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Management of Malignant Wounds Pain and Psycho-social Concerns

Management of Malignant Wounds Pain and Psycho-social Concerns. Darlene Grantham RN, MN, CHPCN(c). Objectives. Knowledge of stage & nature of illness Pain Management Psychological Issues and Quality of Life Concerns. Knowledge of Stage & Nature of Illness. Palliative Performance Scale

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Management of Malignant Wounds Pain and Psycho-social Concerns

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  1. Management of Malignant WoundsPain and Psycho-social Concerns Darlene Grantham RN, MN, CHPCN(c)

  2. Objectives • Knowledge of stage & nature of illness • Pain Management • Psychological Issues and Quality of Life Concerns

  3. Knowledge of Stage & Nature of Illness Palliative Performance Scale • What is the PPS? • Purpose of PPS • How to Use PPS • Making the Best Fit Decisions

  4. Palliative Performance Scale

  5. Malignant Wound Care

  6. Pain • Malignant wound pain may be caused by nerve dysfunction (neuropathic) pain or stimulation of nerve endings (nociceptive) pain

  7. Pain • Symtpom Assessment • Deep pain, aching, stabbing, continuous • Superficial pain: burning, stinging, may be only associated with dressing changes • Pruritis

  8. Pain Interventions • Very short acting medications such as fentanly, sufentanil may be useful for pain that occurs with dressing changes as these drugs have rapid onset and are quickly metabolized • Incident Pain Protocol • Consider relaxation, distraction, therapeutic touch etc. • Cancer patients –Mind Body Approaches at CCMB – 787-4119

  9. INCIDENT PAIN PROTOCOL Mike Harlos

  10. Assessment of Psychosocial and Quality of Life Concerns • Naylor, (2000) and Kelly, (2002) • Beliefs and values/meaning of the event • Cultural issues/marginalization • Alterations in life related to wound and dressings-family, career, social and activities • Impact on family and partner e.g. relationship problems, sexual intimacy, impact on role • Financial issues • Spiritual issues

  11. Assessment of Psychosocial and Quality of Life Concerns • Naylor, (2000) and Kelly, (2002) • Cosmetic effects of dressings • Body image alterations • Attitudes and feelings regarding wound, cancer and treatment: e.g. depression, anxiety, denial, anger, shock, embarrassment, fear, guilt, lack of respect or self-esteem • Coping strategies/style-Isolation

  12. Assessment of Psychosocial and Quality of Life Concerns • Naylor, (2000) and Kelly, (2002) • Communication difficulties • Informational needs • Support and support networks • Identification of the person who will do wound care • Determine expectations and needs • Determine short/long term goals

  13. Questions?

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