1. ALTERATION IN SKIN
FUNCTION AND
INTEGRITY

2. 1. PROTECTS DEEPER TISSUES FROM:
A. MECHANICAL DAMAGE
B. CHEMICAL DAMAGE
C. BACTERIAL DAMAGE
D. ULTRAVIOLETRADAIATION
E. THERMAL DAMAGE
F. DESICCATION
2. AIDS IN BODY HEAT LOSS OR HEAT RETENTION
3. AIDS IN EXCRETION OF UREA AND URIC ACID
4. SYNTHESIZES VITAMIN D
INTEGUMENTARY SYSTEM

3. WHAT IS PSORIASIS???
PSORIASIS
*AN AUTOIMMUNE DISEASE THAT AFFECTS THE SKIN
*IS A NONCONTAGIOUS SKIN CONDITION THAT PRODUCES RED, DRY
PLAQUES OF THICKENED SKIN
*COMMONLY AFFECTS THE SKIN OF THE ELBOWS, KNEES, AND SCALP
*CONTROLLABLE WITH MEDICATION
*THERE ARE MANY PROMISING THERAPIES, INCLUDING NEWER
BIOLOGIC DRUGS

4. 1. NON-PUSTULAR PSORIASIS
A. PSORIASIS VULGARIS *
*CHRONIC STATIONARY PSORIASIS
*MOST COMMON FORM OF PSORIASIS.
B. PSORIATIC ERYTHRODERMA *
*ERYTHRODERMIC PSORIASIS
2. PUSTULAR PSORIASIS
A. GENERALIZED PUSTULAR PSORIASIS *
B. PERSISTENT PALMOPLANTAR PUSTULOSIS * *
C. ANNULAR PUSTULAR PSORIASIS *
D. ACRODERMATITIS CONTINUA *
E. IMPETIGO HERPETIFORMS *
CLASSIFICATION

5. 3. ADDITIONAL TYPES OF PSORIASIS:
A. DRUG INDUCED PSORIASIS
B. INVERSE PSORIASIS
C. NAPKIN PSORIASIS *
D. SEBBORRHEIC-LIKE PSORIASIS
E. GUTTATE PSORIASIS *
F. NAIL PSORIASIS *
G. PSORIATIC ARTHRITIS *

6. T CELLS OR T LYMPHOCYTES ARE TYPE OF WHITE BLOOD CELL THAT
NORMALLY WARDS OFF FOREIGN INVADERS (VIRUSES AND BACTERIA)
AND FIGHTS INFECTION. IN PSORIASIS, T CELLS ARE MISTAKENLY
ACTIVATED (AS IF TO HEAL A WOUND OR TO FIGHT AN INFECTION) AND
TRIGGER OTHER IMMUNE RESPONSES THAT SPEED UP THE GROWTH
CYCLE OF SKIN CELLS. A NORMAL SKIN MATURES AND FALLS OFF THE
BODY’S SURFACE IN 28-30 DAYS, BUT A PSORIATIC SKIN CELL TAKES
ONLY 3-4 DAYS TO MATURE AND MOVE TO THE SURFACE. INSTEAD OF
FALLING OFF (SHEDDING), THE CELLS PILE UP AND FORM LESIONS.
PATHOPHYSIOLOGY

7. OVERACTIVE T CELLS TRIGGER OTHER IMMUNE RESPONSES. THE
EFFECTS INCLUDE DILATION OF BLOOD VESSELS IN THE SKIN AROUND
THE PLAQUES AND AN INCREASE IN OTHER WHITE BLOOD CELLS THAT
CAN ENTER THE OUTER LAYER OF SKIN. THESE CHANGES RESULT IN AN
INCREASED PRODUCTION OF BOTH HEALTHY SKIN CELLS AND MORE T
CELLS AND OTHER WHITE BLOOD CELLS. THIS CAUSES AN ON-GOING
CYCLE IN WHICH NEW SKIN CELLS MOVE TO THE OUTERMOST LAYER OF
SKIN TOO QUICKLY — IN DAYS RATHER THAN WEEKS. DEAD SKIN AND
WHITE BLOOD CELLS CAN'T SLOUGH OFF QUICKLY ENOUGH AND BUILD
UP IN THICK, SCALY PATCHES ON THE SKIN'S SURFACE. THIS USUALLY
DOESN'T STOP UNLESS TREATMENT INTERRUPTS THE CYCLE.

