NURSING CARE OF CLIENTS WITH INTEGUMENTARY PROBLEMS

1. NURSING CARE OF CLIENTS WITH INTEGUMENTARY PROBLEMS This section focuses on nursing care of clients with integumentary problelms. Please review the anatomy & physioloogy of the skin in your text. The next 6 slides offer a brief review.This section focuses on nursing care of clients with integumentary problelms. Please review the anatomy & physioloogy of the skin in your text. The next 6 slides offer a brief review.

2. The Skin Epidermis- Epithelial cells Melanocytes- provides difference in skin color Keratinocytes-fibrous, water-repellent protein that gives the epidermis its tough, protective quality Dermis- Second, deeper layer Blood cells, nerve fibers, and lymphatic vesicles Hair follicles, sebaceous glands, and sweat glands

3. The Skin Subcutaneous tissue Below the dermis & not part of the skin Attaches skin to muscle & bone Stores fat Regulates temperature Provides shock absorption The subcutaneous tissue-----same a slideThe subcutaneous tissue-----same a slide

4. The Skin Sebaceous glands Contain sebum to soften and lubricate the skin and hair Secretion stimulated by sex hormones Sweat glands Eccrine glands-forehead, palms, and soles Apocrine sweat glands- axillary, anal, and genital Ceruminous glands-external ear canal for cerumen The skin contains sebaceo9us glands which contain sebum to ….Sex horones stimulate their secretion.Sweat glans are also found in the skin. Eccrine glands are found in the forehead, palms and soles of the feet. Apocrine gands are found in the axicillary, anal & genital regions Ceruminous glands are found in the external ear canal and secrete cerumenThe skin contains sebaceo9us glands which contain sebum to ….Sex horones stimulate their secretion.Sweat glans are also found in the skin. Eccrine glands are found in the forehead, palms and soles of the feet. Apocrine gands are found in the axicillary, anal & genital regions Ceruminous glands are found in the external ear canal and secrete cerumen

5. The Skin Nails- Nail bed Color ranges from pink to yellow or brown depending on skin color Pigmented bands in nail bed normal for dark skinned people Protects ends of fingers and toes Nails & hair are also a part of the integumentary system. Finger & toe nails arise from the nail bed. Normal color ranges------read slideNails & hair are also a part of the integumentary system. Finger & toe nails arise from the nail bed. Normal color ranges------read slide

6. The Skin Hair Grows over most of body except lips, palms & soles Color is inherited & depends on amount of melanin Protects and warms the head Hair arises from hair follicles & grows over --------read slideHair arises from hair follicles & grows over --------read slide

7. Functions of the Skin Protect underlying tissue Barrier against pathogens & excessive water loss Controls heat regulation Provides sensory perception (pain, heat, cold, touch, pressure & vibration Mirrors emotion, e.g. anger or embarrassment The functions of the skin include protecting----,acting as a barrier---,controlling--,providing ---& mirroring our emotions, such as blushing with embarrassment or flushing with angerThe functions of the skin include protecting----,acting as a barrier---,controlling--,providing ---& mirroring our emotions, such as blushing with embarrassment or flushing with anger

8. Assessment Past medical history involving skin (jaundice, delayed wound healing, pallor, bruising) Skin reactions to foods, insect bites, medications Exposure to ultraviolet light (sun, radiation, tanning beds) Use of sunscreen Changes in skin, hair or nails Family history of skin diseases (alopecia, psoriases, cancer) Tobacco use The RN should begin the skin assessment by taking a history. He client should be asked about any past or current problems involving the skin such as----.Allergic skin reactions to foods, insect bites & medications should be noted. The amount of exposure to ultraviolet light should be assessed. Does his job require him to work outside such as construction work, lawnwork? Does he sunbathe at the beach? Has he has radiation for cancer? Does he frequent tanning beds? How often does he use sunscreen? Have there ben rcent changes in his skin, hair or nails? Is there family hx of skin diseases (alopecia, psoriasis, skin cancer?? Does he smoke, dip or chew tobacco??The RN should begin the skin assessment by taking a history. He client should be asked about any past or current problems involving the skin such as----.Allergic skin reactions to foods, insect bites & medications should be noted. The amount of exposure to ultraviolet light should be assessed. Does his job require him to work outside such as construction work, lawnwork? Does he sunbathe at the beach? Has he has radiation for cancer? Does he frequent tanning beds? How often does he use sunscreen? Have there ben rcent changes in his skin, hair or nails? Is there family hx of skin diseases (alopecia, psoriasis, skin cancer?? Does he smoke, dip or chew tobacco??

