Dermatological Disorders

Module 13

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Pharmacology Review

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Critical Thinking Exercise

• You are caring for an 18-year-old female college student with chronic,
cystic acne. She has been prescribed oral isotretinoin.
• a. What side effects should you review with this patient?
• b. What type of screening should be done before she is started on the
isotretinoin?
• c. What are some self-care strategies you could recommend?

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Critical Thinking Exercise Answers

• Bone or joint pain; redness or burning at the eye; nosebleeds; slain or

redness of the lips; skin infection or rash
• Pregnancy screening should be done before giving isotretinoin
• Clean skin gently with mild non-dry soap; always wash face after
exercising; have a healthy diet; avoid picking at face

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Assess this skin lesion

This lesion is shiny, pink

and flat.
I believe it is basal cell
carcinoma.

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Assess this skin lesion

This lesion is red and scaly

I believe it is Squamous cell
carcinoma

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Case Study
(©Jupiterimages/Comstock/Thinkstock)

• E.N., a 45-year-old white female with strawberry blonde hair and blue
eyes, works at a garden center.
• She has come to the dermatology clinic because she noticed that the
mole on her left shoulder has increased in size and darkened in color.

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Case Study
(©Jupiterimages/Comstock/Thinkstock)

• You assess E.N.’s mole and note that it is 5 mm x 8 mm in diameter,

shaped like a jagged pebble.
• She describes the changes she has noticed: the color has changed
from brown to black and it has increased in size and feels bumpy.

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Discussion

A blonde, blue-eyed adolescent has come to the health clinic because

the mole on her back has become enlarged and rough.
• What are risk factors for the development of skin cancer?
• Discuss assessment of moles

• Family history, light skin, age, gender, sun exposure

• The ABCDE rule is used to assess moles.
• Asymmetry, border, color, diameter and evolving appearance.

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Malignant Skin Neoplasms

• ABCDE Rule
• Asymmetry
• Border irregularity
• Color change
• Diameter >6 mm
• Evolving in appearance

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Malignant Melanoma

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Case Study
(©Jupiterimages/Comstock/Thinkstock)

• An incisional biopsy is done on E.N.’s mole.

• Diagnosis of malignant melanoma is confirmed.
• What factors will determine the next steps in treatment?

• The clients overall health, if surgery is the best option, and the risk of
the cancer returning after treatment.

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Discussion
• Apply the nursing process as a framework for this patient and discuss
options for managing melanoma

• Assessment of the melanoma is confirmed with biopsy since this will

determine the treatment.
• create patient-centered care plans that address skin cancer prevention,
treatment, and management.
• enhance patient health, avoid difficulties, and assist the patient in
avoiding skin malignancies or properly managing those that already
exist.
• In order to guarantee the best possible patient outcome, track and
evaluate the patient's development, look for any problems or
metastases, and make any required modifications to the treatment plan

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Case Study
(©Jupiterimages/Comstock/Thinkstock)

• E.N. has her mole excised and her axillary lymph nodes on the right
side are dissected to assess for metastasis.
• Lymph nodes are negative for cancer cells.

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Case Study
(©Jupiterimages/Comstock/Thinkstock)

• E.N. questions the type of surgery that was performed and how it was
determined that all of the tumor was excised.
• What type of surgical procedure was likely used to excise the mole?
• Surgical excision

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Case Study
(©Jupiterimages/Comstock/Thinkstock)

• Postoperatively, E.N. examines her shoulder.

• She tearfully expresses concern regarding the size of the incision and
its location on her shoulder.

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 NCLEX Review

Which patient is at highest risk for skin cancer?

a. A 56-year-old Native American with colon polyps.
b. A 72-year-old retired high school chemistry
teacher.
c. A 32-year old who uses a tanning booth twice a
week.
d. A 44-year-old who regularly bathes with
perfumed soap.

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 NCLEX Review

The nurse is caring for a patient with anxiety related to a skin

condition. Which intervention would be most appropriate at
this time for the nurse to add to this patient’s plan of care?
a. Encourage the patient to express feelings of anxiety.
b. Use touch to demonstrate acceptance of appearance.
c. Refer the patient for counseling and further evaluation.
d. Teach the patient use of cosmetics and cover-up
techniques.

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Case Study

• Mark Penn, a 25-year-old patient, is diagnosed with psoriasis. He presents with multiple lesions
of red, raised patches of skin covered with silver scales on the back, elbows, and legs. He has
flaky skin lesions of the scalp, and large chunks of skin with hair are flaked off while skin with hair
lies beneath the surface of the flaking lesions. There are several small lesions on the forehead
and cheeks. The fingernail beds are discolored a brownish-yellow, pitted, and the edges are
separating and breaking off the nail plate. The patient reports that it is embarrassing to wear
shorts because people stare, talk among themselves, and avoid him. He states that he wants to
wear a sign that states, “I have a face; you can talk to me.” The patient states that the lesions are
itchy and he scratches them at times, making the lesions bleed so he ends up with blood spots on
his sheets or clothing. The physician orders the patient to use Dermarest Psoriasis Medicated
Shampoo Plus Conditioner, which contains 3% salicylic acid, daily and keep the hair short so the
sun may penetrate the scalp. The patient is instructed to soak daily in the bathtub using Aveeno
Oilated Oatmeal Bath, scrub lightly with a soft bath brush, and pat the skin dry. After the bath,
the patient should apply Lac-Hydrin lotion to the skin to help soften the thick scales. At
nighttime, the patient should apply calcipotriene (Dovonex) lightly to the affected areas and rub
it into the skin; then he should wash his hands with soap and water. The patient should keep his
nails trimmed and soak in a bowl of warm water with 3 capfuls of tar bath oil for 20 minutes.
After soaking, pat the hands dry, apply a tar moisturizer into each nail, and apply cotton gloves
that should be kept on during sleep. The patient is instructed not to use the calcipotriene to the
facial lesions. Instead, the patient should use the Lac-Hydrin lotion. The patient is encouraged to
use sun exposure to the affected areas and observe for burning. If the skin becomes pink, apply a
sunscreen with an SPF of 15 or higher to prevent sunburn. (Learning Objective 3)

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Case Study Questions

• What is the rationale of the treatments ordered?

• The patient's skin protection and strengthening is the reason behind
each and every prescribed treatment.
• What nursing care should be provided for the patient?
• This patient would benefit from the following kind of nursing care:
counseling to make him feel less like he needs to wear a sign that says,
"I have a face; you can talk to me," as well as education on all of his
medications and doctor's orders that have been issued for him.

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