8. THE CAUSE OF PSORIASIS ISN’T FULLY KNOWN, BUT IT'S THOUGHT
TO BE RELATED TO THE IMMUNE SYSTEM AND ITS INTERACTION WITH
THE ENVIRONMENT IN PEOPLE WHO HAVE THE GENETIC SUSCEPTIBILITY.
COMPROMISED SKIN BARRIER FUNCTION HAS A ROLE IN PSORIASIS
SUSCEPTIBILITY.
CAUSATIVE FACTORS

9. 1. INFECTIONS, SUCH AS STREP THROAT OR THRUSH
2. INJURY TO THE SKIN, SUCH AS A CUT OR SCRAPE, BUG BITE, OR A
SEVERE SUNBURN
3. STRESS
4. COLD WEATHER
5. SMOKING
6. HEAVY ALCOHOL CONSUMPTION
7. CERTAIN MEDICATIONS — INCLUDING LITHIUM, WHICH IS
PRESCRIBED FOR BIPOLAR DISORDER; HIGH BLOOD PRESSURE
MEDICATIONS SUCH AS BETA BLOCKERS; ANTIMALARIAL DRUGS; AND
IODIDES
PRECIPITATING FACTORS

10. 1. WHITE FLAKY LAYER OF SILVERY WHITE SCALES OVER THE PATCHED OF
INFLAMED SKIN (ERUPTIONS, USUALLY IN A SYMMETRICAL
DISTRIBUTION, COMMONLY LOCATED ON THE SCALP, ELBOWS,
KNEES, GENITAL AND SACRAL REGIONS)
2. KOEBNER’S PHENOMENON- LESIONS DEVELOP AT THE SITE OF INJURY
(TRAUMA, REPEAT RUBBING OR ABRASIONS)
3. AUSPITZ SIGN- A SPECIAL DIAGNOSTIC SIGN IN PSORIASIS; PULLING
OF ONE OF THESE SMALL DRY WHITE FLAKES OF SKIN CAUSES A TINY
BLOOD SPOT ON THE SKIN
4. ITCHING, BURNING OR SORENESS
5. GENERALIZED ERUPTION (IN SEVERE PSORIASIS VULGARIS)
CLINICAL MANIFESTATIONS

11. 6. GENERALIZED, STERILE CUTANEOUS PUSTULES OR PUS-FILLED,
YELLOWISH, SMALL BLISTERS (IN PUSTULAR PSORIASIS)
7. PINPOINT DEPRESSIONS OR WHITE SPOTS ON THE NAIL OR AS
LARGER YELLOWISH-BROWN SEPARATIONS OF THE NAIL BED CALLED
"OIL SPOTS" (NAIL PSORIASIS)
8. SEVERE DANDRUFF WITH DRY FLAKES AND RED AREAS OF SKIN
(SEBORRHEIC-LIKE PSORIASIS)
9. INFLAMMATION OF ANY JOINTS (PSORIATIC ARTHRITIS)
10. PSYCHOLOGICAL DISTRESS CAN LEAD TO SIGNIFICANT DEPRESSION
AND SOCIAL ISOLATION

12. 1. METABOLIC SYNDROME- A CLUSTER OF CONDITIONS THAT INCLUDE
HIGH BLOOD PRESSURE AND ELEVATED INSULIN LEVELS
2. INFLAMMATORY BOWEL DISEASE
3. CARDIOVASCULAR DISEASE
4. CANCER
5. THICKENED SKIN AND BACTERIAL SKIN INFECTIONS CAUSED BY
SCRATCHING IN AN ATTEMPT TO RELIEVE SEVERE ITCHING
6. FLUID AND ELECTROLYTE IMBALANCE IN THE CASE OF SEVERE
PUSTULAR PSORIASIS
7. DEPRESSION
COMPLICATIONS

13. 1. VISUAL EXAMINATION * *
2. SKIN BIOPSY *
3. X-RAY *
4. LAB TESTS
DIAGNOSTIC TESTS/EXAMS

14. 1. PHARMACOLOGICAL MANAGEMENT
A. TOPICAL
*TOPICAL CORTICOSTEROIDS (STEROIDS, SUCH AS
HYDROCORTISONE)
*VITAMIN D ANALOGUE CREAM CALLED CALCITRIOL
*MOISTURIZERS, ESPECIALLY WITH THERAPEUTIC
CONCENTRATIONS OF SALICYLIC ACID, LACTIC ACID,
UREA, AND GLYCOLIC ACID
*IMMUNOMODULATORS (TACROLIMUS AND PIMECROLIMUS)
*BATH SALTS OR BATHING IN HIGH-SALT-CONCENTRATION
WATERS *
* COAL TAR
* ANTHRALIN
MEDICAL MANAGEMENT

15. *Coal tar- A major advantage with tar is lack of skin thinning *
*Anthralin

16. B. SYSTEMIC DRUGS
*METHROTREXATE- IMPROVEMENTS IN THREE TO SIX WEEKS.
SEVERAL MONTHS MAY BE REQUIRED BEFORE MAXIMAL
BENEFITS ARE ACHIEVED.
*ACITRETIN- IMPROVEMENTS IN EIGHT TO SIXTEEN WEEKS,
THOUGH SEVERAL MONTHS MAY BE REQUIRED FOR
MAXIMAL BENEFIT.
*CYCLOSPORIN- IMPROVEMENTS IN AS FEW AS TWO WEEKS OF
TREATMENTS, BUT MAY REQUIRE SEVERAL MONTHS TO
ACHIEVE MAXIMUM BENEFIT. IN SOME CASES, PATIENTS
MAY CONTINUE WITH A MAINTENANCE LEVEL DOSAGE
AFTER CLEARANCE OCCURS.

