1. Management of Malignant Wounds Pain 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 Evaluate wound and PPS score 10%-30% Comfort Care Focus Manage Odor, Exudate, Bleeding, Pain & Psychosocial Issues And Quality of Life Concerns 30%-100% Follow WRHA Wound Care Guidelines

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 Step # Medication (50 g/ml) # Micrograms Sublingually 1Fentanyl50 2Sufentanil25 3Sufentanil50 4Sufentanil100

12. 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

13. 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

14. 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

15. Questions ?