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NRSG 200: Med Surg 3 > [Exam 1] Chapter 61: Management of Patients with Dermatologic Disorders > Flashcards

[Exam 1] Chapter 61: Management of Patients with Dermatologic Disorders Flashcards

1
Q

Malignant Skin Tumors: Leading preventable cause of skin cancer?

A

Exposure to UV radiation, including sun and artifical UV rays

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2
Q

Malignant Skin Tumors: Over 99% of skin cancers include what?

A

Melanoma

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3
Q

Malignant Skin Tumors: The two most common types of nonmelanoma skin cancers are?

A

Basal Cell Carcinoma and Squamous Cell Carcinoma

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4
Q

Malignant Skin Tumors, BCC and SCC: Stats about BCC?

A

Rarely associated with morbidity and rarely causes men. 80% of men and 90% of women have this.

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5
Q

Malignant Skin Tumors, BCC and SCC: Stats about SCC?

A

Second most prevalent skin cancer.

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6
Q

Malignant Skin Tumors, BCC and SCC, CMs: Where does BCC appear?

A

On sun-exposed areas of body such as face,, neck, hands, and scalp.

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7
Q

Malignant Skin Tumors, BCC and SCC, CMs: How does a BCC begin as?

A

Small, waxy nodule with rolled, translucent, pearly borders. Undergoes central ulceration and sometimes crusting. Appears frequently on face.

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8
Q

Malignant Skin Tumors, BCC and SCC, CMs: Does BCC reoccur?

A

Rarely metastasizes, but recurrence is common.

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9
Q

Malignant Skin Tumors, BCC and SCC, CMs: A neglected BCC lesion can result in?

A

Loss of a nose, an ear, or a lip.

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10
Q

Malignant Skin Tumors, BCC and SCC, CMs: What is a SCC?

A

A malignant proliferation arising from the epidermis.

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11
Q

Malignant Skin Tumors, BCC and SCC, CMs: Precursor of SCC is usually what

A

actinic keratosis.

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12
Q

Malignant Skin Tumors, BCC and SCC, CMs: What does SCC arise from?

A

Appears on sun-damaged skin, but may arise from normal s kin or pre-existing lesions.

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13
Q

Malignant Skin Tumors, BCC and SCC, CMs: Why is SCC a greater concern than BCC?

A

Because it is invasive carcinoma, and metastasizing by blood or lymph system in 8% of cases

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14
Q

Malignant Skin Tumors, BCC and SCC, CMs: SCC appears how?

A

As a rough, thickened, scaly tumor that may be asymptomatic or may involve bleeding. Border may be wider. more inflammatory

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15
Q

Malignant Skin Tumors, BCC and SCC, CMs: What secondary thing can occur with SCCs?

A

Secondary infection.

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16
Q

Malignant Skin Tumors, BCC and SCC, CMs: Common sites for SCC?

A

Upper extremities and of the face. lower lip, ears, nose, and forehead.

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17
Q

Malignant Skin Tumors, BCC and SCC, Medical Mx: Treatment method depends on?

A

Tumor location, cell type, cosmetic desires of patient, and whether it is invasive.

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18
Q

Malignant Skin Tumors, BCC and SCC, Medical Mx: The management of BCC and SCC includes surgical excision, which may include?

A

Mohs micrographic surgery, electrosurgery, or cryosurgery.

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19
Q

Malignant Skin Tumors, BCC and SCC, Medical Mx: What are some alternatives for those not surgical candiates?

A

Radiation therapy, photodynamic therapy or topical chemotherapeutic creams

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20
Q

Malignant Skin Tumors, BCC and SCC, Surgical Mx: Best way to maintain cosmetic appearance?

A

Place the incision properly along natural skin tension lines and natural anatomic body lines.

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21
Q

Malignant Skin Tumors, BCC and SCC, Surgical Mx: What is done when tumor is large?

A

Reconstructive surgery with use of a skin flap or skin grafting. Incsion closed in layers to enhance cosmetic effect.

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22
Q

Malignant Skin Tumors, BCC and SCC, Surigal - Mohs Micrographic Surgery: What is this?

A

Most accurate surgical technique and best conserves normal tissue. Removes tumor layer by later.

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23
Q

Malignant Skin Tumors, BCC and SCC, Surigal - Mohs Micrographic Surgery: What doees the first layer excised include?