17. TRADITIONAL SYSTEMIC DRUGS TEND TO HAVE ONE OR MORE OF
THE FOLLOWING SIDE EFFECTS:
 DECREASED KIDNEY FUNCTION
 HIGH CHOLESTEROL
 HIGH BLOOD PRESSURE
 LIVER DAMAGE
 DEPRESSION
 UPSET STOMACH OR NAUSEA
 SKIN CANCERS (PATIENTS WHO TAKE CYCLOSPORINE AFTER PUVA
THERAPIES HAVE A HIGHER INCIDENCE OF SQUAMOUS CELL SKIN
CANCER. THE RISKS ARE GREATEST WITH LONG-TERM AND PREVIOUS
USE OF PUVA, METHOTREXATE, OR OTHER IMMUNOSUPPRESSANTS.)
 EYE PROBLEMS

18. C. ADDITIONAL SYSTEMIC DRUGS
*ALEFACEPT (AMEVIVE)- T-CELL BLOCKERS
*ETANERCEPT (ENBREL)
*ADALIMUMAB (HUMIRA) TYPES OF TNF BLOCKERS
*GOLIMUMAB (SIMPONI)- NEWLY
EXPERIMENTED INJECTABLES

19. 2. PHOTOTHERAPY
A. UVB/ UVA PHOTOTHERAPY *
PRESENT IN NATURAL SUNLIGHT, UVB IS AN EFFECTIVE
TREATMENT FOR PSORIASIS. UVB PENETRATES THE SKIN AND SLOWS
THE GROWTH OF AFFECTED SKIN CELLS. TREATMENT INVOLVES
EXPOSING THE SKIN TO AN ARTIFICIAL UVB LIGHT SOURCE FOR A SET
LENGTH OF TIME ON A REGULAR SCHEDULE. THIS TREATMENT IS
ADMINISTERED IN A MEDICAL SETTING OR AT HOME.

20. THERE ARE TWO TYPES OF UVB TREATMENT, BROAD BAND AND
NARROW BAND. THE MAJOR DIFFERENCE BETWEEN THEM IS THAT
NARROW BAND UVB LIGHT BULBS RELEASE A SMALLER RANGE OF
ULTRAVIOLET LIGHT. NARROW-BAND UVB IS SIMILAR TO BROAD-BAND
UVB IN MANY WAYS. SEVERAL STUDIES INDICATE THAT NARROW-BAND
UVB CLEARS PSORIASIS FASTER AND PRODUCES LONGER REMISSIONS
THAN BROAD-BAND UVB. IT ALSO MAY BE EFFECTIVE WITH FEWER
TREATMENTS PER WEEK THAN BROAD-BAND UVB.

21. B. HOME UVB PHOTOTHERAPY
LIKE PHOTOTHERAPY IN A CLINIC, IT REQUIRES A CONSISTENT
TREATMENT SCHEDULE. INDIVIDUALS ARE TREATED INITIALLY AT A
MEDICAL FACILITY AND THEN BEGIN USING A LIGHT UNIT AT HOME. IT
IS CRITICAL WHEN DOING PHOTOTHERAPY AT HOME TO FOLLOW A
DOCTOR'S INSTRUCTIONS AND CONTINUE WITH REGULAR CHECK-
UPS. HOME PHOTOTHERAPY IS A MEDICAL TREATMENT THAT REQUIRES
MONITORING BY A HEALTH CARE PROFESSIONAL. ALL PHOTOTHERAPY
TREATMENTS, INCLUDING PURCHASE OF EQUIPMENT FOR HOME USE,
REQUIRE A PRESCRIPTION. SOME INSURANCE COMPANIES WILL COVER
THE COST OF HOME UVB EQUIPMENT. VENDORS OF HOME
PHOTOTHERAPY EQUIPMENT OFTEN WILL ASSIST YOU IN WORKING
WITH YOUR INSURANCE COMPANY TO PURCHASE A UNIT.

22. C. SUNLIGHT *
ALTHOUGH BOTH UVB AND ULTRAVIOLET LIGHT A (UVA) ARE
FOUND IN SUNLIGHT, UVB WORKS BEST FOR PSORIASIS. UVB FROM THE
SUN WORKS THE SAME WAY AS UVB IN PHOTOTHERAPY TREATMENTS.
SHORT, MULTIPLE EXPOSURES TO SUNLIGHT ARE RECOMMENDED. START
WITH FIVE TO 10 MINUTES OF NOONTIME SUN DAILY. GRADUALLY
INCREASE EXPOSURE TIME BY 30 SECONDS IF THE SKIN TOLERATES IT. TO
GET THE MOST FROM THE SUN, ALL AFFECTED AREAS SHOULD RECEIVE
EQUAL AND ADEQUATE EXPOSURE. REMEMBER TO WEAR SUNSCREEN
ON AREAS OF YOUR SKIN UNAFFECTED BY PSORIASIS. IT CAN TAKE
SEVERAL WEEKS TO SEE IMPROVEMENT.

