Page 39 - Wound Care at End of Life Content: A Guide for Hospice Professionals - DEMO
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WOUND TREATMENT GRID: Fungating/Malignant Wounds
               Wound Care Need    Fungating/Malignant                      Comments
               Bleeding           Radiation therapy (short course) may be    Tissue is friable and predisposed to
                                  appropriate for bleeding tumors of the breast   bleeding
                                  or skin                                   Prepare patient/caregivers for possible
                                  Dressing strategies:                       hemorrhage (dark towels & bed linens)
                                     Calcium alginate (silver alginate is not    Consider checking: platelet count,
                                      hemostatic)                            PT/INR, vitamin K deficiency
                                      Non‐adherent dressing                Ask: Is transfusion appropriate? Is
                                      Coagulants: gelatin sponge, thrombin   patient on warfarin?
                                      Acute event dressings: Quikclot®, Celox®
                                  Topical/local strategies:
                                      Sclerosing agent: silver nitrate
                                      Antifibrinolytic agent: tranexamic acid
                                     Astringents: Alum solution, sucralfate
                                     Epinephrine (1:1000) spray
                                     Topical thrombin
                                     Oxymetalozine (Afrin®) spray
                                  Oral: Tranexamic acid
               Support Surface    N/A. Only pressure ulcers determine use of   Medicare reimbursement is based on
                                  support surfaces                         presence of pressure ulcers, not other
                                                                           wound types.
               Pain               Topical:                                    Allow procedural time‐outs.
                                    2% lidocaine or EMLA® cream 30‐60 min     Use moisture‐balanced dressing.
                                                       3
                                    before dressing change                    Use appropriate irrigation force.
                                    Ketamine (see Other Therapies, p53)      Avoid adherent dressings.
                                    Morphine in hydrogel (only for           Use warm saline irrigation to remove
                                                        4
                                    open/inflamed wounds)                    dressing.
                                  Systemic:                                   Contact layer protects wound bed.
                                   Pre‐medicate with appropriate agent for pain     Complementary therapies, such as
                                    and/or anxiety prior to dressing change    music, relaxation, aromatherapy,
                                   Neuropathic pain (burning, stabbing, stinging,   visualization, meditation, can be
                                    shooting pain): tricyclic antidepressant,   helpful.
                                    anticonvulsant
                                   Nociceptive pain (gnawing, throbbing,
                                    tenderness): opioid or corticosteroid

















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