Question

The nurse is caring for 75-year-old male client who reports liver spots in addition to a change in color and size to one of his moles. The nurse notes that the client is speaking loudly and answering questions inappropriately.

1. What information can the nurse provide the patient on the common causes and treatments of senile lentigines?
2. Explain the rationale for asking the client about his current medication.
3. Discuss the danger signs of pigmented lesions and the implications.
4. Compare and contrast basal cell carcinoma and malignant melanoma as far as causative factors and presentation
5. Discuss a common test used for assessing hearing acuity.

Answer 1

Causes of senile lentigines that a nurse should provide to the patient are :

• Ulrta violet radiation exposure can cause lentigo if the patient is having a fair skin. If the patient is exposed to sun a lot then it can occur, If the patient got radiation therapy or phototherapy then chances to develop lentigines are high.
• It can be inherited if there is a family history then chances are high.

Treatment of senile lentigines:

Senile lentigines are not very serious health issue, however the doctor may recomment any topical cream or medication to lighten the skin colour. Some medicines such as bleaching creams containing hydroquinone can be recommended, chemical peels, Or will provide light therapy to destroy melanocytes which darkens the skin pigmentation, freezing to be done to destroy skin darkening pigments.

Advise the patient to avoid sun exposure as much as he can, especially dring mid day time, and advise to always apply high quality sunscreen to prevent sun burn, long sleeve clothing can be wore.

Rationale of the patient's current medication is to know about the medicine what he takes, Explain him to take proper dose of medicine on time, not to skip the dose unless doctor advises, regular followups should be followed.

Danger signs of pigmented skin leisions are:

• Look for any unusual skin pigmentation change is an alarming sign
• Borders of the leisions are uneven.
• If it change colour, it is a danger sign
• If there is any bleeding, itching etc.,

Impliction of pigmented skin leision:

• Surgical excision is the only treatment . Delay in diagnosis can create a big problem.

Melanoma is atype of skin cancer. It generates in the skin cells known as melanocytes, It spread to the other parts of the body very fast. It actually develops as a mole and can arise in any part of the body. The treatment therapy is surgery, targeted therapy, Immunotherapy, radiation therapy. Melanoma is very aggresive disease, if it is not detected in early stage then the patient will die soon.

Basal cell carcinoma is a type of skin cancer. In this cells of the body grows abnormally and goes out of control. If this is not detected earlier it can spread to other parts of the body. This usually appears in the sun exposed areas of the body.

The nuse notes that the patient speaks loudly and answering inapropriately it is because he is having a hearing loss problem so the nurse should recommend the patient to the ENT doctor. An audiometer device is used to tst the hearing ability. An otoscope is used to check the ear for excessive ear wax, infection in the ear, eardrum is intact or not, any foreign body present in the ear or not, aeging problem, genetic problem, any trauma,certain injury tothe ear or whether the patient is taking any type of medicine which caused hearing loss.

The name of the ear test is Weber and Rinne. In this a vibrating tuning fork is placed near the ear and check whether the patient can feel/hear the vibrating sound.