23. D. PUVA/ PHOTOCHEMOTHERAPY *
LIKE UVB, ULTRAVIOLET LIGHT A (UVA) IS PRESENT IN SUNLIGHT.
UNLIKE UVB, UVA IS RELATIVELY INEFFECTIVE UNLESS USED WITH A
LIGHT-SENSITIZING MEDICATION PSORALEN, WHICH IS
ADMINISTERED TOPICALLY OR ORALLY. THIS PROCESS, CALLED PUVA,
SLOWS DOWN EXCESSIVE SKIN CELL GROWTH AND CAN CLEAR
PSORIASIS SYMPTOMS FOR VARYING PERIODS OF TIME.
STABLE PLAQUE PSORIASIS, GUTTATE PSORIASIS, AND PSORIASIS OF
THE PALMS AND SOLES ARE MOST RESPONSIVE TO PUVA
TREATMENT. THE MOST COMMON SHORT-TERM SIDE EFFECTS OF
PUVA ARE NAUSEA, ITCHING AND REDNESS OF THE SKIN. DRINKING
MILK OR GINGER ALE, TAKING GINGER SUPPLEMENTS OR EATING
WHILE TAKING ORAL PSORALEN MAY PREVENT NAUSEA.
ANTIHISTAMINES, BATHS WITH COLLOIDAL OATMEAL PRODUCTS OR
APPLICATION OF TOPICAL PRODUCTS WITH CAPSAICIN MAY HELP
RELIEVE ITCHING. SWELLING OF THE LEGS FROM STANDING DURING
PUVA TREATMENT MAY BE RELIEVED BY WEARING SUPPORT HOSE.

24. 3. LASER TREATMENT *
A. LASER UVB TREATMENT *
B. PULSED-DYE LASERS

25. 1. DEFICIENT KNOWLEDGE OF DISEASE AND ITS TREATMENT
A. EXPLAIN WITH SENSITIVITY THAT THERE IS NO CURE AND THAT
LIFETIME MANAGEMENT IS NECESSARY; THE DISEASE PROCESS CAN
USUALLY BE CONTROLLED.
B. REVIEW PATHOPHYSIOLOGY OF PSORIASIS AND FACTORS THAT
PROVOKE IT: ANY IRRITATION OR INJURY TO THE SKIN (CUT,
ABRASION, SUNBURN), ANY CURRENT ILLNESS, EMOTIONAL STRESS,
UNFAVORABLE ENVIRONMENT (COLD), AND DRUG (CAUTION PATIENT
ABOUT NONPRESCRIPTION MEDICATION).
NURSING DIAGNOSIS &
ITS MANAGEMENT

26. 2. IMPAIRED SKIN INTEGRITY RELATED TO LESIONS AND INFLAMMATORY
RESPONSE
A. EXAMINE THE SKIN IN GENERAL CIRCUMSTANCES
B. INSTRUCT THE PATIENT TO NOT PINCH OR SCRATCH THE SKIN AREA
C. PATIENT'S MOTIVATION FOR CONSUMING NUTRIENTS: HIGH IN
CALORIES AND HIGH IN PROTEIN
D. ENCOURAGE PATIENT TO PREVENT THE SKIN FROM DRYING OUT; DRY
SKIN CAUSES PSORIASIS TO WORSEN (KEEP SKIN MOIST)

27. E. INFORM PATIENT THAT WATER SHOULD NOT BE TOO HOT AND
SKIN SHOULD BE DRIED BY PATTING WITH A TOWEL.
F. TEACH PATIENT TO USE BATH OIL OR EMOLLIENT CLEANSING
AGENT FOR SORE AND SCALING SKIN.
3.DISTURBED BODY IMAGE RELATED TO EMBARRASSMENT OVER
APPEARANCE AND SELF-PERCEPTION OF UNCLEANLINESS
A. INTRODUCE COPING STRATEGIES AND SUGGESTIONS FOR
REDUCING OR COPING WITH STRESSFUL SITUATION TO FACILITATE
A MORE POSITIVE OUTLOOK AND ACCEPTANCE OF THE DISEASE.

28. 4. RISK FOR INFECTION RELATED TO HYPOPROTEINAEMIA
A. MONITOR VITAL SIGNS
B. EXAMINED FOR SIGNS OF INFECTION
C. PATIENT'S MOTIVATION TO IMPROVE NUTRITION: HIGH IN
CALORIES AND HIGH IN PROTEIN.
D. KEEP THE WOUND CLEAN
E. COLLABORATION ANTIBIOTICS

29. 1. PROMOTING HOME AND COMMUNITY-BASED CARE/TEACHING PATIENT
SELF-CARE
A. INSTRUCT THE CLIENT TO AVOID SUN EXPOSURE DURING
PHOTOCHEMOTHERAPY. THIS REGIMEN OF PHOTOTHERAPY WITH
ULTRAVIOLET A (PUVA) LIGHT DECREASES CELLULAR PROLIFERATION. PUVA
THERAPY RESULTS IN PHOTOSENSITIVITY AND THE CLIENT SHOULD AVOID
EXPOSURE TO SUNLIGHT DURING THIS TIME.
B. BE KNOWLEDGEABLE ABOUT TREATMENT, AND GIVE THE CLIENT
WRITTEN INSTRUCTIONS.
C. ADVISE PATIENT THAT THE TOPICAL AGENT ANTHRALIN LEAVES A
BROWNISHI-PURPLE STAIN THAT SUBSIDES WHEN TREATMENT STOPS.
LESIONS SHOULD BE COVERED TO PREVENT STAINING CLOTHING,
FURNITURE, AND BED LINENS.
ADDITIONAL
MANAGEMENT

