This document discusses fungating wounds in cancer patients and the nursing role in management. Fungating wounds occur in up to 15% of advanced cancer patients and cause physical, psychological, social and spiritual challenges. Nursing aims to improve quality of life through managing symptoms like bleeding, malodor, exudate, pain and infection. This involves dressing selection, pain control, education and psychosocial support. Case studies demonstrate nursing interventions for specific fungating wounds in palliative cancer patients.
2. Introduction
What is
fungating
wound?
Malignant fungating wounds are infiltration of
the tumour or the metastasis into the skin
Up to 15% of cancer patients develop fungating
wounds in the most advanced stage of the
disease
Commonly found on patients suffering from skin,
breast, head and neck, and gynecological cancer
(Collier, 1997)
(Lo et al., 2006)
(Collier, 1997)
4. Malignant FungatingWound
From patient’s aspect:
• Intense, distressing and unforgettable experience
• Generate excessive suffering for patients and their carers.
• Immensely lower the quality of life of individuals
(Alexander, 2010)
5. Common symptoms
Physical aspect
• Bleeding
• Malodor
• Exudation
• Pain
• Superficial
infection
Psychological
aspect
• Stigmatization
from wound
• Label of cancer
• Compromised
body image
Social aspect
• Sense of
isolation
• Avoid
interactions
• Distancing from
family
Spiritual aspect
• Loss of hope
• Approaching
death
6. Nursing role
• To improve quality of life of patient by regaining sense of control with quality
management of fungating wound
Advocate
• To provide adequate information for patient to fully understand their condition
and how to manage fungating wound
Education
• To provide not only physical support but also support from psychological,
social and spiritual aspects
Support
7. Nursing
roles
Evaluation and correct
management of symptoms
increase the quality of life
Competence of nursing has a
direct impact on the quality of life
of patients assisted
Provides patients with comfort, a
positive body image, and
improved psychosocial wellness
12. Malodor
Profoundly
negative
impact on
the quality of
life
feelings of guilt
repulsion
social isolation
depression.
Caused by a
combination
of
bacteria
necrotic tissue
poorly vascularised tissue
high levels of exudate
14. Pain
Pressure of the tumour on other body structures
Damage to the nerves caused by the growing tumour
Swelling resulting from impaired capillary and lymphatic drainage
Infections
Exposure of dermal nerve endings
Mismanaged change of wound dressing
15. Pain
Management
Before dressing
• administer an analgesic booster dose prior to
dressing change
Wound Cleansing
• Irrigation with room temperature lotion and
avoid cleansing with gauze swabs
Dressing
• Non-adherent dressing materials are
preferred to prevent trauma from dressing
removal
26. PSYCHOLOGICAL
VS.
PHYSICAL MANAGEMENT
Related issue Management
Exudate management
- embarrassment, shame, social isolation
• Minimize leakage
• Protect peri-wound skin
Malodor
- Embarrassment, shame, social isolation
• Use of topical agents to reduce odor
• Use of deodorizing agent to relief strong odor
Bleeding
- Fear, depression, social isolation
• Use of non-adherent primary dressing to prevent bleeding
• Hemostatic agents for minor bleeding
Pain
- Fear, depression, social isolation
• Assess and administered when in need
• Use of non-adherent dressing to minimize pain
• Cleanse wound by irrigation not swabs
27. Psychological problems
Feeling of wothelessness
Fear of stigma associated with cancer
Social isolation
Constant reminder of presence of cancer
29. Psychosocial care
Assess patient’s perception of body image
Encourage patients to verbalize their feeling & concern
Active listening with non-judgmental attitude & being acceptance
Improve patient’s self image & resume normal activity
Give practical advices e.g. dress, control malodour, use of cosmetic devices
Enhancing patients acceptance of self & reinforcing own personal value
Family members should be educated in order to promote their understanding & participation in care
31. Case 1 – Ca Breast
• 98 yrs / F
• Ca Breast on palliative care
• Under in-patient care
• Breast fungating wound over the right trunk
• Daily dressing
• Flagyl powder 200mg
• Jelonet + gauze + combine pad
32. Case 1 – Ca Breast
•Dressing adherence
•Contact bleeding
•Pain when removing the dressing
•No odour or inflammatory
•Mild yellowish exudate
•One layer of jelonet, dry up
33. Interventions
•Moist the gauze with normal
saline before remove them
•Remove the gauze gently
•Consider other alternative of non-
adherent dressing material
•Or use 3-4 layer of jelonet to keep
wound moist
• Discuss the continuance of Flagyl
powder
34. Case 2 – Ca Ovary
•56 yrs / F
•Ca ovary with peritoneum and brain met
•Fungating wound on abdomen
•Fistular over intestinal and abdominal wall
•Large exudate mixed up with feces
•Odour ++
•Surrounding skin erythema
•Pain controlled with syrup morphine
•Plan discharge to home
•Wound care by sister and home care nurse
35. Interventions
•Use colostomy bag to collect exudate
•Stomahesive powder and protective barrier cream
•Wound care skill educated to patient and her sister
•Take the wound photo to patient
•Consult wound nurse for frequent oozing
36. Case 3 – Ca Anus
•86yrs / F
•Ca anus
•Inserted foley
•Frequent bowel open
•Very painful when changing napkin
37. Interventions
•Better pain control
•Irrigate the wound with normal saline and clean
gently
•Avoid diarrhea
•Avoid laxative and milk products
•Use of breakthrough analgesic
•Protect surrounding skin
38. Reference
• Alexander S.J. (2010). An intense and unforgettable experience: the lived experience of malignant
wounds from the perspective of caregivers and nurses. International Wound Journal 7(6), 456-65.
• Collier, M. (1997). The assessment of patients with malignant fungating wounds – a holistic approach:
part 1. Nurse Times 93, S1-S4
• Lo, S.F., Hsu, M.Y. & Chang, S.C. (2006). Clinical follow-up of patient with malignant fungating wounds
in adults in Taiwan. Proceedings of the 16th Biennial Congress of the World Council of Enterostomal
Therapists, abstract A180.
