nursing.elitecme.com Page 81 Complete Your CE Test Online - Click Here in the United States. Its effects range from mild, easily curable lesions, to devastating, life-threatening malignancies [9,13]. Basal cell cancer Basal cell cancer is the most common type of skin cancer in all ethnicities especially those with Caucasian ancestry. It is primarily due to sun exposure [9,13]. Fortunately, if diagnosed early, 95% of basal cell cancers can be cured [14]. This type of skin cancer can occur on any exposed surface of the skin, but is most common on the face, head, neck, nose, and ears [9,13]. There are three types of basal cell cancers: ● ● Oduloulcerative lesions: Usually found on the face, these lesions are small, smooth, pink, and translucent papules. As they grow, their centers become depressed with firm, elevated borders. They seldom metastasize, but if untreated they can become infected or lead to hemorrhage if they grow into large blood vessels [13]. ● ● Superficial basal cell lesions: Commonly found on the chest and back, these cancers are oval or irregular in shape, lightly pigmented, and have clearly defined, slightly elevated threadlike borders. They look scaly and may be mistaken for psoriasis or eczema. These lesions are associated with ingestion of or exposure to arsenic- containing substances. ● ● Sclerosing basal cell lesions: These lesions are waxy, yellow to white plaques and do not have clearly defined borders. They are most often found on the head and neck and appear in patches. Nursing consideration: Report suspicious lesions for medical follow-up. Diagnosis is based on appearance and biopsy. Treatment involves careful excision and, possibly, chemotherapy and/or radiation depending on the extent of the lesion [14]. Squamous cell cancer Squamous cell cancer is the second most common type of skin cancer in those with Caucasian ancestry and the most common type of skin cancer in persons with dark skin [9]. It is an invasive tumor that has the potential to metastasize. Clues to the existence of squamous cell cancer include changes in existing skin lesions (e.g. moles, warts) or the appearance of a new lesion that ulcerates and fails to heal. This type of skin cancer, if diagnosed and treated early, is very curable, but if it spreads, it can lead to disability or death [14]. Squamous cell tumors often develop on the face, ears, and dorsa of the hands and forearms. Risk factors for this type of skin cancer include sun overexposure and/or overexposure to X-rays as wells as radiation therapy, chronic irritation of the skin, and ingestion of arsenic-containing substances. It is most commonly found in fair-skinned, white men older than 60 years of age [14]. Diagnosis is based on appearance and biopsy. Treatment includes excision, and if the tumor is extensive, radiation therapy, and/or possibly chemotherapy. Malignant melanoma Malignant melanoma is the most serious of all skin cancers and is responsible for more than 75% of all deaths due to skin cancer. Melanoma lesions may grow from an existing mole or appear as a new lesion. In appearance, melanoma lesions grow and become brown, black, or multicolored. They develop nodules or plaques with irregular black outlines. Melanomas may crust or bleed and are usually larger than six millimeters (mm) in diameter [9,14]. Nursing consideration: Some people may assume that skin cancers are minor problems and may ignore signs of skin malignancies because they assume it is “no big deal.” Be sure to emphasize to patients and their families how important it is to report any signs and symptoms of skin cancer to their healthcare providers immediately as skin cancers can be serious and even fatal! Skin assessment and care is very important. Older patients require more frequent position changes because of the decrease in peripheral blood flow. Blood flow is even more compromised by external pressure caused by the body remaining in a stationary position. It is important when moving an older person, that it is done as to not cause a shearing injury, leading to skin breakdown, i.e., older adults should be lifted when able, instead of sliding. Because of the fragility of the older adult person’s skin and its decreasing sensation, they have a high risk of skin breakdown. A slight cut may go unnoticed until it becomes infected. Sitting or sleeping for long periods of time in one position may lead to redness and even breakdown of the skin over bony prominences. Persons who rely on wheelchairs for their mobility are at particular risk for skin breakdown over the sacrum and gluteal areas [9,14]. Patient/family education An important part of skin assessment should include patient education regarding the prevention of skin cancers. Advise patients to avoid exposure to the sun, especially between the hours of 10 AM and 4 PM. Sunscreen should be used year-round and clothing should cover the arms and legs when spending time in the sun. A broad-brimmed hat should be worn to protect the face and scalp. Patients should perform regular skin checks to monitor the appearance of new lesions or detect changes in old ones. Be sure to explain the potential for photosensitivity that some medications can cause. Encourage patients to have an adequate intake of vitamin D, since this vitamin may actually lower the risk for certain cancers [14]. Educate patients as to how to prevent or reduce their risk for skin breakdown. Here are some points to include in patient/family education [9,13,14]: ● ● Eat a nutritious diet. Proper nutrition helps all body systems maintain a healthy balance. ● ● Encourage adequate hydration. Older adults dehydrate easily and need adequate amounts of fluid. Discourage excessive intake of caffeine and alcohol. ● ● Avoid sitting or lying in one position for extended periods of time. Change positions frequently. If using a wheelchair for mobility, change your position by lifting the weight off the buttocks several times every hour. ● ● Massage bony prominences such as the heels, hips, and elbows. Apply moisturizing lotion with gentle motions. Vigorous massage may bruise or tear the skin. Avoid lotions with large amounts of perfume as these can further dry the skin. ● ● Examine the skin for reddened areas, cuts, abrasions, and lacerations, as well as newly developing or changing moles, lesions, or freckles. Seek medical attention for areas that fail to heal, bleed, swell, become red and warm to the touch, drain pus or foul-smelling discharge and/or change in appearance. ● ● Avoid having bath or shower water too hot. Be sure that sensitive areas of the skin are dried thoroughly after bathing. For example, if moisture is allowed to collect in the genital areas and underneath breasts, skin integrity may be compromised. ● ● Avoid wearing clothing that is too tight or rubs or irritates the skin which can lead to skin breakdown. ● ● Avoid wearing shoes that are too tight or too loose which can irritate or damage skin. Nursing consideration: Help older adults to identify a family member, close friend, or caregiver to help perform skin examination and skin care as needed. It may not be possible to examine the entire body without help. Teach patients who are examining their own skin to use a long-handled mirror to visualize hard-to-see areas such as the back and buttocks. Cosmetic skin changes due to aging may cause a negative change in body image in the older adult. Monitor older adults for signs of depression or unrelieved stress and anxiety related to appearance. Never assume that because a patient is “old” that s/he may not be concerned about physical appearance. Remember that pride in appearance is a life-long trait and should be considered when working with patients of all ages. The cardiovascular system Mr. Lewis is 80 years old. He is hypertensive, has elevated cholesterol, and suffered a moderately significant myocardial infarction one year ago. He takes his medications on schedule but does not follow his recommended low-fat, low cholesterol diet. Mr. Lewis arrives at his physician’s office for a routine check-up. The nurse performs the initial assessment and reviews his lab work, which indicates that his cholesterol