30. D. ADVISE PATIENT THAT TOPICAL CORTICOSTEROID PREPARATIONS
ON FACE AND AROUND EYES PREDISPOSE TO CATARACT DEVELOPMENT.
FOLLOW STRICT GUIDELINES TO AVOID OVERUSE.
E. PROVIDE HELPFUL TIPS ON APPLICATION OF TAR PREPARATIONS.
F. TEACH PATIENT TO AVOID EXPOSURE TO SUN WHEN UNDERGOING
PUVA TREATMENTS.
G. REMIND PATIENT TO SCHEDULE OPHTHALMIC EXAMINATIONS ON A
REGULAR BASIS.

31. H. ADVISE FEMALE PATIENTS OF CHILDBEARING AGE THAT PUVA
THERAPY IS TERATOGENIC (CAN CAUSE FETAL DEFECTS). THEY MAY
WANT TO CONSIDER USING CONTRACEPTIVES DURING THERAPY.
I. ENCOURAGE PATIENT TO JOIN A SUPPORT GROUP AND TO
CONTACT THE NATIONAL PSORIASIS FOUNDATION FOR INFORMATION.

32. 1. DEMONSTRATES KNOWLEDGE AND UNDERSTANDING OF
DISEASE AND ITS TREATMENT
2. DEMONSTRATE SELF-ACCEPTANCE
3. ACHIEVES SMOOTHER SKIN AND CONTROL OF LESIONS
4. EXPERIENCES RELIEF OF ITCHING AND DISCOMFORT
5. EXPERIENCES NO COMPLICATIONS
EXPECTED PATIENT
OUTCOMES

33. WHAT IS SKIN CANCER??? *
-UNCONTROLLED GROWTH OF ABNORMAL SKIN CELLS
-GENERALLY DEVELOPS IN THE EPIDERMIS (THE OUTERMOST LAYER OF SKIN), SO
A TUMOR CAN USUALLY BE SEEN
-MOST COMMONLY DIAGNOSED TYPE OF CANCER. IT ACCOUNTS FOR NEARLY
HALF OF ALL CANCERS IN THE UNITED STATES. MORE THAN 2 MILLION CASES OF
BASAL AND SQUAMOUS CELL SKIN CANCER ARE FOUND IN THIS COUNTRY EACH
YEAR. MELANOMA, THE MOST SERIOUS TYPE OF SKIN CANCER, WILL ACCOUNT
FOR MORE THAN 75,000 CASES OF SKIN CANCER IN 2012.
-SECOND MOST COMMON CANCER IN YOUNG ADULTS AGED 15–34 IN THE UK
-NON-MELANOMA SKIN CANCERS ARE THE MOST COMMON SKIN CANCERS. THE
MAJORITY OF THESE ARE BASAL CELL CARCINOMAS
SKIN CANCER

34. 1. BASAL CELL CARCINOMA- PEARLY TRANSLUCENCY TO FLESHY COLOR,
TINY BLOOD VESSELS ON THE SURFACE, AND SOMETIME ULCERATION
WHICH CAN BE CHARACTERISTICS. THE KEY TERM IS TRANSLUCENCY. THIS
FORM OF SKIN CANCER IS THE LEAST DEADLY AND WITH PROPER
TREATMENT CAN BE COMPLETELY ELIMINATED, OFTEN WITHOUT SCARRING.
*
2. SQUAMOUS CELL CARCINOMA- COMMONLY PRESENTS AS A RED,
CRUSTED, OR SCALY PATCH OR BUMP. OFTEN A VERY RAPID GROWING
TUMOR. ULCERATION AND BLEEDING MAY OCCUR. WHEN SCC IS NOT
TREATED, IT MAY DEVELOP INTO A LARGE MASS. SQUAMOUS CELL IS THE
SECOND MOST COMMON SKIN CANCER. *
CLASSIFICATION

35. 3. MALIGNANT MELANOMA- ON APPEARANCE IS AN ASYMMETRICAL
AREA, WITH AN IRREGULAR BORDER, COLOR VARIATION, AND OFTEN
GREATER THAN 6 MM DIAMETER. MOST MELANOMAS ARE BROWN TO BLACK
LOOKING LESIONS. WARNING SIGNS OF MALIGNANT MELANOMA INCLUDE
CHANGE IN THE SIZE, SHAPE, COLOR OR ELEVATION OF A MOLE. OTHER
SIGNS ARE THE APPEARANCE OF A NEW MOLE DURING ADULTHOOD OR
NEW PAIN, ITCHING, ULCERATION OR BLEEDING. AN OFTEN-USED
MNEMONIC IS "ABCDE", WHERE A= ASYMMETRICAL, B= "BORDERS"
(IRREGULAR= "COAST OF MAINE SIGN"), C= "COLOR" (VARIEGATED), D=
"DIAMETER" (LARGER THAN 6 MM—THE SIZE OF A PENCIL ERASER) AND E=
"EVOLVING.“ *