9. The Skin Health Assessment Describe itching? When did you see a change in the mole? Any new hair products or skin products? Allergies? Any new medications How do you care for your skin? Intake in the last 24 hours Is your scalp oily or dry? Do you perspire heavily? Describe your activities in the past 24 hours? How much sleep do you get? Any changes in your hair or nails Any recent hair loss? Nails changed shape or color? This slide lasts some of the questions to be asked during a skin health assessment. Read slideThis slide lasts some of the questions to be asked during a skin health assessment. Read slide

10. The Skin Health Assessment Color Lesions Pearly-edged nodules with a central ulcer are seen in basal cell carcinoma Dark, asymmetric, multicolored patches with irregular edges appear in malignant melanoma Circular lesions can be ringworm Urticaria-hives Psoriasis-scaly red patches Temperature Inspect for general color in sclera, conjunctiva, nail bed, lips & buccal mucosa in light skinned client. Observe lips, mucous membranes, palms & nail beds in dark skinned client. Important to note change because “normal” is different for different clients Look for bruising, vascular lesions (petechiai) jaundice, cyanosis, erythema, & pallor. Look for lesions describe color, size, distribution, location & shape .(Read slide lesions) Palpate temperature using back of hand.Inspect for general color in sclera, conjunctiva, nail bed, lips & buccal mucosa in light skinned client. Observe lips, mucous membranes, palms & nail beds in dark skinned client. Important to note change because “normal” is different for different clients Look for bruising, vascular lesions (petechiai) jaundice, cyanosis, erythema, & pallor. Look for lesions describe color, size, distribution, location & shape .(Read slide lesions) Palpate temperature using back of hand.

11. The Skin Health Assessment Moisture Tugor tenting Edema Hair Hirsutism – increased hair growth on face or trunk Alopecia – absence of hair Scalp lesions Ring worm – Tinea capitius Furnicles- red swollen hair follicles Lice- Pediculosis Skin should be moist & without flaking, scaling or cracking. Skin becomes dryer with increased age. Turgor is tested by pinching an area of skin under clavicle. Normal is immediate return to position. Tenting indicates dehydration or aging. Observe ankles & fingers for edema. Hair should be shiny &scalp should be free of lesions & parasites. Excessive hair growth could be indicative of Cushing’s disease. Alopecia can result from stress, drugs or unknown causes. Scalp lesions may be present & can occur from ringworm, obstructed hair follicles which are red & swollen called furnicles or from parasites such as lice. Skin should be moist & without flaking, scaling or cracking. Skin becomes dryer with increased age. Turgor is tested by pinching an area of skin under clavicle. Normal is immediate return to position. Tenting indicates dehydration or aging. Observe ankles & fingers for edema. Hair should be shiny &scalp should be free of lesions & parasites. Excessive hair growth could be indicative of Cushing’s disease. Alopecia can result from stress, drugs or unknown causes. Scalp lesions may be present & can occur from ringworm, obstructed hair follicles which are red & swollen called furnicles or from parasites such as lice.

12. The Skin Health Assessment Nails Curvature Color Thickness Pseudomonas and Candida infections can cause the nail to separate and to be darker or red Normal Older Adult Variations of the skin Dry, itchy, decreased melanocytes, liver spots decrease in Subcutaneous fat, increased wrinkling, sagging, bruising, hair loss in outer third of eyebrows, thick, ridged nails Nails should be free of infection & fungus. Look for clubbing (angle greater than 180 degrees which is indicative of COPD). Spoon shaped nails indicative of iron deficiency anemia. Very thick nails, esp toenails can be indicati8ve o9f fungus. Pseudomonas & candida infections can cause the nail to separate & be darker or red. The older client may normally present with---read slideNails should be free of infection & fungus. Look for clubbing (angle greater than 180 degrees which is indicative of COPD). Spoon shaped nails indicative of iron deficiency anemia. Very thick nails, esp toenails can be indicati8ve o9f fungus. Pseudomonas & candida infections can cause the nail to separate & be darker or red. The older client may normally present with---read slide

