Question

F. E. is a 74-year-old woman who comes to the medical clinic with concerns related to various “spots” on

her face. She says they have been there for a while and she thought they were just “age spots” but got

concerned after her friend was diagnosed with a malignant melanoma

Nursing Care Plan

Provide a nursing care plan for F.E. Provide a two nursing diagnosis.

Nursing Care Plan 1 and 2.

1.Assessment

2.Diagnosis

3.Goals/Plan Nursing

Interventions

4.Rationale for

the Nursing

Intervention

5. Evaluation

Please cite the reference. Thanks

or the link of reference

Answer 1

assessment should include a complete history and a comprehensive physical exam. The patient's perception of the cause of the rash is important. Also ask if she's treated it with topical, systemic, or over-the-counter medications. Ask about previous skin problems, allergic skin reactions, skin disorders, and treatments. Document the history of her present illness, including skin changes, date of onset, sequence of occurrence, and development. Assess and document associated symptoms such as itching, pain, or drainage; fever; and location of lesions throughout her body. Perform medication reconciliation. Ask if she's been exposed to anyone else with a similar condition and if she's traveled recently. Also ask about environmental exposures such as contact with occupational toxins, insects, and poison ivy.

Ask your patient if she or anyone in her family has a history of allergies, asthma, or hay fever. Also ask her about her daily skin care, substance abuse, and any psychological or physiologic stress.

Your physical assessment should include a complete inspection and palpation of the skin, assessing the entire skin surface for color, odor, texture, and hygiene. Be sure to document any lesions present, noting anatomic location and distribution over the body, size, shape, color, type, pattern, and any associated drainage.

Diagnosis has spots in face for evaluation

Nursing intervention and evaluation

• Assess skin from head to toe; note areas of suspected skin cancers and their size and characteristics

Get baseline data to determine if growth continues to spread or if treatment is effective

• Prepare patient and assist with biopsies of skin lesions

Most biopsies will be performed by punch or scalpel;

• Assess and manage pain as necessary

Patients may experience pain following a procedure or chemotherapy

• Monitor for signs of infection following biopsy or excision

• Biopsies may be followed with electric current cauterization, but may result in an open wound that can become infected.
• Following excision and curettage, monitor for draining of pus, odor or areas that do not show signs of healing

• Apply or administer medications as appropriate
  • Topical medications
  • Medications for advanced cancer (vismodegib, sonidegib)

Superficial basal cell carcinoma often only requires topical medications for treatment, however more advanced cancers, melanomas or with metastases, medication may be required, especially if other treatments have not been effective.

• Monitor vital signs; changes in skin

Watch for signs of adverse reactions to medications given

• Prevention education for patients and their families
  • Avoidance of extended UV exposure
  • Use daily sunscreen

Prevention of further cancers or development of new cancer is important for patients and their families.

• Educate patient on how to evaluate suspicious moles using ABCDE mnemonic

Patients can easily self monitor any suspicious moles and report any changes or developments to their primary care provider or dermatologist.