36. PATHOPHYSIOLOGY

37. THE ROOT CAUSE OF SKIN CANCER HAS NOT BEEN DISCOVERED
BUT IT’S THOUGHT TO BE RELATED TO CELLULAR DNA MUTATION AND
FAILURE OF THE IMMUNE SYSTEM TO RESPONSE.
CAUSATIVE FACTORS

38. 1. LIGHT SKIN COLOR
2. SMOKING TOBACCO
3. HPV INFECTIONS
4. HISTORY OF SUNBURNS
5. EXCESSIVE SUN EXPOSURE
6. MOLES
7. CHRONIC NON-HEALING WOUNDS (CALLED MARJOLIN'S ULCERS)
8. PRECANCEROUS LESIONS
9. FAMILY HISTORY OF SKIN CANCER
10. WEAKENED IMMUNE SYSTEM
11. EXPOSURE TO RADIATION
12. AGING ( 50 & ABOVE)
13. EXPOSURE TO CERTAIN SUBSTANCES SUCH AS ARSENIC
PRECIPITATING FACTORS

39. 1. A SORE THAT WON’T HEAL
2. PRURITUS, PAIN ON THE SKIN
3. CHANGES IN EXISTING MOLE
4. A PEARLY OR WAXY BUMP (BCC)
5. STIFF AND PLAQUE PAPULE IN EARLY STAGE (BCC)
6. MARGINAL TRANSLUCENCY POTENTIAL ULCER (BCC)
7. A FLAT, FLESH-COLORED OR BROWN SCAR-LIKE LESION (BCC)
8. A FIRM, RED NODULE (SCC)
9. THE MARGIN OF ULCER ELEVATES AND FEATURES RED AND STIFF,
WHICH MANIFESTING AS CIRCULAR OR CAULIFLOWER-LIKE (SCC)
CLINICAL MANIFESTATION

40. 10. A FLAT LESION WITH A SCALY, CRUSTED SURFACE (SCC)
11. A LARGE BROWNISH SPOT WITH DARKER SPECKLES (M)
12. A MOLE THAT CHANGES IN COLOR, SIZE OR FEEL OR THAT
BLEEDS(M)
13. A SMALL LESION WITH AN IRREGULAR BORDER AND PORTIONS
THAT APPEAR RED, WHITE, BLUE OR BLUE-BLACK(M)
14. DARK LESIONS ON YOUR PALMS, SOLES, FINGERTIPS OR TOES,
OR ON MUCOUS MEMBRANES LINING YOUR MOUTH, NOSE,
VAGINA OR ANUS(M)

41. THE ABCD RULE :
IF YOU NOTICE ANY OF THE FOLLOWING SIGNS, THEN SEE YOUR
DOCTOR WITHOUT DELAY.
ASYMMETRY THE TWO HALVES OF YOUR MOLE DO NOT LOOK THE SAME.
BORDER THE EDGES OF YOUR MOLE ARE IRREGULAR, BLURRED OR
JAGGED.
COLOUR THE COLOUR OF YOUR MOLE IS UNEVEN, WITH MORE THAN
ONE SHADE.
DIAMETER YOUR MOLE IS WIDER THAN 6MM IN DIAMETER (THE SIZE OF
A PENCIL ERASER).

42. 1. CELLULITIS
2. RISK OF RECURRENCE
3. BRAIN METASTASES
4. CHEMOTHERAPY SIDE EFFECTS
5. FATIGUE
6. LIVER METASTASES
7. LUNG METASTASES
8. METASTASIS
9. STRESS, ANXIETY AND DEPRESSION
COMPLICATIONS

43. 1.SKIN EXAMINATION- THE DOCTOR WILL NOTE THE SIZE, SHAPE,
COLOR, AND TEXTURE OF THE SUSPICIOUS AREA. HE OR SHE WILL THEN
EXAMINE YOUR LYMPH GLANDS TO CHECK FOR SWELLING, A POTENTIAL
SIGN OF CANCER. *
2.SKIN BIOPSY
METHODS:
A. SHAVE BIOPSY *
B. PUNCH BIOPSY *
C. INCISIONAL BIOPSY *
D. EXCISIONAL BIOPSY *
DIAGNOSTIC
TESTS/EXAMS

44. 3. BLOOD TEST FOR LDH (LACTATE DEHYDROGENASE) LEVELS
4. MAGNETIC RESONANCE IMAGING
5. POSITRON EMISSION TOMOGRAPHY SCAN
6. SENTINEL LYMPH NODE MAPPING OR FINE NEEDLE ASPIRATION
7. STAGING
STAGE 0: THE CANCER INVOLVES ONLY THE TOP LAYER OF SKIN. IT IS
CALLED MELANOMA IN SITU.
STAGE I: THE GROWTH IS LESS THAN TWO MILLIMETERS DEEP.
STAGE II: THE GROWTH IS MORE THAN TWO MILLIMETERS DEEP.
STAGE III: THE CANCER HAS SPREAD BELOW THE SKIN TO CARTILAGE,
MUSCLE, BONE, OR TO NEARBY LYMPH NODES. IT HAS NOT
SPREAD TO OTHER PLACES IN THE BODY.
STAGE IV: THE CANCER HAS SPREAD TO OTHER PLACES IN THE BODY.

