Background: A 36year old Caucasian male who is a construction worker presented to his physician’s office complaining of several moles on his scalp and face that were “changing. ” The client noticed a color change on the moles and states “they’ve increased in size”. The borders on the facial moles are irregular. In addition; he states “the mole on his scalp is the worst”. One half does not look equal to the other half. The client states “the moles are very bothersome and they itch a lot”. Social History: Client did not finish high school; he has worked mediocre jobs since dropping out of school.
The client is a poor historian and he can’t say with certainty if he has a family cancer history. The client thinks that cancer means a death sentence when his physician shared his diagnosis of melanoma. Patient/ Family Centered Goals: I. Patient/ Family will have understanding of the treatments given for the disease by being able to recognize the complications that may occur II. Patient/ Family will be able decide on strategies that will aid in coping with anxiety/stress that may occur when being diagnosed/ or being close to someone diagnosed with cancer III.
Patient/ Family will understand the importance of maintaining a balanced diet IV. Patient/ Family will be able to recognize the signs & symptoms of infection Teaching Plan: 1. Patient teaching will take place when the patient is most awake and free of any medications that may affect their ability to learn/ observe the information being given. Patient will also express willingness to learn. 2. Family members that are going to be assisting in caring for the patient will be notified of the teaching ahead of time so they may be available to attend. 3.
Patient/ Family will demonstrate their understanding by performing any techniques taught 4. Patient/ Family will be given a pretest and posttest to help demonstrate their understanding of the knowledge given as well as informational handouts to take home 5. The information given will be in their language of choice. 6. Patient/ Family will be allowed appropriate time to ask questions Teaching Outline: i. Skin cancer Overview: Skin cancer is the most common form of cancer. It is an abnormal growth of skin cells. It can be caused by too much exposure to sunlight, which is its main cause.
Other causes include tanning lamps & beds and being exposed to toxic substances. There are three major types of skin cancer and where your cancer begins determines its type and the treatment options. It can begin in squamous cells ( cells on the outer surface of your skin/ the skins inner lining), basal cells (cells which produce new skin cells), and melanocytes (produce the pigment that gives skin color). There are different treatments from removal of the growth to chemotherapy. Tools: Nurse will speak in a clear understandable tone.
The nurse will allow time for any questions to provide clarification. Evaluation: Patient/ Family will be able to relay to the nurse their understanding of skin cancer by stating how it is caused and the different options for treatment. ii. Skin Cancer Treatments & their Complications/ Side Effects: There are different ways to treat skin cancer. It just depends on the type diagnosed. Small superficial skin cancers may be removed by a skin biopsy (removal of growth), freezing (freeze cancer and as it thaws it sloughs off), or laser therapy (light beam destroys the growth).
These treatments have little to no side effects. It may only cause some bleeding or scarring. Chemotherapy and radiotherapy are other options. Chemotherapy is when the physician uses a combination of drugs to kill off the cancer. Side effects include: bone marrow suppression, nausea, vomiting, fatigue and loss of hair. Patient is also at risk for toxic effects to the heart, lungs, and kidneys. Radiotherapy is the use of radiation to kill off cancer cells and prevent more from forming.
Side effects include: bone marrow depression, hair loss, loss of appetite, dry mouth, nausea, vomiting, skin changes, fatigue, and inflammation of the bladder & lungs. Tools: Nurse will effectively and clearly explain the different types of treatment and their side effects in terms easily understood. Patient/ Family will be allowed to ask questions. Evaluation: Patient/ Family will be able to recognize side effects that occur from treatment. Patient/ Family will be able to relay some of the side effects stated to the nurse to demonstrate their understanding.
iii. Coping with Anxiety/Stress: Many diagnosed patients and their family have a hard time coping with the diagnoses of cancer. It can out a strain on their life and be stressful. Many have difficulties managing this stress/ anxiety. There are support groups that they can attend. Effectively communicating the issues that are causing the anxiety amongst each other can also help. Tools: The nurse will explain that it is normal to feel anxiety/stress when being diagnosed with cancer.
There will be time to express feelings in regards to the illness in which the nurse will be empathetic and aide with strategies in coping. The nurse will teach relaxation and diversion activities as a method to cope with stress. The nurse will also show a video related to coping with stress Evaluation: Patient/ Family will inform the nurse that they will seek support groups and begin to communicate their feelings about the disease in order to aide in coping. The patient will demonstrate some of the techniques being taught. iv.
Recognizing Signs and Symptoms of Infection: Patient will use the A-B-C-D-E rule that is use to describe possible melanoma, A-asymmetrical shape, B-border, C-change in color, D-diameter, E- evolving and indentify broken lesions that oozing, scaliness, itching spreading Tools: Nurse will explain the importance of recognizing the signs and symptoms of infection and leave time for any questions or concerns. Evaluation: Pt able to comprehend and read back material containing signs and symptoms of melanoma, pt able to describe the differences of the ABCDE rule. v.
