Congress Abstracts 2005

41

A SOLUTION FOR PAINFUL SURFACE WOUNDS: A CASE STUDY. Ann Blackett, MS, RN, COCN, CWCN, Susan Kay Bohnenkamp, MS, RN, CCM, and Patricia McDonald, ARNP-BC, CWOCN, University Medical Center, Tucson, AZ.

Oncology patients are susceptible to a variety of painful skin conditions, which may be related to therapies such as chemotherapy, radiation, and bone marrow transplant. The treatment myth is frequently to “leave it open to air” so the wound will “dry out”. However, partial thickness wounds require a non-adherent moist dressing that covers the wound and the naked nerve endings. The following is a case study of a 66-year-old female recently treated with chemotherapy for chronic lymphocytic leukemia who developed Pemphigus Vulgaris, an autoimmune disease with cutaneous manifestations of blisters and surface ulcers. The patient’s wounds were causing excruciating pain.

To describe the wound care necessary to relieve the pain and discomfort of partial thickness wounds from dermatological conditions in oncology patients.

Initially, the wound Plan of Care was “Leave it open to air”. The serous sanguineous fluid drained onto the bed linens causing excruciating pain with the constant cycle of being stuck and unstuck to the sheets. The patient agreed to the dressing and allowed progressive Photographic documentation.

The dressing is a daily dressing. It utilizes a foaming skin care wash, non-sting skin barrier, and hydrogel sheet.

Three outcome measurements:

1. Pain management via Wong-Baker pain scale
2. Pain management via amount of pain medication
3. Wound healing by Photo documentation
• Wong-Baker pain scale
• Prior to the dressing application, the patient reported her pain level as ten. After the dressing, the patient reported the pain level as one.
• After 12 hours, the pain level advanced to 6 and 8. Therefore, another dressing change was added before bedtime.
• BID dressing changes kept her pain between 1 and 2 consistently throughout the 24 hours.
• Pain Medication usage decreased.
• Photographic documentation indicated complete wound healing after approximately 4 months.

More research is necessary to determine the impact of wound care on pain for cancer patients. The oncology patient has unique skin care issues due to therapy modalities. This case study exemplifies the unique skin issues and how a wound care plan can reduce pain.