45. 1.PHARMACOLOGICAL MANAGEMENT
A.FLUOROURACIL CREAM (BRAND NAME CARAC OR EFUDEX)- A
TOPICAL ANTINEOPLASTIC
B.IMIQUIMOD (BRAND NAME ALDARA)- TOPICAL CREAM
ACTIVATES YOUR BODY'S OWN IMMUNE SYSTEM VIA A
MOLECULE CALLED TOLL-LIKE RECEPTOR 7 (TLR7), WHICH IN
TURN ACTIVATES INTERFERON-ALPHA TO FIGHT THE
CANCEROUS CELLS. IT IS USED TO TREAT SUPERFICIAL BASAL CELL
CARCINOMA.
MEDICAL MANAGEMENT

46. 2.SURGICAL MANAGEMENT AND OTHER THERAPIES
A.EXCISIONAL SURGERY *
B.LASER THERAPY *
C.MOHS SURGERY *
D.CURETTAGE AND ELECTRODESICCATION *
E.RADIATION THERAPY *
F.CHEMOTHERAPY
G.PHOTODYNAMIC THERAPY (PDT)
H.BIOLOGICAL THERAPY

47. 1.RISK FOR IMPAIRED SKIN/TISSUE INTEGRITY RELATED TO CUTANEOUS
LESIONS
A. ASSESS SKIN FREQUENTLY FOR SIDE EFFECTS OF CANCER THERAPY;
NOTE BREAKDOWN/DELAYED WOUND HEALING. EMPHASIZE
IMPORTANCE OF REPORTING OPEN AREAS TOCAREGIVER.
B. BATHE WITH LUKEWARM WATER AND MILD SOAP.
C.ENCOURAGE PATIENT TO AVOID VIGOROUS RUBBING AND
SCRATCHING AND TO PAT SKIN DRY INSTEAD OF RUBBING.
D. RECOMMEND WEARING SOFT, LOOSE COTTON CLOTHING; HAVE
FEMALE PATIENT AVOID WEARING BRA IF IT CREATES
PRESSURE.
NURSING DIAGNOSIS
AND ITS MANAGEMENT

48. E.ENCOURAGE LIBERAL USE OF SUNSCREEN/BLOCK AND BREATHABLE,
PROTECTIVE CLOTHING.
F.USE APPROPRIATE PERIPHERAL OR CENTRAL VENOUS CATHETER, DILUTE
ANTICANCER DRUG PER PROTOCOL AND ASCERTAIN THAT IV IS
INFUSING WELL;
G.ASSESS SKIN/IV SITE AND VEIN FOR ERYTHEMA, EDEMA, TENDERNESS;
WELTLIKE PATCHES, ITCHING/BURNING; OR SWELLING, BURNING,
SORENESS; BLISTERS PROGRESSING TO ULCERATION/TISSUE
NECROSIS.
H.WASH SKIN IMMEDIATELY WITH SOAP AND WATER IF ANTINEOPLASTIC
AGENTS ARE SPILLED ON UNPROTECTED SKIN (PATIENT OR
CAREGIVER)

49. I.ADVISE PATIENTS RECEIVING 5-FLUOROURACIL (5-FU) AND
METHOTREXATE TO AVOID SUN EXPOSURE. WITHHOLD
METHOTREXATE IF SUNBURN PRESENT.
J.REVIEW EXPECTED DERMATOLOGIC SIDE EFFECTS SEEN WITH
CHEMOTHERAPY, E.G., RASH, HYPERPIGMENTATION, AND PEELING
OF SKIN ON PALMS.
K.INFORM PATIENT THAT IF ALOPECIA OCCURS, HAIR COULD GROW BACK
AFTER COMPLETION OF CHEMOTHERAPY, BUT MAY/MAY NOT
GROW BACK AFTER RADIATION THERAPY.
L.ADMINISTER APPROPRIATE ANTIDOTE IF EXTRAVASATION OF IV SHOULD
OCCUR.

50. 2.RISK FOR INFECTION RELATED TO SURGICAL WOUND
A.TEACH THE PATIENT HOW TO CARE FOR THE WOUND
ASEPTICALLY.
B.COORDINATE A CONSISTENT, STANDARD PLAN SO THAT THE PATIENT
CAN BEGIN TO ASSUME CARE FOR THE WOUND.
C.IF THE WOUND IS LARGE AND INFECTED, KEEP IT DRY AND CLEAN. IF
IT HAS AN ODOR, CONTROL THE ODOR WITH ODOR-MASKING
SUBSTANCES SUCH AS OIL OF CLOVES OR BALSAM OF PERU IN THE
ROOM.
D.PROMOTE GOOD HAND-WASHING PROCEDURES BY STAFF AND
VISITORS. SCREEN AND LIMIT VISITORS WHO MAY HAVE
INFECTIONS.