Maintaining Balanced Nutrition: It’s important to maintain a balanced diet while recovering because nutrition is an essential tool to aid in cell production and recovery. Nutrients aid in Circulatory responses and recovery as well. We are what we eat. Tools: Nurse will explain to patient/family the importance of a balanced meal in aiding with boosting the immune system. Nurse will also talk about foods that will aide in keeping a balanced meal. In addition, a consult for a nutritionist will be ordered. Evaluation: Patient/family will make a daily diet plan.
The patient will be able to verbally give examples/ explain the importance of maintain a balance meal. Pretest Skin Cancer 1. What are 2 treatment options used to treat skin cancer? a) Diet & exercise b) Personal therapy & Chemotherapy c) Freezing & Diet d) Chemotherapy & skin biopsy 2. What is a major cause of skin cancer? a) Exposure to toxic substances b) Poor diet c) Excessive exposure to sunlight d) Tanning beds 3. What are some side effects of chemotherapy? a) Nausea & hair loss b) Poor bladder control & scarring c) Poor concentration & dry mouth.
d) Vomiting & constipation 4. When should you IMMEDIATELY contact your physician? a) A rash occurs b) Hair loss occurs c) Trouble breathing or swallowing d) Mild redness to radiation site 5. What are some ways of coping with anxiety/ stress that may occur? a) Effective communication & support groups b) Physical therapy & support groups c) Diet & exercise d) Effective communication & sleep 6. How can the diagnosed patient prevent some fatigue? a) Complete all errands/ activities all at once b) Schedule activities with time to rest in between c) Get plenty of sleep.
d) Maintain diet 7. What are signs of infection? a) Nausea & fatigue b) Fever & foul smelling wound drainage c) Redness to radiation site & vomiting d) Fever & poor diet 8. It is important to maintain a balanced diet while undergoing cancer treatments. (circle one)TRUEFALSE 9. Chemotherapy is: a) The use of a combination of drugs to kill off the cancer cells b) Use of a beam of light to kill the cancer cells and prevent new ones from forming c) Removal of the entire skin cancer growth d) Freezing the growth so that it may slough off when thawed out 10. Radiotherapy is:
a) Use of a beam of light to kill cancer cells and prevent new ones b) A support group c) Removal of skin growth d) Use of a combination of drugs to kill the cancer cells Posttest Skin Cancer 1. What are signs of infection? a) Redness to radiation site & vomiting b) Fever & foul smelling wound drainage c) Nausea & fatigue d) Fever & poor diet 2. When should you IMMEDIATELY contact your physician? a) Mild redness to radiation site b) Hair loss occurs c) A rash occurs d) Trouble breathing or swallowing 3. Radiotherapy is: a) Removal of a skin growth b) A support group.
c) Use of a beam of light to kill cancer cells and prevent new ones d) Use of a combination of drugs to kill the cancer cells 4. What are 2 treatment options used to treat skin cancer? a) Freezing & Diet b) Chemotherapy & skin biopsy c) Diet & exercise d) Personal therapy & Chemotherapy 5. How can the diagnosed patient prevent some fatigue? a) Maintain diet b) Schedule activities with time to rest in between c) Complete all errands/ activities all at once d) Get plenty of sleep 6. What are some side effects of chemotherapy? a) Poor concentration & dry mouth b) Vomiting & constipation.
c) Nausea & hair loss d) Poor bladder control & scarring 7. Chemotherapy is: a) Removal of the entire skin cancer growth b) Use of a beam of light to kill the cancer cells and prevent new ones from forming c) Freezing the growth so that it may slough off when it thaws out d) The use of a combination of drugs to kill off the cancer cells 8. What are some ways of coping with anxiety/ stress that may occur? a) Diet & exercise b) Effective communication & sleep c) Effective communication & support groups d) Physical therapy & support groups 9. What is a major cause of skin cancer?
a) Excessive exposure to sunlight b) Tanning beds c) Poor diet d) Exposure to toxic substances 10. It is important to maintain a balanced diet while undergoing cancer treatments. (circle one)TRUEFALSE Answer Key: Pretest 1 D 2 C 3 A 4 C 5 A 6 B 7 B 8 TRUE 9 A 10 A Answer Key:
Posttest 1. B 2. D 3. C 4. B 5. B 6. C 7. D 8. C 9. A 10. TRUE Below are resources the nurse will use to aid in teaching the patient about their diagnoses. Where skin cancer develops: Mayo Clinic medical information and tools for healthy living – MayoClinic. com Video: Melanoma — Early-stage and advanced melanoma – MayoClinic. com.