Module 11 - IPCRC.NET
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Transcript Module 11 - IPCRC.NET
The
EPEC-O
TM
Education in Palliative and End-of-life Care - Oncology
Project
The EPEC-O Curriculum is produced by the EPECTM Project with major funding
provided by NCI, with supplemental funding provided by the Lance Armstrong
Foundation.
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EPEC – Oncology
Education in Palliative and End-of-life Care – Oncology
O
Module 3q
Symptoms – Skin
Skin wounds . . .
Acute vs. chronic; likely to heal or not
Chemotherapy agent extravasation
Radiation damage
Decubitus ulcers
Malignant wounds
. . . Skin wounds
Associated with
Pain
Depression
Anxiety
Poorer interpersonal interactions
Key points
1. Pathophysiology
2. Assessment
3. Management
Skin symptoms
Organ system
Highly innervated
Visible
Psychological, social, and spiritual
Interdisciplinary care
Symptom control
Chemotherapy
extravasation: pathophysiology
Acute wound
Products of inflammation
Redness
Swelling
Pain
Cell death
Necrosis, open wound
Radiation:
pathophysiology
Radiation damage
Acute wound
Products of inflammation
Cell death
Decubitus ulcers:
pathophysiology
Pathophysiology
Ischemia
Fat is protective
Malignant wounds:
pathophysiology
Disrupted physiology
Products of inflammation
Neovascularization
Bleeding
Necrosis
Anaerobic and fungal infections
Assessment . . .
Acute versus chronic
By wound type
Chemotherapy
extravasation: assessment
Type of chemotherapy
Vesicant, eg, doxorubicin
Irritant, eg, carmustine
Non-irritants, eg, fluorouracil
Extent
Volume of extravasation and time
Seconds, minutes, hours
Involved anatomy
Radiation: assessment
Radiation sensitizers
Topical agents
Drugs, including chemotherapy
Dose and fractionation schedule
Expected course
Decubitus ulcers
Assessment
Risk factors
Prevention
Skin protection – shear / tear / moisture
Pressure reduction and pressure relief
Decubitus ulcers: staging
1. Non-blanchable erythema
2. Partial-thickness skin loss
3. Full-thickness skin loss
4. Extensive necrosis exposing
muscle or bone
Management
Acute versus chronic
By wound type
Necrotic wound:
management
Debridement
Surgical
Enzymes and gels
Mechanical
Pain control
Cleansing
Chemotherapy
extravasation: management
Contain damage
Stop infusion
Neutralize
Assess for surgical consultation
Watch and wait
Radiation: management
Promote healing
Avoid cytotoxic agents
Moist environment
Treat infection
Pain control
Decubitus ulcers:
management
Goals: healing vs non-healing
Healing
Debridement
Dressings that promote healing
Non-healing
Pain control, comfort
Prevent worsening
Decubitus ulcers:
dressing
Moist, interactive environment
Control infection
6 types of dressing
Foams
Alginates
Hydrogels
Hydrocolloids
Thin films
Cotton gauze
Malignant wounds:
management
Healing vs non-healing
Infections
Odors
Pain
Exudate
Bleeding
Odors
Topical and / or systemic antibiotics
Metronidazole
Silver sulfadiazine
Kitty litter
Activated charcoal
Vinegar
Burning candles
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Summary
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Use comprehensive
assessment and
pathophysiology-based therapy
to treat the cause and improve
the cancer experience