Chapter 25: Wound management
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Source: Adapted from EONS ([38]).
Wound assessment
Assessment and evaluation of a wound are discussed in Chapter c18: Wound management.
Fungating wounds are unique and will have a range of different appearances, symptoms and problems that can be very difficult to treat and require individual, patient‐specific management plans (Benbow [14]). Assessment is difficult due to the uniqueness and complexity of the wounds and how quickly they may change (Schulz et al. [126]). It is important that health professionals use sound clinical assessment skills, understand the dressing products that they use and are aware of the functions and limitations of a dressing. The management of wounds through dressings can have a significant impact on all areas of a patient's quality of life (Watret [138]).
An accurate holistic assessment is an extremely important aspect of a patient's care. The assessment should be ongoing and involve the patient's physical, nutritional intake, psychological, spiritual and cultural needs and social state as well as specific wound factors. It is important that the patient is encouraged to carry out a self‐assessment that includes how they are coping with the wound, their overall coping strategies and ability to self‐care, together with the impact the wound is having on their quality of life and their family. The patient should be involved in the management planning and implementation process to enable the development of a patient‐centred treatment plan that considers the perspectives of the patient and of the healthcare practitioner (Alexander [3]).
Wound assessment tools
Literature identifies that palliative care tools are most effective when they are simple to follow, complete and encompass the wide range of needs of the patient and their families (Schulz et al. [126]). Patient self‐assessment is the optimum method of symptom reporting. However, if a patient is very unwell and communication is difficult then this is not realistic. It is then that accurate assessment is extremely important (Naylor [100]).
The European Oncology Nursing Society (EONS [38]) looked at a range of assessment tools that can be used for patients with malignant fungating wounds. The tools help to structure individualized care in an area that is not often encountered by healthcare professionals (Table 25.1).
Table 25.1 Some assessment tools for fungating wounds
| Assessment tool | Description | Advantages/disadvantages |
|---|---|---|
The TELER System
(Grocott et al. [55]) | Covers all aspects of wound management and the psychosocial impact of wounds: discomfort from skin conditions, exudate, leakage and intrusion of dressings
Designed to be completed by patients, carers and healthcare professionals | Enables the perspectives of patient and healthcare professionals to be considered when developing treatment plan (Alexander [3])
Includes long‐term goals negotiated with patient
Available in digital format
Identifies what patient finds the most challenging aspects of wound to influence choice of product management (Watret [138]) |
| The Wound and Symptoms Self‐assessment chart (WoSSac) (Naylor [100]) | Quantitative tool developed to enable patients to rate the symptoms and impact the wound has on them and their wider environment. Completed by patient or their carer, uses visual analogue scale and Likert scale when measuring the severity of the wound‐related symptoms and impact on the patient | Tool has pre‐determined set of criteria which may not reflect individual needs of the patient; further discussion would be required for comprehensive assessment (Alexander [3])
Enables a patient to rate the most significant area they feel is the most challenging, considering the severity of symptoms and impact on their quality of life (Watret [138]). |
| Malignant fungating wound assessment tool (Schulz et al. [126]) | Completed by health professionals. Covers general information about the patient, wound and symptoms | Open‐ended questions to enable assessment of patients' perceptions |
Figure 25.5 shows the wound assessment chart used at the Royal Marsden.
Pre‐procedural considerations
Dressing changes should be scheduled where possible at times when the patient feels at their best. Pain medication should be offered at least 30 minutes prior to changing the dressing and it should have reached its maximum effectiveness prior to commencing the procedure (Rogers [119]). The dressing should be changed in a well‐ventilated room, and consideration should be given to relaxation, comfortable position and music or complementary therapies where appropriate. If the patient experiences any discomfort during the dressing change the procedure should be stopped, further analgesia given if required, the patient given a break and the procedure not resumed until the patient has consented (Rogers [119]).
For further information please see Chapter c18: Wound management.
Procedure guideline 25.1