13. Common Assessment Abnormalities Alopecia- absence of hair Comedo – blackheads & whiteheads Cyst – fluid filled sac d/t obstructed duct or gland Ecchymosis – bruise Erythema – redness occurring in patches Hematoma – extravasion of blood causing swelling d/t trauma Read slide Comedo related to acne. Look for shape of bruise – hand or fingers, consider physical abuse Erythema related to heat, drugs, alcohol, sunRead slide Comedo related to acne. Look for shape of bruise – hand or fingers, consider physical abuse Erythema related to heat, drugs, alcohol, sun

14. Common Assessment Abnormalities Hirsutism – male distribution of hair in women Keloid – hypertrophied scar beyond margin of trauma Mole – benign overgrowth of melanocytes Petechiae – pinpoint deposits of blood under the skin Telangiectasia – dilated, superficial small blood vessels found on face & thighs Hirsutism caused by abnormality of ovaries, adrenals, decrease of estrogen or heridity. Keloids are seen most often in African Americans. Petechiae seen with blood dyscrasias that result in bleeding tendencies. Telangiectasia d/t aging, acne, alcohol, liver failure, radiation & othr diseases.Hirsutism caused by abnormality of ovaries, adrenals, decrease of estrogen or heridity. Keloids are seen most often in African Americans. Petechiae seen with blood dyscrasias that result in bleeding tendencies. Telangiectasia d/t aging, acne, alcohol, liver failure, radiation & othr diseases.

15. Primary Skin Lesions Macule – flat, nonpalpable, less than 1 cm Papule – elevated, solid, palapable, less than 0.5 cm Vesicle – circular, superficial collection of serous fluid, less than 1 cm. Plaque – elevated, solid, palpable, more than 0.5 cm. Wheal – firm, edematous Pustule – elevated, superficial, filled with purulent fluid Nodule – elevated , solid, extends into dermis, circumscribed border, 0.5 – 2 cm Tumor – elevated, solid, extends into dermis, irregular border, greater than 2 cm Macule – freckles, measles, flat mole. Pupule – wart, elevated mole. Vesicle - varicella ( chicken pox), herpes zoster ( shingles). Plaque psoriasis, actinic keratosis. Wheal – insect bite, urticaria (hives) Pustule- acne impetigo Nodule – Lipoma, Squamous cell carcinoma. Tumor CarcinomaMacule – freckles, measles, flat mole. Pupule – wart, elevated mole. Vesicle - varicella ( chicken pox), herpes zoster ( shingles). Plaque psoriasis, actinic keratosis. Wheal – insect bite, urticaria (hives) Pustule- acne impetigo Nodule – Lipoma, Squamous cell carcinoma. Tumor Carcinoma

16. Secondary Skin Lesions Fissure – linear cracks Scale - excess shedding of dead keratinized tissue Scar – abnormal formation of connective tissue Ulcer – irregular, crater-like loss of epidermis & dermis Atrophy – depression in skin from thinning of the epidermis or dermis Excoriation – area where epidermis is missing, exposing dermis Ex Fissure – Athleter’s foot, cracks in edges of mouth. Scale - Dandruff, psoriasis. May also see crust – dry blood/serum/pus with eczema, herpes, scabs. Scar following surgical incision. Ulcer – Diabetic or pressure ulcer. Atrophy aged skin & “stretch marks” Excoriation scratch ,abrasionEx Fissure – Athleter’s foot, cracks in edges of mouth. Scale - Dandruff, psoriasis. May also see crust – dry blood/serum/pus with eczema, herpes, scabs. Scar following surgical incision. Ulcer – Diabetic or pressure ulcer. Atrophy aged skin & “stretch marks” Excoriation scratch ,abrasion

17. Nursing Diagnoses Impaired skin integrity Situational low self esteem Ineffective health maintenance Altered body image Social interaction, impaired Examples of Nursing Diagnoses for clients with skin problems are impaired skin integrity, situational low self esteem & altered body image d/t how they present physically. Social interaction may be impaired d/t low self esteem. Ineffective health maintenance may related not seeking medical care & not using measures to prevent problems of the skin.Examples of Nursing Diagnoses for clients with skin problems are impaired skin integrity, situational low self esteem & altered body image d/t how they present physically. Social interaction may be impaired d/t low self esteem. Ineffective health maintenance may related not seeking medical care & not using measures to prevent problems of the skin.