51. E.EMPHASIZE PERSONAL HYGIENE.
F.MONITOR TEMPERATURE.
G.ENCOURAGE FLUIDS.
H.ASSESS ALL SYSTEMS (E.G., SKIN, RESPIRATORY, GENITOURINARY) FOR
SIGNS AND SYMPTOMS OF INFECTION ON A CONTINUAL BASIS.
I.MONITOR CBC WITH DIFFERENTIAL WBC AND GRANULOCYTE COUNT
AND PLATELETS, AS INDICATED.

52. 3.DEPRESSION/ANXIETY/LOW SELF-ESTEEM RELATED TO DIAGNOSIS OF SKIN
CANCER
A.LISTEN TO THE PATIENT’S FEARS AND ANXIETIES AND ACCEPT THE
PATIENT’S PERCEPTION OF HER OR HIS APPEARANCE.
B.ASSIST THE PATIENT AND SIGNIFICANT OTHERS TO HAVE REALISTIC
EXPECTATIONS.
C.HELP THE PATIENT PRESENT A PLEASANT APPEARANCE BY ASSISTING
WITH HAIR CARE AND CLOTHING. SOME PATIENTS EXPERIENCE
INCREASED SELF-ESTEEM WHEN THEY WEAR THEIR OWN CLOTHING
RATHER THAN HOSPITAL-ISSUED CLOTHING, IF HOSPITALIZATION IS
NEEDED.

53. D.IF HAIR LOSS OCCURS DURING RADIATION, ENCOURAGE THE PATIENT TO
WEAR ANY TYPE OF HEAD COVERING THAT IMPROVES BODY IMAGE,
SUCH AS BASEBALL CAPS, WIGS, SCARVES, OR BANDANAS.
E.IF IT IS APPROPRIATE, ARRANGE FOR THE PATIENT TO INTERACT WITH
OTHERS WHO HAVE A SIMILAR PROBLEM.
F.IF THE PATIENT HAS END STAGE DISEASE, LISTEN TO THE PATIENT’S AND
SIGNIFICANT OTHERS’ FEARS AND CONCERNS. IDENTIFY THE NEEDS
OF THE FAMILY, AND INVESTIGATE MECHANISMS FOR SUPPORT
FROM THE CHAPLAIN, THE AMERICAN CANCER SOCIETY, OR A LOCAL
HOSPICE.

54. 4.ACUTE/CHRONIC PAIN RELATED TO SURGERY/THERAPY/DISEASE PROCESS
A.DETERMINE PAIN HISTORY, FOR EXAMPLE, LOCATION OF PAIN,
FREQUENCY, DURATION, AND INTENSITY USING A RATING SCALE
(SCALE OF 0–10), OR VERBAL RATING SCALE—“NO PAIN” TO
“EXCRUCIATING PAIN”; AND RELIEF MEASURES USED. BELIEVE
CLIENT’S REPORT.
B.DETERMINE TIMING AND PRECIPITANTS OF “BREAKTHROUGH” PAIN
WHEN USING AROUND-THE-CLOCK AGENTS, WHETHER ORAL,
INTRAVENOUS (IV), TOPICAL, TRANSMUCOSAL, EPIDURAL, OR
PATCH MEDICATIONS.
C.EVALUATE PAINFUL EFFECTS OF PARTICULAR THERAPIES, SUCH AS
SURGERY, RADIATION, CHEMOTHERAPY, OR BIOTHERAPY. PROVIDE
INFORMATION TO CLIENT AND SO ABOUT WHAT TO EXPECT.

55. D.PROVIDE NONPHARMACOLOGICAL COMFORT MEASURES SUCH AS
MASSAGE, REPOSITIONING, AND BACK RUB; AS WELL AS
DIVERSIONAL ACTIVITIES, SUCH AS MUSIC, READING, AND TV.
E.ENCOURAGE USE OF STRESS MANAGEMENT SKILLS AND
COMPLEMENTARY THERAPIES SUCH AS RELAXATION TECHNIQUES,
VISUALIZATION, GUIDED IMAGERY, BIOFEEDBACK, LAUGHTER,
MUSIC, AROMATHERAPY, AND THERAPEUTIC TOUCH.
F.PROVIDE CUTANEOUS STIMULATION, SUCH AS HEAT AND COLD PACKS,
OR MASSAGE.
G.BE AWARE OF BARRIERS TO CANCER PAIN MANAGEMENT RELATED TO
CLIENT, AS WELL AS THE HEALTHCARE SYSTEM.
H.REFER TO STRUCTURED SUPPORT GROUP, PSYCHIATRIC CLINICAL NURSE
SPECIALIST, PSYCHOLOGIST, OR SPIRITUAL ADVISOR FOR
COUNSELING, AS INDICATED.

56. 1. DEMONSTRATES KNOWLEDGE AND UNDERSTANDING OF
DISEASE AND ITS TREATMENT
2. DEMONSTRATES SELF-ACCEPTANCE
3. PREVENT INFECTION
4. ABLE TO MANAGE/CONTROL PAIN
EXPECTED PATIENT
OUTCOMES