This chapter discusses the care of people with terminal illnesses who have skin breakdown and wounds. There are a number of underlying conditions and diseases which give rise to skin breakdown, together with frailty, at any age. People can need palliative wound care for years, months, or weeks when disease is life-limiting. The focus will be on the care of people with malignant wounds. These wounds develop when the skin is infiltrated by malignant cells with subsequent fungation and ulceration. A small metastatic nodule can develop into an extensive fungating and ulcerating wound, with associated exudate, malodour and bleeding. Malignant wounds cause significant distress to the individual concerned and their family and social group. These wounds present major challenges to clinicians. Nurses, in particular, are the frontline professionals when it comes to the day-to-day care of people with malignant wounds, and their families. The nursing care of people with malignant wounds, and palliative wound care generally, is about recognising the relationship between the physical nature of wounds and the distress they cause, which requires us to plan wound care interventions with an understanding of the impact of broken skin and wounds on the individuals concerned, their family and social group. Physical wound care is complemented by empathy, hope and support.
- The aetiology of malignant wounds
- Assessment of a person with a malignant wound
- Malignant wounds and peri-wound skin assessment
- Principles of palliative wound care
- Treatment and palliation of the underlying tumour
- Symptom control and local wound management