18. Common Benign Conditions Pruritis Psoriasis Acne Examples of common benign conditions of the skin include 0prur8itis, psoriasis & acne.Examples of common benign conditions of the skin include 0prur8itis, psoriasis & acne.

19. Pruritis Itching If a chronic problem… C/S of scrapings Fungal studies Cutaneous patch testing Pharmacology Antihistamines, Tranquilizers, and Antibiotics The primary symptom of pruritis is itching. If it becomes a chronic problem, the cause can be identified by taking a cs of skin scrapings, testing for fungus & prerorming cutaneous patch testing for allergies. Drug Treatment includes antihistamines, tranquilizers & antibiotics if necessary.The primary symptom of pruritis is itching. If it becomes a chronic problem, the cause can be identified by taking a cs of skin scrapings, testing for fungus & prerorming cutaneous patch testing for allergies. Drug Treatment includes antihistamines, tranquilizers & antibiotics if necessary.

20. Pruritis Nursing Intervention Therapeutic baths Aveno, colloid , alpha-keri Administer creams, pastes, or ointments Comfortable, cool room temperature Monitor skin for infection Nursing intervention includes -----read sloideNursing intervention includes -----read sloide

21. Psoriasis Chronic, noninfectious skin condition characterized by raised, reddened, round circumscribed plaques covered by silvery white scales. Size varies. Cause unknown; some evidence supports autoimmune. Stress, sunlight, hormonal fluctuations, and some medications can induce. Read slideRead slide

22. Psoriasis Pharmacology Corticosteriods Tar preparations-suppress miotic activity Amevive (alefacept) injection- suppress rapid turnover of epidermal cells Antimetabolites (Methotrexate) Treatments Sunlight Ultraviolet Light Therapy-decreases the growth rate of epidermal cells Read slideRead slide

23. ACNE Acne vulgaris effects 85%^ of the population. The peak incidence is age 17 to 18 years of age. Family history, premenstrual flares, and sometimes stress can cause a flare up. Cosmetics containing lanolin, petrolatum, vegetable oils, lauryl alcohol, butylsterate, and oleic acid can increase comedome production. Exposure to oils in cooking grease can be a precursor in adolescents.     READ SLIDEREAD SLIDE

24. Acne Acne is a disease that involves the sebacceous glands & hair follicles of the face, neck, chest, and upper back.. Characterized by comedones & inflammatory lesions   Adequate rest, moderate exercise, a well-balanced diet, reduction of emotional stress, and elimination of any foci of infections are all part of general health promotion.        Read slideRead slide

25. Acne Retin-A is the only drug that disrupts the abnormal follicular keratinization that produces microcomedones. It is available in cream, gel, or liquid. A pea-sized dot of medication is used. It should not be applied until 30 minutes after washing face to prevent burning.    Topical benzyl peroxide is antibacterial and can be used to treat mild cases. The medication can have a bleaching effect on sheets and clothes. Other antibacterials used topically are Clindamycin, Erythromycin and Metronidazole. When combined with benzyl peroxide, glycolic acid or Retin-A penetration improves    

26. Acne  Accutane is a potent and effective oral agent. It decreases sebum production. This medication needs to be managed by a dermatologist. Adolescents with multiple, active, deep dermal or subcutaneous cyctic and nodular acne lesions are treated for 20 weeks. Side effects include dry skin, dry mucous membranes, nasal irritation, dry eyes decreased night vision, photosensitivity, arthralgia, headaches, mood changes, depression, and suicidal ideation. The most significant is tetragenic effects. It is contraindicated in pregnancy. If the young women are sexually active, they must be on some kind of contraceptive. Tetracycline longterm Read slideRead slide

27. Acne Gentle cleansing with a mild cleanser once or twice daily is needed. Antibacterial soaps are not effective and may cause drying.     Nursing care is focused on supportive and educating the child and parent. Teenagers need to understand that it takes 4 to 6 weeks to see improvement.   Read slideRead slide

28. Infections of the Skin Bacterial, Viral & Fungal Infections of ther skin may be d/t bact, viral of fungal causesInfections of ther skin may be d/t bact, viral of fungal causes

29. Bacterial Infections Impetigo- Staphylococcus. Reddish macule, vesicle, then erupts. Dries to a honey-colored crusts. Topical, oral, or IV antibiotics.Contagious. Seen in toddler and preschool. Folliculitis- Staph aurous. Pimple- infection of hair follicle. On legs of women or bearded faces of men. Contagious. Never pop or squeeze. Examples of bact infections include---read slideExamples of bact infections include---read slide

