Skin Problems In Palliative Care

Question 1

List the 4 stages of pressure injuries

Answer 1

1. Non-blanchable erythema
2. Partial thickness skin loss with exposed dermis
3. Full thickness skin loss
4. Full thickness skin and tissue loss

Question 2

Examples of skin damage and wounds in palliative care (7)

Answer 2

1. Pressure ulcers
2. Moisture lesions
3. Skin tears
4. Dry, irritated skin
5. Malignant fungating wounds
6. Fistulae
7. Blistering skin conditions

Question 3

List 5 Assessment Scales for Wound Care

Answer 3

1. Toronto Symptoms Assessment System for Wounds
2. Schulz Malignant Fungating Wound Assessment Tool
3. Wound Symptoms Self-Assessment Chart
4. TELER System
5. Hopkins Wound Assessment Tool

Question 4

5 Core Symptoms of Wounds

Answer 4

1. Odour
2. Pain
3. Exudate
4. Itching
5. Bleeding

Question 5

3 Keys to good skin care

Answer 5

1. Cleansing (use cleanser that doesn’t strip oils, avoid soap and water).
2. Moisturizing and Hydrating (emollients, lotions)
3. Protecting (barrier products like creams)

Question 6

3 Ways to Prevent Pressure Wounds

Answer 6

1. Identify those at risk
2. Repositioning on pressure redistribution devices
3. Test cap refill to determine skin with pressure damage

Question 7

List 4 general management strategies for pressure ulcers and moisture lesions

Answer 7

1. Pressure relief and management of friction and shear forces.
2. Good skin care
3. Wound management
4. Continence and fistula management

Question 8

4 ways to manage moisture wounds

Answer 8

1. Disposable pads and close fitting underwear
2. Urinary catheters
3. Anal or stoma bags
4. Fecal management systems

Question 9

3 treatment strategies for fungating malignant wounds

Answer 9

1. Control tumour growth with anti cancer tx
2. Control bleeding
3. Promote wound closure if possible

Question 10

What lab values distinguishes NMS from SS (5)

Answer 10

1. Elevated CK
2. Elevated AST
3. Elevated LDH
4. Elevated WBC
5. Low serum iron level

Question 11

What three considerations make up the framework of wound management?

Answer 11

1. Management or palliation of underlying cause of the wound.
2. Management of wound-related symptoms.
3. Management of the wound and peri-wound skin.

Question 12

How do fungating malignant wounds cause skin damage? (5)

Answer 12

1. Tumour growth
2. Loss of local blood supply with subsequent loss of tissue viability
3. Local infections
4. Colonization with aerobic and anaerobic bacteria causing exudate and potential for further tissue damage.

Question 13

List 4 key components of local wound management.

Answer 13

TIME

1. Tissue management
2. Infection and inflammation management
3. Moisture balance
4. Edge of wound (in terms of how this advanced inwards to cover the broken area)

Question 14

List 6 methods for wound debridement of necrotic tissue and one example of each.

Answer 14

1. Autolytic (hydrogel dressing)
2. Biological (larval therapy)
3. Mechanical (ultrasound and water irrigation devices)
4. Surgical and sharp debridement (scalpel, scissors, forceps)
5. Chemical (active dressings, medical grade honey)
6. Enzymatic (collagenase agents)

Question 15

Under what circumatances would you promote scab formation in wound care?

Answer 15

1. Short life expectancy
2. Multiple wounds over body
3. H&N wounds

Question 16

How do you manage a wound with granulating tissue?

Answer 16

Promote and protect fragile granulating tissue by applying semi-occlusive, non-gauze based dressings.

Question 17

How do you manage a wound with epithelializing tissue?

Answer 17

Protect epithelializing tissue by applying low-adherent moisture conserving primary dressings.

Question 18

List two treatment strategies for an infected wound? (2)

Answer 18

1. Debride dead tissue harbouring bacteria, unless scab formation is indicated.
2. Treat with appropriate antimicrobial (includes application of an antimicrobial dressings and solutions to remove bacteria).

Question 19

List 4 topical anti microbials for wound care.

Answer 19

1. Medical grade honey
2. Polyhexamethylene biguanide impregnated dressings
3. Metronidazole gel
4. Silver impregnated dressings.

Question 20

List 3 wound management strategies for wounds with high fluid output.

Answer 20

1. Two layer dressing system (low adherent primary dressing and secondary absorbent dressing or super-absorbent pad).
2. Low adherent foam dressing.
3. Topical negative pressure device.

Question 21

What are two things to monitor around the edge of a malignant wound?

Answer 21

1. Epithelialization of the edge of the wound to cover granulation tissue.
2. Edge of wound free of non-viable tissue and debris in non-healing wounds.

Question 22

Define a fistula

Answer 22

A tract between two hollow organs.

Question 23

List 4 causes of fistulae.

Answer 23

1. Surgery
2. Infection
3. Radiation
4. Progressive malignant disease

Question 24

List 5 principles of fistula management

Answer 24

1. Prevention of skin excoriation with barrier products.
2. Collection of effluent in closed stoma devices or wound management devices.
3. Management of odour in a closed device.
4. Nutrition and fluids to maintain a balance between intake and loss.
5. Supportive care to protect pts sense of self, autonomy and ability to socialize.

Question 25

List two non-pharm management strategies for pruritic skin irritate caused by wounds.

Answer 25

1. TENS | 2. Clothing and linens that wick away hear and moisture.

Question 26

List 4 ways to manage malodour in malignant sounds.

Answer 26

1. Systemic antibiotics 2. Topical antimicrobials 3. Debridement of dead tissue 4. Adsorption of volatile malodorous chemicals by charcoal cloth

Question 27

List three reasons to apply a dressing to an infected wound.

Answer 27

1. Contain infection and prevent contamination to and from the wound. 2. Keep anti-microbial agents in contact with the wound. 3. Contain exudate and odour

Question 28

List 8 ways to reduce incidence of minor wound bleeding.

Answer 28

1. Careful dressing application and removal techniques. 2. Maintenance of humidity at the wound/dressing interface. 3. Radiotherapy to control spontaneous bleeding. 4. ECT 5. Topical TXA 6. Topical adrenaline 7. Hemostatic sponges 8. Sucralfate suspension

Question 29

Clinical indicators for superficial wound infection.

Answer 29

``` NERDS Non-healing or deterioration Exudate Red wound bed (hypergranulation) Debris in wound Smell ```

Question 30

Clinical indicators for deep wound infection

Answer 30

``` STONES Size of wound increased Temperature increased Os (palpable exposed bone) New areas of breakdown Exudate, erythema, edema Smell ```