NU 310 HA -Capstone Study

NU 310 HA -Capstone Study

NU 310 HA -Capstone Study

The following case presented a 77 year old male admitted to the medical surgical floor for community-acquired pneumonia.  His daughter brings to the nurse’s attention that the patient is concerned about a spot on his shoulder.  Skin lesions are common in the elder adult.  The most common ones mentioned were senile lentigines, seborrheic keratosis, sebaceous hyperplasia, acrochordons and actinic keratosis.  Senile lentigines are commonly known as “liver spots”.  They are flat tan, brown or black in color and it’s common with age.  Seborrheic keratosis appears as a waxy growth that is tan, brown or black in color.  This lesion is non-  cancerous. Sebaceous hyperplasia is a benign condition that manifests itself as a single or multiple lesions that are tan, yellow, soft small papules on the face.  It appears particularly in the nose, cheeks and forehead.  Acrochordons are known as “skin tags”.  They are benign tumors that appear where the skin forms creases.  Common areas are the neck, armpit and groin.  Actinic keratosis is seen as a rough scaly patch on the skin.  This caused by years of exposure to the sun.

A skin assessment is performed on the patient. Using a strong direct light source, a small ruler, a pen light and gloves, the skin inspection is done.  The first abnormal finding is on his hands are described to be most likely a senile lentigines (liver spots).  These are benign and common with age. The second abnormal finding is in his shoulder.  The lesion appears to be a raised isolated lesion that is crusted and black/brown in color. It appears to be a type of seborrheic keratosis. This is a non-cancerous lesion. The third lesion is in his nose and appears as an elevated solid lesion with a silvery white patchy texture.  This seems to be more like an actinic keratosis type of lesion which warrants an assessment by a physician to diagnose it as such.

In conclusion this study was quite interesting as it really teaches you what to look for when assessing the skin for lesions that may be cancerous.  Also as the study pointed out, this is a perfect time to teach the patient self-assessment using the ABCDE mnemonic.  A for Asymmetry, B for border, C for color, D for diameter and E for elevation and enlargement.

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