30. Bacterial Infections Furnucle- Boil. Larger lesion with more redness and edema . Painful. Moist compress Systemic antibiotics. Contagious. Never pop or squeeze Carbuncle- Multiple boils. Wide spread inflammation. Moist compress. Systemic antibiotics. Never pop or squeeze. Treatment: good hand washing, antibiotics, good hygiene, warm compresses Read slideRead slide

31. Bacterial Infections Cellulitis – inflammation of subcutaneous tissue following break in skin -Caused by staph of strep. Treat with anitbiotics Erysipelas – involved the dermis – Caused by strep. Treatment is IV antibiotics (PCN usually) to prevent septicemia

32. Viral Infections Warts – caused by HPV Common wart – fingers Planter warts – soles of feet Flat wart – forehead Condylomata acuminata – venereal warts Treatment Salicylic acid, Cyrotherapy, Liquid Nitrogen Examples of viral infections are---read slide hpv human pappiloma virusExamples of viral infections are---read slide hpv human pappiloma virus

33. Viral – Herpes Simplex Vesicle type lesion Type 1 – above the waist – cold sores Type 11 – below the waist – STD, Genital herpes Signs/Symptoms – burning, tingling Diagnosed with Tzanck smear – identifies herpes but doesn’t differentiate between simplex & zoster Treatment – Zovirax (Acyclovir), moist compresses & white petrolatum Read notesRead notes

34. Viral – Herpes Zoster AKA Shingles Caused by varicella zoster which also causes chickenpox Painful Treatment – Acyclovir & Narcotics Isolate from people who have not had chickenpox Read slideRead slide

35. Fungal Infections Candidiasis – caused by Candida albicans Occurs with immunosuppression & following antibiotics Found in mouth, vagina & skin (yeast infection) Treatment –Antifungal such as Mycostatin, Diflucan Treat sexual partner Examples of fungal infections include candidiasis & the “tineas” candidiasis is caused by—read slideExamples of fungal infections include candidiasis & the “tineas” candidiasis is caused by—read slide

36. Fungal Infections – the “tineas” Tinea pedis – athlete’s foot Tinea capitis – scalp ringworm Tinea corporis – body ringworm Tinea cruris – groin – jock itch Treatment – antifungal cream or solution, Griseofulvin, Diflucan Contagious Read slideRead slide

37. Common Allergic Conditions Contact dermatitis - Hypersensitivity response/ chemical irritation, i.e Latex glove allergy Urticaria – allergic phenomena causing hives Treatment – remove the irritant & give antihistamines Common allergic conditions include contact dermatitis resulting from hypersentivity to an irritant like latex gloves & urticaria resulting from a medication, insect bite or food to which the client is allergic. treatment is (read slide)Common allergic conditions include contact dermatitis resulting from hypersentivity to an irritant like latex gloves & urticaria resulting from a medication, insect bite or food to which the client is allergic. treatment is (read slide)

38. Atopic Dermatitis Inflammatory skin disorder also called eczema Cause unknown, thought to be related to IgE, T lymphocytes, monocytes, and other inflammatory cells. Adult have lichenification, erythema, scaling, itching, and scratching. Familial history, foods, cold weather, stress can be the cause Treat with antipruritic, oral antihistamines, and oral and or topical corticosteriod. Read slideRead slide

39. Skin Cancers Non-Melanoma’s Basal cell carcinoma Squamous cell carcinoma Melanoma Skin cancers are divided into general types: melanoma & non-melanoma. Non- melanoma skin cancers are the most common.Skin cancers are divided into general types: melanoma & non-melanoma. Non- melanoma skin cancers are the most common.

