Nursing Clinical Practice Guide
Clinical Scenario: You are a nurse in a dermatology clinic. Mr. Johnson, a 70-year-old retired farmer, comes in for a routine check. During the skin assessment, you note several small, rough, reddish-brown, scaly patches on his bald scalp, the tops of his ears, and the back of his hands. He says they've been there for years and sometimes itch or catch on his shirt.
Nursing Intervention Strategy:1. Assessment: Document the location, size, number, and characteristics (color, texture, borders) of each lesion. Use a body diagram. Ask about changes in size, color, or sensation (itching, tenderness). Complete a full skin assessment.2. Nursing Diagnosis: Risk for impaired skin integrity related to presence of precancerous lesions. Deficient knowledge regarding sun protection and skin surveillance.3. Planning & Implementation:- Prepare for Procedure: Assist the provider with a biopsy if any lesion is suspicious (e.g., thickened, bleeding, rapidly growing). Set up for cryotherapy.- Patient Education: This is your primary role. Teach the "ABCDE" of melanoma for self-exam. Emphasize sun-protective behaviors: use broad-spectrum sunscreen (SPF 30+), reapply every 2 hours, wear wide-brimmed hats, long sleeves, and seek shade between 10 am and 4 pm.- Medication Administration: If prescribed topical 5-FU or imiquimod, teach proper application (usually once or twice daily to affected areas), expected skin reaction (redness, crusting, erosion—signs it's working), and skin care.4. Evaluation: Patient verbalizes understanding of sun protection measures and demonstrates proper skin self-examination technique. Patient follows up as scheduled for monitoring.
Patient Safety and Precautions: For patients undergoing cryotherapy, educate on post-procedure care: the lesion will blister, may darken, and will slough off in 1-2 weeks. Advise not to pick at it to prevent scarring or infection. For topical treatments, ensure they understand it is for external use only and to wash hands after application.
Nursing Procedure & Medication Flow
Topical 5-Fluorouracil (5-FU) Administration Education:1. Indication: Treatment of multiple or widespread actinic keratoses.2. Action: Antimetabolite that interferes with DNA synthesis in rapidly dividing cells (like AK cells).3. Nursing Points:- Apply a thin layer to affected areas with a gloved finger or applicator.- Use once or twice daily as prescribed for the full course (typically 2-4 weeks).- Key Point! Expected Reaction: Skin will become red, inflamed, crusted, and eroded. This indicates the medication is destroying abnormal cells. Reassure the patient this is normal but can be uncomfortable.- Avoid contact with eyes, nostrils, and mouth.- Sun exposure can worsen inflammation; strict sun avoidance is crucial during treatment.
A Word from Your Senior Nurse
"In dermatology nursing, your eyes and your patient teaching skills are your most powerful tools. Spotting that rough patch on a patient's ear during a routine exam isn't just a test question—it's an opportunity for early intervention that could prevent skin cancer. When you see a patient with significant sun damage, your education on sun protection can change their family's habits too. On the NCLEX, they're testing your knowledge, but in real life, you're using that knowledge to protect your patients. Always connect the lesion to the history, and the treatment to the education!"