Nursing Care Plan (NCP) for Skin cancer – Melanoma, Basal Cell Carcinoma, Squamous Cell Carcinoma

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Outline

Pathophysiology

Skin cancer is an uncontrolled growth of abnormal skin cells. There are three main types of skin cancers:  Basal cell carcinoma is the most common, squamous cell carcinoma (also common), and melanoma (less common, more dangerous).

Etiology

UV radiation from the sun or tanning beds is the main cause of mutations in the DNA of skin cells which leads to skin cancers. Cumulative UV exposure over time may result in nonmelanoma cancers, while episodes of severe sunburns before the age of 18 can result in melanoma later in life.  A family history of skin cancer and immunosuppressant drugs increase the risk of developing skin cancers. Other, less likely causes may be repeated x-ray exposure, scars from burns, or occupational exposure to chemicals (arsenic).

Desired Outcome

The patient will be free from skin cancers, the patient is educated on prevention of skin cancers, the patient will be free from complications or metastasis

Subjective Data:

  • Itching
  • Painful bumps on the skin

Objective Data:

  • Shiny pink, red or pearly bumps on the skin
  • Skin growths with raised borders that are crusty in the center
  • The white, yellow or waxy area with irregular borders (may resemble a scar)
  • Open sore that does not go away (weeks)
  • Raised growth with a rough surface
  • Wart-like growth
  • Suspicious Mole (ABCDE)
    • Asymmetry
    • Borders
    • Color
    • Diameter
    • Elevation

Nursing Interventions and Rationales

Nursing Intervention (ADPIE) Rationale
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) educate patient on what is being done. Help prepare any supplies or equipment needed to perform the task. 
Assess and manage pain  patients may experience pain after a procedure.
Monitor for signs of infection following biopsy or excision (pus, odor, color) after a biopsy, there may be an open wound which increases risk of infection 
Apply/Administer Medications  more superficial basal cell carcinomas may just require topical medications whereas more advanced stage cancer like melanoma may require other medications, watch for any adverse reaction after medication given 
Education on prevention-

Avoidance of UV exposure

Wearing sunscreen, hats, long sleeves, sunglasses)

Avoiding tanning beds 

ABCDE mnemonic 

patients can easily self-monitor themselves from home and report any suspicious changes in their skin to their doctor or a dermatologist 

Writing a Nursing Care Plan (NCP) for Skin cancer – Melanoma, Basal Cell Carcinoma, Squamous Cell Carcinoma

A Nursing Care Plan (NCP) for Skin cancer – Melanoma, Basal Cell Carcinoma, Squamous Cell Carcinoma starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

https://www.mayoclinic.org/diseases-conditions/basal-cell-carcinoma/diagnosis-treatment/drc-20354193

https://my.clevelandclinic.org/health/diseases/15818-skin-cancer

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Transcript

Hey everyone, today, we’re going to be creating a nursing care plan for skin cancer. That includes melanoma, basal cell carcinoma, and squamous cell carcinoma. So if you’re ready, let’s get started. We’re going to first go over pathophysiology. So skin cancer is an uncontrolled growth of abnormal skin cells. There are three types of skin cancers: basal cell carcinoma is the most common, squamous cell carcinoma is also common, and melanoma, which is less common, is more dangerous. Nursing considerations: you want to do a full head to toe assessment, assist with skin biopsy, manage pain, monitor for signs of infection, administer medications, and educate patient on preventing skin cancer. Desired outcome: the patient will be free from skin cancer. The patient will be educated on prevention of skin cancers, and the patient will be free from complications or metastasis. 

Okay, we’re going to go ahead and get started on a care plan. So we’re going to be going through some subjective data and we’re going to go through some objective data. So what are we going to see with these patients? The patient may be complaining of some itchiness or some painful bumps. You might also see shiny pink or red pearly bumps. You may also see white, yellow, or waxy spots with an irregular border. Other things to consider that you might see are some skin growth with raised borders that are crusty in the center, or an open sore that doesn’t go away. Assess a suspicious mole using the mnemonic A, B, C, D, E. 

So interventions. We want to make sure we’re doing an assessment from head to toe. You want to make sure that we’re noting areas of suspected skin cancers and their size and characteristics. We want to make sure we’re getting baseline data to determine if the growth continues to spread or if the treatment is being effective. Another invention we’re going to be doing is to prepare the patient by assisting with the biopsy of the skin lesions. This is performed by a punch or scalpel. So we want to educate the patient on what is being done. We want to help prepare any supplies or equipment that’s needed and able to perform this task. Another invention we want to do, we want to make sure we’re managing pain as some patients may experience pain after a procedure. So we may want to give them some pain medication as needed. We’re going to monitor for signs of infection following a biopsy. So, odor and color after a biopsy as it may be an open wound which would increase their risk of the infection. 

Another intervention we want to do is apply or administer any sort of medications.The more basal cell carcinomas usually just require a topical medication, whereas advanced stage cancers, like melanomas, may require other medications. So we want to watch for any sort of adverse reactions with any medication that is given. We also want to make sure we’re educating on prevention. This is a biggie: prevention of skin cancer. So what are we going to educate them on? We want them to avoid UV exposure, and want to make sure they’re wearing sunscreen when they are in the sun. They can also wear some hats, long sleeve shirts, and make sure they’re wearing sunglasses. They want to avoid tanning booths – huge, huge avoiding tanning beds and tanning booths. Another big thing is the pneumonic, A, B, C, D E. So patients can easily self monitor themselves from home and report any suspicious changes in their skin to their doctor or dermatologist. 

Hey, we’re going to go over the key points. So skin cancer is an uncontrolled growth of abnormal cells. The main causes are tanning beds and UV radiation. Subjective and objective data: may complain of itchiness, painful bumps on the skin, shiny pink pearly bumps, skin growth with raised borders, open source that do not go away, wart-like growth, white, yellow, or waxy area with irregular borders. We want to do a full head to toe assessment. You’ll assist in skin biopsy of lesions and monitor for signs of infection post biopsy. We’ll want to make sure we’re applying or administering medications. And the big thing is education – educating the patient on preventing skin cancer. All right. And that we have a completed care plan. 

You guys did amazing. We love you guys. Go out, be yourselves today and, as always, happy nursing.

 

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