Integumentary, Ostomy, Lymphedema, and Wound Care
Key Takeaways
- Skin, wound, ostomy, and lymphedema concerns may arise from surgery, radiation, systemic therapy, immobility, nutrition deficits, infection, or tumor burden.
- Oncology nurses assess location, severity, drainage, odor, pain, infection signs, functional impact, self-care ability, and supply access.
- Radiation dermatitis, hand-foot syndrome, pressure injury, malignant wounds, extravasation injury, and surgical wounds require distinct teaching and escalation triggers.
- Ostomy education includes stoma appearance, output expectations, pouch fit, peristomal skin protection, dehydration risk, and when to call.
- Lymphedema care emphasizes risk reduction, early swelling recognition, compression or therapy referral, skin protection, and prompt infection evaluation.
Integumentary, Ostomy, Lymphedema, and Wound Care
Skin and Wound Assessment
Cancer care can injure skin through surgery, radiation, systemic therapy, vascular access devices, immobility, edema, malnutrition, steroid use, infection, and tumor invasion. The nurse assesses color, temperature, moisture, turgor, rash pattern, pain, pruritus, open areas, drainage, odor, bleeding, undermining when trained, surrounding erythema, and functional impact. Include photos only under policy. Document location, size when appropriate, patient report, interventions, and whether wound care, radiation oncology, surgery, or provider follow-up is needed.
Radiation dermatitis usually appears in the treatment field and may progress from erythema and dryness to moist desquamation. Teaching includes gentle cleansing, avoiding friction, avoiding adhesive trauma, protecting from sun, avoiding heating pads or ice, and checking with the radiation team before applying products in the field. Escalate moist desquamation, severe pain, fever, purulent drainage, rapidly spreading redness, or inability to continue treatment setup.
| Problem | Assessment focus | Nursing priorities |
|---|---|---|
| Surgical wound | Approximation, drainage, fever, pain, dehiscence | Protect incision, teach care, escalate infection or opening |
| Hand-foot syndrome | Palmar or plantar redness, swelling, pain, peeling | Reduce friction, moisturize as ordered, report severe pain |
| Pressure injury | Mobility, nutrition, moisture, device pressure | Repositioning, support surfaces, wound referral |
| Malignant wound | Odor, bleeding, drainage, pain, distress | Symptom control, dignity, supplies, palliative support |
Ostomy Care and Anatomical Alterations
Ostomies may be created for colorectal, gynecologic, bladder, or palliative reasons. Nursing assessment includes stoma color, edema, bleeding, output amount and character, peristomal skin, pouch seal, patient dexterity, vision, learning readiness, supply access, and emotional response. A healthy stoma is typically moist and pink to red. Dusky, black, or severely painful stoma tissue requires urgent evaluation. No output with cramping, vomiting, or distention can suggest obstruction.
Education should be practical and repeated. Patients need to know how to empty and change the pouch, measure the barrier opening, protect peristomal skin, prevent leakage, manage odor, order supplies, and recognize dehydration risk. Ileostomy output can be high and watery, increasing fluid and electrolyte risk. Urinary diversions require attention to urine flow, mucus, infection signs, and pouch connection. The nurse should normalize body image and sexuality concerns and refer to wound, ostomy, continence nursing when available.
Lymphedema
Lymphedema can occur after lymph node surgery, radiation, tumor obstruction, infection, or trauma. It may affect an arm, leg, breast, trunk, head and neck area, or genitals. Assess swelling, heaviness, tightness, aching, range of motion, skin changes, infection signs, limb measurements if trained, and functional limitations. Early symptoms may be subtle, such as jewelry or sleeves feeling tight.
Risk reduction teaching includes skin protection, prompt care of cuts, avoiding burns, gradual activity, weight management support, and reporting swelling early. Compression garments, manual lymphatic drainage, exercise, and complete decongestive therapy should be directed by trained clinicians. Avoid promising that blood pressure cuffs or venipuncture always cause lymphedema; instead follow institutional policy and individual risk plans. Cellulitis signs, including redness, warmth, fever, pain, or rapid swelling, require urgent evaluation.
Site-Specific Radiation and Surgical Changes
Anatomical changes affect skin care. Head and neck surgery may alter speech, swallowing, saliva, airway clearance, and tracheostomy care. Breast, axillary, pelvic, and groin procedures can change drainage patterns and lymphedema risk. Pelvic radiation may injure perineal skin, bladder, rectum, and sexual tissues. Limb surgery or amputation changes pressure points, prosthesis fit, balance, and body image. The nurse should ask where treatment occurred, what structures were removed or radiated, what supplies the patient uses, and which daily tasks are now difficult.
Extravasation, Infection, and Reassessment
Possible extravasation of vesicant or irritant therapy is an oncology emergency. Stop the infusion, leave the catheter in place initially if policy directs, assess the site, aspirate if ordered by protocol, notify the provider, administer antidote or thermal measures only as directed, photograph or mark the area if policy allows, and document carefully. Do not flush the line.
Skin and wound care requires reassessment. Is pain improving? Is drainage increasing? Can the patient perform care? Are supplies available? Has peristomal skin healed? Does swelling respond to the plan? Oncology nurses protect skin, function, dignity, and safety by connecting visible findings to the treatment history and escalating early.
Which ostomy finding requires urgent escalation?
A patient receiving a vesicant reports burning and swelling at the IV site. What is the nurse's priority action?
Which teaching is most appropriate for a patient at risk for lymphedema?