malignant tissue is also useful in reducing the size of the Wound and allows better Wound management StrategiesMalignant WoundsMALIGNANT / Fungating Wounds Managing Malignant Wounds is frequently based on expert opinion and the experiences of the clinicians. The assessment of a Malignant Wound requires clinician to gain insight into the patient s perception of the Wound and its consequent impact on his/her life. Nursing care requires counseling skills and knowing how to provide care that is based on an awareness of and insight into the patients experience2018 Management StrategiesMalignant WoundsMALIGNANT / Fungating Wounds Treatment selections should include those that provide minimum side effects and maximum benefit to the client. Establish goal of care Healing vs Palliation Wound bed preparation will vary based on the goal.

5 If palliation is the goal, tissue debridement and management of bacterial overload is required to minimize odor and decrease risk of StrategiesMalignant WoundsMALIGNANT / Fungating Wounds The impact of a Malignant / fungatingwound on a patient s life cannot be underestimated. It can have a devastating effect on physical, psychological and social wellbeing as well as on the family and friends. Treatment plan shall include the management of; Pain, Comfort, Psychological factors, Aesthetics, odor, drainage , and quality of StrategiesMalignant WoundsMALIGNANT / Fungating WOUNDSPain ManagementAlthough many patients experience debilitating pain at the end of life, there are many options to improve analgesia and quality of life. Appropriate pain assessment with attention to patient needs and specific goals, helps tailor individual treatment plans.

6 Medications: Morphine, Hydromorphone, Oxycodone, Methadone, Fentanyl2018 Management StrategiesMalignant WoundsMALIGNANT / Fungating WOUNDSE xudate / drainage ManagementFor Wounds with mild to moderate drainage ; use of super absorbent pads is recommended. For copious drainage , Negative Pressure Wound Therapy is ideal; only if patient is able to tolerate it. 2018 Management StrategiesMalignant WoundsMALIGNANT / Fungating WOUNDSE xudate / drainage ManagementFor Wounds with frequent bleeding issues can be managed with:-Hemostatic dressings-Surgifoam/Gelfoamto fill the cavity-Silver Nitrate sticks-Topical Tranexamicacid (TXA) 2018 Management StrategiesMalignant WoundsMALIGNANT / Fungating WOUNDSOdor ManagementWound malodor causes serious physical and psychological effects on the client. Management may include:-Removal of necrotic tissue-Sharp Wound Debridement - Wound Culture Antibiotics & Antifungals-Topical Antimicrobials / Antifungals: Dakin s Solution, Gentian violet, Methylene Blue, Polyhexanidesolution, Cider, Baxedin.

7 Vinegar,MetronidazolePowder, Nystatin Powder, Charcoal Concealers Lavender Oil, Chamomile Oil2018 References Bergstrom, and Management of :Journal of Wound , Ostomy and Continence Nursing. 38 (1): 31-37, 2011 Jan/Feb Bryant, R. (2000).Acute and Chronic Wounds : Nursing Management,Second Edition (pp. 374-379).MosbyInc. Barton, P., & Parslow, N, (1998)Caring for Oncology Krasner, D, RodeheaverG, SibbaldG. (2001)Chronic Wound CareThirdEdition Chapter 10 (pp. 79-90) Kohr, Rosemary. Sawhney, practice Nurses ' role in thetreatment of pain. [Review] [23 refs] Source:Canadian Nurse. 101(3):30-4, Reddy, M., Kohr, R., Queen, D., Sibbald, R Gary. Practical treatment ofwound pain and trauma: a patient-centered approach. An Wound Management. 49(4 Suppl):2-15, 2003 Apr Sibblad, G., Woo, K. & Goodman, L. Update on Wound BedPreparation 2011: A review of the principles of treating the rootcause of Wounds , pain and Wound healing, and local Wound Care Canada, vol.

8 10, number 10, pp18-22 Woo, K. & Sibbald, G. (2010). Local Wound Care for Malignantand Palliative Wounds . ADV SKIN Wound CARE 2010;23:417-28;quiz 429-30


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