{"title":"Skin problems in palliative care","authors":"P. Grocott, G. Gethin, S. Probst","doi":"10.1093/MED/9780199656097.003.0111","DOIUrl":"https://doi.org/10.1093/MED/9780199656097.003.0111","url":null,"abstract":"Nursing aspects of palliative wound care are driven by patient and family goals integrated with three components of wound management: the management or palliation of the underlying cause of the wound, management of wound-related symptoms, and management of the wound and peri-wound skin. Wounds most commonly encountered include pressure ulcers, fungating malignant wounds, and fistulae. Patients with blistering skin conditions, inherited and acquired, have extensive long-standing wounds and palliative care needs. In addition, meticulous skin care for patients of all ages with debilitating long-term conditions is crucial to prevent unnecessary skin breakdown. The symptoms and local problems associated with broken skin and wounds include odour, exudate, excoriation, maceration, bleeding, pain, and pruritus. Key clinical interventions include the application of wound dressings and skin care products. Unless these are managed effectively and consistently, body image and feelings of self-worth are affected together with the ability to socialize and maintain function, including, for some people, employment.","PeriodicalId":369448,"journal":{"name":"Oxford Textbook of Palliative Medicine","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122282777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"End-stage kidney disease","authors":"F. Murtagh","doi":"10.1093/med/9780199656097.003.0156","DOIUrl":"https://doi.org/10.1093/med/9780199656097.003.0156","url":null,"abstract":"End-stage kidney disease accounts for 1–2% of all deaths. With ageing of the population, this proportion will grow steadily over the coming years. Symptom burden in end-stage kidney disease exceeds advanced cancer, with added renal-specific symptoms, such as itch and restless legs. Pain and depression are also more prevalent. Many renal symptoms go under-recognized and undertreated, especially as they arise from comorbid conditions, rather than the renal disease itself. The most useful intervention to address symptoms is regular assessment, followed by pharmacological interventions that take account of the constraints on using renally cleared drugs and the high risk of toxicity from accumulation of parent compounds or metabolites. The population with end-stage kidney disease have extensive palliative care needs, and require significant medical, nursing, psychological, and social care to address these as their illness advances towards the end of life.","PeriodicalId":369448,"journal":{"name":"Oxford Textbook of Palliative Medicine","volume":"26 11","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"113976462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}