Carville ... a tour to remember.
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Hospitals, Special↗
Biomedical subjects
C Rund
Publications and source records attributed to C Rund.
A nursing protocol for the management of perineal-rectal skin alterations.
Perineal-rectal care is defined as skin care to the region between the vulva and anus in the female and scrotum and anus in the male (Costello, 1997). Perineal-rectal care is essential to prevent infection and promote comfort but is complicated by the anatomical location of the perineum and rectum. In addition, no standardized perineal-rectal care approach exists. Patients with cancer are at particular risk for developing perineal-rectal skin breakdown because of immunosuppression, side effects of radiation and chemotherapy, and compromised nutritional status. A perineal-rectal skin-care protocol is presented that incorporates recommendations for routine care as well as recommendations for managing common skin alterations, including erythema, dry and moist desquamation, and infection.
Dermatitis↗
Malignant cutaneous wounds: a management protocol.
Malignant cutaneous wounds are emotionally traumatic and difficult to manage lesions which occur secondary to infiltration of cancer into the skin. They occur in patients with end-stage disease and are highly exudative, malodorous, and bleed easily. Quality of life is the goal for treatment, which includes radiation, chemotherapy, surgery, and local wound care. Odor is addressed with varying levels of success through wound cleansing, external deodorizers, charcoal-impregnated dressings, topical antimicrobial therapy, and metronidazole. Exudate is managed with highly absorbent dressing materials, topical steroids or hyoscine (a drying agent). Light bleeding is controlled with local pressure and hemostatic dressings; heavier bleeding may require ligation or cauterization. Cosmetic appearance and other psychosocial issues must be assessed on an ongoing basis. Creative dressing techniques can help restore the look of symmetry to the patient's body. Effective wound management, debridement, and antimicrobial therapy can reduce the risk of infection. Wound cleansing, through irrigation or flushing, should not cause pain, further trauma or bleeding. Dressings should maintain a moist wound environment and not traumatize the wound upon removal. A protocol is included which can be individualized to the needs of each patient and addresses assessment, interventions, patient teaching, documentation, and expected outcomes.
Bandages↗