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The Skin. Epidermis-Epithelial cellsMelanocytes- provides difference in skin colorKeratinocytes-fibrous, water-repellent protein that gives the epidermis its tough, protective qualityDermis-Second, deeper layerBlood cells, nerve fibers, and lymphatic vesiclesHair follicles, sebaceous glands,
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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- ˝ 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. ˝ 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. ˝ 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.