A

All evident tumor and a small margin or normal-appearing tissue. Specimen frozen and analyzed to see if tumor removed, if not, another layer shaved.

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24
Q

Malignant Skin Tumors, BCC and SCC, Surigal - Mohs Micrographic Surgery: Whar part of the body is this most useful on?

A

ARound the eyes, nose, upperlip. and auricular and periauricular areas

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25
Q

Malignant Skin Tumors, BCC and SCC, Surgical - Electrosurgery: what is this?

A

Destruction or removal of tissue by electrical energy. Current converted to heat, which then passes to tissue from cold electrode.

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26
Q

Malignant Skin Tumors, BCC and SCC, Surgical - Electrosurgery: This may eb preceded by what?

A

Curettage (excising the skin tumor by scraping its surface with a curette)

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27
Q

Malignant Skin Tumors, BCC and SCC, Surgical - Electrosurgery: After this, electrodesiccation is done why

A

to achieve homeostasis and destroy any viable malignant cells at the base of the wound or its edges. Useful for lesions smaller than 1-2 cm.

28
Q

Malignant Skin Tumors, BCC and SCC, Surgical - Electrosurgery: This method takes advantage of what?

A

That utmor is softer than surrounding skin and can be outlined by a curette, which feels for the extent of the tumor. Usually repeated twice, and healing within 1 month

29
Q

Malignant Skin Tumors, BCC and SCC, Surgical - Cryosurgery: How does this work

A

DEstroys tumor by deep-freezing the tissue. Needle inserted into skin and liquid nitrogen directed to center of tumor.

30
Q

Malignant Skin Tumors, BCC and SCC, Surgical - Cryosurgery: What happens to tumor here?

A

Tissue is frozen, allowed to that, and then refrozen. Site thaws naturally and then becomes gelatinous and heals spontaneously.

31
Q

Malignant Skin Tumors, BCC and SCC, Non-Surgical Alternatives: What are two options that can be done?

A

Local radiation therap or PDT

32
Q

Malignant Skin Tumors, BCC and SCC, Non-Surgical Alternatives: What does PDT involve?

A

Application of 5-aminolevulinic acid to the lesion, which is followed by photoactivation with directed blue light for approximately 1 hour. Destroys neoplastic cells.

33
Q

Malignant Skin Tumors, BCC and SCC, Non-Surgical Alternatives: Problem with PDT?

A

Skin may become red and blistered after any of these therapies

34
Q

Malignant Skin Tumors, BCC and SCC, Nurse Mx: Patient is advised to watch for what?

A

Excessive bleeding and tight dressings that compromise circulation.

35
Q

Malignant Skin Tumors, BCC and SCC, Nurse Mx: What is done after sutures are removed?

A

Emollient cream may be used to prevent dryness.

36
Q

Malignant Skin Tumors, BCC and SCC, Nurse Mx: Follow-up exams should occur how often?

A

At regular intervals, usually every 3 months for a year. Should include palpation of adjacent lymph nodes.

37
Q

Malignant Skin Tumors, Melanoma: Wht is this?

A

Nancerous neoplasm characterized by neoplastic melanocytes present in the epidermis and the dermis.

38
Q

Malignant Skin Tumors, Melanoma: How deadly is this?

A

It is the most lethal

39
Q

Malignant Skin Tumors, Melanoma, CMs: This may manifest as what>?

A

Change in the nevus or a new growth on the skin arising from cutaneous epidermal melanocytes.

40
Q

Malignant Skin Tumors, Melanoma, CMs: Malignant melanoma looks how

A

dark, red, or blue colored, or a mix of any of these and irregular in shape.

41
Q

Malignant Skin Tumors, Melanoma, CMs: What may this be associated with?

A

Itching, rapid growth, ulceration, and bleeding. Found mmore commonly in lower extremities.

42
Q

Malignant Skin Tumors, Melanoma, CMs: Can occur in what forms?

A

Superficial Spreading of Melanoma (SSM)

Lentigo Maligna Melanoma (LMM)

Nodular Melanoma (NM)

Acral LEntiginous Melanoma (ALM)

43
Q

Malignant Skin Tumors, Melanoma, CMs: In rare instances, melanomas may develop where?

A

In the uveal tract of the eye or from the mucosal lining of the GI or GU tract

44
Q

Malignant Skin Tumors, Melanoma, CMs: Spread in what two growth phases?