40. Basal Cell Carcinoma Most common malignant tumor in U.S. Originates from basal layer of epidermis Risk factors: UV exposure & severe sunburn in childhood or adolescence Usually found on head or neck, especially the nose Dome-shaped, flat, slightly red papule or macule, translucent, indistinct border, hard scale BCC s are the most common malignant tumor in the US, wiwth 900,000 cases siagnosed each year. BCC is increasing by 2-3 % each year. It originates from the basal layer of the epidermis & is most commonly found on the head or neck, especially the nose. May also occur on back of hands or arms & other hair-bearing skin. The biggest risk factor is UV exposure, especially severe sunburn in childhood or adolescence. BCC presents as a dome-shaped, flat, pearly or slightly red papule or macule. It is transllucent, has a hard scale, & it’s borders are indistinct & rolled. Treatment is removal by surgical incision or freezing. Radiation & topical chemotherapy may be used.BCC s are the most common malignant tumor in the US, wiwth 900,000 cases siagnosed each year. BCC is increasing by 2-3 % each year. It originates from the basal layer of the epidermis & is most commonly found on the head or neck, especially the nose. May also occur on back of hands or arms & other hair-bearing skin. The biggest risk factor is UV exposure, especially severe sunburn in childhood or adolescence. BCC presents as a dome-shaped, flat, pearly or slightly red papule or macule. It is transllucent, has a hard scale, & it’s borders are indistinct & rolled. Treatment is removal by surgical incision or freezing. Radiation & topical chemotherapy may be used.

41. Squamous Cell Carcinoma Malignant tumor of keratinocytes of skin & mucosal surfaces Actinic keratosis is precursor Second most common skin cancer in U.S. Can be aggressive & metastasize Found on head & neck (lips & mouth of smokers) Begins as firm, dull red keratosis & progresses to nodule which ulcerates & attaches to underlying tissue SCC is a malignant tumor of the keratinocytes of the skin & mucous membranes the head & neck in the US. It can be very aggressive & metastasize to underlying tissue. It is usually found on the head & neck, especially the lips & mouth of cigarette, cigar & pipe smokers. In African-Americans, it can be found anywhere on the skin. SCC begins as a firm, dull red keratosis & progresses to a nodule, which ulcerates. It may be crusted with keratin products & may bleed and become painful. The risk o9f SCC increases 18-36 ntimes in organ transplant patients d/t immunosuppression. Treatment is the same as for BCC, exept that if metastasis has occurred, IV chemotherapy & radiation will be necessary.SCC is a malignant tumor of the keratinocytes of the skin & mucous membranes the head & neck in the US. It can be very aggressive & metastasize to underlying tissue. It is usually found on the head & neck, especially the lips & mouth of cigarette, cigar & pipe smokers. In African-Americans, it can be found anywhere on the skin. SCC begins as a firm, dull red keratosis & progresses to a nodule, which ulcerates. It may be crusted with keratin products & may bleed and become painful. The risk o9f SCC increases 18-36 ntimes in organ transplant patients d/t immunosuppression. Treatment is the same as for BCC, exept that if metastasis has occurred, IV chemotherapy & radiation will be necessary.

42. Actinic Keratosis

43. Basal & Squamous Cell Carcinomas

44. Malignant Melanoma 55,100 new cases of invasive melanoma in U.S. per year (1 or 57 males & 1 of 75 females) Arises from melanocytes. 1/3 occurs in existing moles Most often found on chest & trunk on males & lower legs of females. Can form in eyes, mouth, vagina, & other internal organs. Read slideRead slide

45. Signs & Symptoms of Melanoma Asymmetry of mole- ½ doesn’t match the other Border irregularity - edges are ragged or notched Color – differing shades of tan, brown, black with sometimes patches of red, blue or white. Diameter – mole is wider than 6 mm (1/4 inch) Any change of a spot or bleeding from lesion Read slideRead slide

46. Moles

47. Melanoma

48. Risk factors Congenital moles, large or numerous moles Fair skin that freckles, red or blond hair Family history of melanoma Immune Suppression Excessive exposure to UV radiation & sunburn Age & gender Moles present at birth place the person at increased risk if the congenital mole is large or numerous. The risk of melanoma is about 20 times higher for Caucasians than for African americans because darker pigment is more protective. People who burn easiy are at high risk. Dark-skinned people can develop melanoma, particularly on palms of hands, soles of feet, under nails, inside mouth & rarely in internal organs.10% of people with melanoma have a family history of this cancer. Risk is greater if first-degree relative has melanoma. People who have been immunosuppressed , such as organ transplant patients and an increased risk. Excessive exposure to sunlight or tanning booths, especially without sunscreen & protective clothing increases risk as does having severe sunburns during childhood or adolescence. ½ of all melanomas occur in people over the age of 50, but is is one of the most comkmon cancers in people under the age of 30. Men have a higher rate of melanoma than women.Moles present at birth place the person at increased risk if the congenital mole is large or numerous. The risk of melanoma is about 20 times higher for Caucasians than for African americans because darker pigment is more protective. People who burn easiy are at high risk. Dark-skinned people can develop melanoma, particularly on palms of hands, soles of feet, under nails, inside mouth & rarely in internal organs.10% of people with melanoma have a family history of this cancer. Risk is greater if first-degree relative has melanoma. People who have been immunosuppressed , such as organ transplant patients and an increased risk. Excessive exposure to sunlight or tanning booths, especially without sunscreen & protective clothing increases risk as does having severe sunburns during childhood or adolescence. ½ of all melanomas occur in people over the age of 50, but is is one of the most comkmon cancers in people under the age of 30. Men have a higher rate of melanoma than women.

