Page 36 - Wound Care at End of Life Content: A Guide for Hospice Professionals - DEMO

WOUND TREATMENT GRID: Radiated Skin
Wound Care Need Radiated Skin Comments
Description  Damaged by radiation therapy;  Any radiated area of body
appears burned, crusty, peeling,  May include hair loss to the area, decreased
or friable perspiration, superficial changes to blood vessels,
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 Usually fairly superficial, but is edema, and scarring
possible for the wound to be  Inflammation usually occurs immediately after
deeper area is radiated
Cleanse Use lukewarm water & mild non‐  Hydrogel for desquamation (removal of scaling)
alkaline soap: baby soap, Dove®, or  Normal saline soaks to loosen crusting
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Ivory®  Do not rub skin‐pat dry
Debridement Don’t usually debride  See Debridement Algorithm
 Consult physician re: surgical debridement if
appropriate
Topical Treatment  Apply unscented, lanolin‐free  Protect periwound area with a skin barrier film if
hydrophilic moisturizers: an adhesive is used
Lubriderm®, Eucerin®, Keri®,  Cover wound to minimize evaporation, pain, and
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Aquaphor® risk of infection
 Corticosteroid cream for  Apply moisturizer 2‐3 times/day
erythema  Protect from sun with SPF 15 or higher
 Hydrogel: dry desquamation  Protect from friction, rubbing, or tight clothes
 Foam: moist desquamation  Protect from extreme heat/cold, cuts, and scrapes
Infection  Topical antibiotics helpful as this See Antimicrobials on Wound Care Products chart,
damaged tissue is less able to page 42.
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resist or fight infection May treat empirically.
 Use topical antibiotics ≤ 14 days •MRSA: cadexomer iodine, mupirocin ointment,
to reduce colonization risk silver dressing
•Pseudomonas: acetic acid 0.25%
• VRE: hydrofera blue, silver dressing
• MSSA: cadexomer iodine, chlorhexidine, hydrofera
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blue, mupirocin silver dressing
Malodor  Honey
 Topical metronidazole (Flagyl®)
Dead Space N/A
Pruritus  Topical corticosteroid creams If patient reports pruritus, evaluate for contact
 Normal saline compresses dermatitis, hypersensitivity, or yeast dermatitis
 Cool mist humidifier
 Cooled hydrogel sheets
Bleeding Not likely, but may occur Encourage gentle cleansing and moisturizers
Support Surface N/A. Only pressure ulcers Medicare reimbursement is based on presence of
determine use of support surfaces pressure ulcers, not other wound types.
Pain  Aloe vera gel may soothe and  Allow procedural time‐outs.
cool radiated skin  Use moisture‐balanced, dressing.
 Morphine in hydrogel (only for  Use appropriate irrigation force.
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open/inflamed wounds)  Avoid adherent dressings or clothing.
 Complementary therapies, such as music,
relaxation, aromatherapy, visualization,
meditation, can be helpful.
Other Do not use petrolatum based
products, products with perfumes
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or alpha‐hydroxy acids

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