A

Radial and vertical

45
Q

Malignant Skin Tumors, Melanoma, CMs: What occurs during the first growht phase ,the radial phase?

A

Cutaneous melanomas tend to spread radially within the layer of the epidermis. Is most amenable to treatment

46
Q

Malignant Skin Tumors, Melanoma, CMs: What occurs during the second growth phase, the vertical phase?

A

Characterized by vertical tumor growth into the dermal layer and eventual metastasis.

47
Q

Malignant Skin Tumors, Melanoma, Assess/Diagnostic: What confirms the diagnosis of melanoma?

A

Biopsy results

48
Q

Malignant Skin Tumors, Melanoma, Assess/Diagnostic: Excisional biopsy provides information on what

A

type, level of invasion, adn thickness of lesion. Includes a 1-2 cm margin of normal tissue.

49
Q

Malignant Skin Tumors, Melanoma, Assess/Diagnostic: When should incisional biopsy be performed?

A

When suspicious lesion is too large to be removed safely without extensive scarring.

50
Q

Malignant Skin Tumors, Melanoma, Assess/Diagnostic: What should a thorough history and physicl exam include?

A

A meticulous skin exam and palpation of regional lymph nodes that drain the lesional area.

51
Q

Malignant Skin Tumors, Melanoma, Assess/Diagnostic: What is usually performed after diagnosis of melanoma is confirmed?

A

Chest X-Ray, CBC, complete chemistry panel with creatinine, liver function tests, and lactate dehydrogenase (LDH) performed

52
Q

Malignant Skin Tumors, Melanoma, Assess/Diagnostic: How will LDH levels be here?

A

Elevated in presence of metastatic disease.

53
Q

Malignant Skin Tumors, Melanoma, Assess/Diagnostic: Depending on results, what diagnostic tests can be performed?

A

MRI of brain, CT scans of chest, abdomen, or pelvivs, and PET scan of the lymphatics.

54
Q

Malignant Skin Tumors, Melanoma, Assess/Diagnostic: Staging of tumors follows what system?

A

TNM

55
Q

Malignant Skin Tumors, Melanoma, Medical Mx: What is the treatment of choice for small, superficial lesions?

A

Surgical excision

56
Q

Malignant Skin Tumors, Melanoma, Medical Mx: Deeper lesiosn require what?

A

Wide, local excision where skin grafting may be necessary

57
Q

Malignant Skin Tumors, Melanoma, Medical Mx: Sentinel lymph node biopsy performed why

A

to examine the nodes nearest the tumor and to spare the patient the long-term sequelae of extensive removal of lymph nodes.

58
Q

Malignant Skin Tumors, Melanoma, Medical Mx: What genetic mutation do most people have which helps in guiidng targeted therapy?

A

BRAF

59
Q

Malignant Skin Tumors, Melanoma, Medical Mx: Patients with Stage II/III considered at risk for relapse are typically prescribed what?

A

High-dose interferon alpha-2 IV for 4 weeks, followed by subcutaneous dosing for an additional 48 weeks. Helps with decreased rates of relapse.

60
Q

Care of Pt With Melanoma, Assess: The patient is asked specifially about what

A

pruritus (itching), tenderness, and pain which are not features of benign nevus.

61
Q

Care of Pt With Melanoma, Assess: Moles can be assessed by using ABCDE, which stand for what

A 
A: Asymmetry 
B: Irregular Broder
C: Variegated Color
D: Diameter
E: Evolving
62
Q

Care of Pt With Melanoma, Assess: Common sites of melanomas include

A

skin of the back, legs, between toes, and on the feet, face, scalp, fingernails and back of hands.

63
Q

Care of Pt With Melanoma, Assess: Potential problems from this?

A

Metastasis

64
Q

Care of Pt With Melanoma, Reducing Anxiety: Support includes what

A

encouargign the patient to express anxieities and feelings about serousness of neoplasm

65
Q

Care of Pt With Melanoma, Monitoring/Managing Complications: What would cause a greater likelihood ofmetastasis?

A

A deeper and thicker melanoma

66
Q

Care of Pt With Melanoma, Monitoring/Managing Complications: Signs of metastasis may include?

A

Lung (difficult breathing, SOB)

Bone (Pain, decreased mobility, fractures)

Liver (change in liver enzyme levels, pain, jaundice)

NRSG 200: Med Surg 3 (46 decks)

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