49. Treatment of Melanoma Biopsy of skin & underlying tissue if necessary Wide, local incision to remove all of lesion Wedge resection of earlobe Amputation of fingers or toes Wide resection of sole of foot Thickness of lesion & ulceration are strongest prognostic features Treatment of melanoma is aimed at removing the total lesion. Depending on the location, wide local incision, wedge resection, or amputation may be necessary. The most important pathological feature of the primary lesion is it’s thickness in mm. Thickness of above 4 mm indicates a high risk for mets to the lymph. An ulcerated melanoma is more aggressive & also has a higher risk for mets. Patients with these prognostic features may also be treated with systemic chemotherapy, cytokine therapy using interferon-alpha & interleukin-2 to boost the immune system to destroy cancer cells more effectively. Treatment of melanoma is aimed at removing the total lesion. Depending on the location, wide local incision, wedge resection, or amputation may be necessary. The most important pathological feature of the primary lesion is it’s thickness in mm. Thickness of above 4 mm indicates a high risk for mets to the lymph. An ulcerated melanoma is more aggressive & also has a higher risk for mets. Patients with these prognostic features may also be treated with systemic chemotherapy, cytokine therapy using interferon-alpha & interleukin-2 to boost the immune system to destroy cancer cells more effectively.

50. Prognosis Patients treated early with removal of total lesion have 100% cure rate. Patients who have metastasis to the lymph nodes have 50% survival rate after 5 years following treatment. Patients who have systemic metastasis can live 6-9 months after treatment Read side…These statistics powerfully illustrate the importance of prevention, early case-finding and treatment.Read side…These statistics powerfully illustrate the importance of prevention, early case-finding and treatment.

51. Nursing Intervention Teaching prevention Teaching ABCD’s Support patient receiving chemotherapy Routine post-op care Support the patient & family emotionally to decrease fear, and low self-esteem if body image is altered. The RN can make a great impact in preventing skin cancers by teaching people to limit their exposure to UV radiation. Avoid midday sun when possible, wear long sleeves & pans and a hat with wide brim, wear wrap-around sunglasses that have a UV absorbng lens that blocks at leat 99% of UV radiation, use sunscreen with SP of 30 or higher, avoid tanning beds & sun lamps, & monthly assess for changes in any spots on the skin. An annual skin assesssment should be part of the annual physical exam. The patient undergoing chemotherapy needs intervention with nausea & vomiting, loss of appetite preventi0on of infection, & protection from falls d/t fatigue. Please refer to your Fundamentals of Nursing notes for specific interventions for the patient undergoing chemotherapy and surgery. The patient iw often frightened about the outcome of his treatment and may become depressed & isolate is his surgery has been disfiguring, such removal of part of the nose or lip.Both patient & family require much emotional support during this time & may need to be referred to a support group.The RN can make a great impact in preventing skin cancers by teaching people to limit their exposure to UV radiation. Avoid midday sun when possible, wear long sleeves & pans and a hat with wide brim, wear wrap-around sunglasses that have a UV absorbng lens that blocks at leat 99% of UV radiation, use sunscreen with SP of 30 or higher, avoid tanning beds & sun lamps, & monthly assess for changes in any spots on the skin. An annual skin assesssment should be part of the annual physical exam. The patient undergoing chemotherapy needs intervention with nausea & vomiting, loss of appetite preventi0on of infection, & protection from falls d/t fatigue. Please refer to your Fundamentals of Nursing notes for specific interventions for the patient undergoing chemotherapy and surgery. The patient iw often frightened about the outcome of his treatment and may become depressed & isolate is his surgery has been disfiguring, such removal of part of the nose or lip.Both patient & family require much emotional support during this time & may need to be referred to a support group.