Integumentary Lecture 2026

Integumentary Nur261 THERMAL BURNS (most common) Mechanism: • Direct contact with flames, hot liquids (scalds), hot objects, steam Burn Injuries (Type by mechanism) • Tissue destruction from heat transfer causing protein denaturation and cell death Clinical Presentation: • Erythema, blistering, charring depending on depth • Clear demarcation between burned and unburned tissue • Scald burns often have irregular borders • Flame burns may show circumferential involvement Associated Risks: • Inhalation injury if enclosed space/fire • Carbon monoxide poisoning • Cyanide toxicity CHEMICAL BURNS Mechanism: • Acid or alkali contact with skin • Alkali burns deeper and more severe Clinical Presentation: • May not appear severe initially but damage continues Burn Injuries (Type by mechanism) • Tissue destruction progresses over hours • Surrounding tissue inflammation • Alkali: soapy, slippery sensation; deeper penetration • Acid: coagulation creates eschar that limits depth Critical Nursing Action: • Continuous irrigation with copious water/saline for 20+ minutes minimum • Remove all contaminated clothing while irrigating • DO NOT neutralize • Brush off dry chemicals before irrigation Burn Injuries (Type by mechanism) ELECTRICAL BURNS Mechanism: Electrical current passes through body from contact point to ground Heat generated proportional to tissue resistance Most damage is internal - electricity follows path of least resistance Contact points show entrance and exit wounds Clinical Presentation: Deceiving external appearance Entrance wound: charred, depressed, leathery Exit wound: often more extensive, explosive Muscle necrosis, nerve damage common Associated Risks: Cardiac dysrhythmias/arrest Myoglobinuria → acute kidney injury Compartment syndrome Fractures/dislocations from tetanic muscle contractions Neurological deficits RADIATION BURNS Mechanism: • Ionizing radiation damages DNA and cellular structures • UV radiation, therapeutic radiation, nuclear accidents Clinical Presentation: • Sunburn: Erythema, pain, blistering (severe) • Therapeutic radiation: Erythema, dry/moist desquamation, hyperpigmentation • Nuclear exposure: Severe burns, systemic radiation sickness Associated Risks: • Radiation sickness • Delayed wound healing • Increased infection risk • Long-term cancer risk Burn Injuries (Type by mechanism) Burn Classification by DepthSUPERFICIAL Burns (First degree) Tissue Involvement: Epidermis only Appearance: • Pink to red • Dry, no blisters • Blanches with pressure • Example: Mild sunburn Sensation: Painful (nerve endings intact) Healing: • 3-6 days • No scarring • Complete regeneration • Peeling of dead skin Burn Classification by Depth-PARTIAL-THICKNESS Superficial Partial-Thickness (Second-Degree Superficial) Epidermis + upper dermis Appearance: • Pink to cherry red • Fluid-filled blisters (hallmark) • Moist, weeping surface if blisters rupture • Blanches with pressure Sensation: VERY PAINFUL (exposed nerve endings) Healing: • 10-21 days Deep Partial-Thickness (SecondDegree Deep)- Epidermis + deeper dermis layers Appearance: • Mottled white to red • Blisters present but may be thickwalled • Less blanching • May appear waxy Sensation: Painful to pressure only (some nerve damage) Healing: • 3-6 weeks or longer Tissue Involvement: Epidermis, entire dermis, may extend into subcutaneous fat, muscle, bone Burn Classification by Depth-FULLTHICKNESS (Third-Degree) Burns Appearance: • White, waxy, leathery, or charred black • Dry, hard surface (eschar) • Does NOT blanch • Thrombosed blood vessels visible beneath surface Sensation: NO PAIN (complete nerve destruction) Healing: • Cannot heal by regeneration • Requires surgical excision and skin grafting • Heals by scar formation from wound edges (very slow) • Massive scarring, contractures inevitable without grafting Complications: • Eschar formation → circulation compromise • Infection risk Tissue Involvement: All skin layers PLUS muscle, fascia, bone Burn Classification by Depth-DEEP FULLTHICKNESS (Fourth-Degree) Appearance: Blackened, charred; may see exposed bone/tendon Mechanism of Injury: • Enclosed space fires → inhalation injury highly likely • Electrical → internal damage exceeds external • Chemical → ongoing tissue damage • Flame vs. scald → flame burns typically deeper Extent of Injury: • TBSA >20% → systemic inflammatory response, fluid shifts • TBSA >30% → significant mortality risk • Burns involving face, hands, feet, genitals, joints → functional impairment risk Question A patient arrives at the emergency department after exposure to hydrochloric acid during an industrial accident. The chemical splash occurred 15 minutes ago. What is the nurse's priority action? • A. Apply neutralizing agent to affected areas • B. Begin continuous irrigation with normal saline • C. Cover burns with sterile dry dressings • D. Obtain venous access for fluid resuscitation Question An industrial worker is admitted after electrical injury from a high-voltage power line. External burns appear minimal - small charred areas on the hand and foot. Which complication should the nurse monitor for most closely? • A. Superficial wound infection • B. Hypothermia • C. Respiratory alkalosis • D. Cardiac dysrhythmias and myoglobinuria Calculating Burn Extent Calculating Total Body Surface Area (TBSA) Burned Why TBSA Matters: • Determines fluid resuscitation needs (Parkland formula) • Predicts mortality risk • Guides transfer to burn center • TBSA >10% in children or elderly OR >20% in adults → requires IV fluid resuscitation Rule of Nines vs Lund-Browder Chart PALMAR SURFACE METHOD Case: Adult patient with burns covering: • Entire anterior trunk • Entire right arm • Anterior right leg PRACTICE CALCULATION Using Rule of Nines: • Anterior trunk: 18% • Right arm: 9% • Anterior right leg: 9% (half of 18%) Total TBSA: 36% • This patient requires aggressive fluid resuscitation and transfer to burn center. Pathophysiology of Burn Shock BURN SHOCK = Hypovolemic Shock from Capillary Leak What Happens in Major Burns (>20% TBSA): Phase 1: Capillary Leak (First 24-48 hours) Massive inflammatory response release >Third spacing: Massive fluid shift from intravascular → interstitial Decreased Intravascular Volume Increased Capillary Permeability Loss of Oncotic Pressure Pathophysiology of Burn Shock Phase 2: Fluid Mobilization (48-72 hours post-burn) • Capillary integrity begins to restore • Inflammatory mediators decrease • Interstitial fluid shifts BACK into intravascular space • Risk shifts from hypovolemia to fluid overload • Diuresis begins Cardiovascular: • Hypotension (SBP <90 mmHg) • Tachycardia (HR >120 bpm) - compensatory Renal: • Oliguria (<0.5 mL/kg/hr or <30 mL/hr) Clinical Manifestations of Burn Shock Neurological: • Restlessness, anxiety (early) • Confusion, lethargy (worsening) • Decreased level of consciousness Metabolic: • Metabolic acidosis (lactic acid from hypoperfusion) • Hyperkalemia (cellular damage releases K⁺) • Hyponatremia initially (dilutional) Skin: • Massive edema (burned AND unburned tissue) • Cool, clammy extremities Systemic Complications of Severe Burns DISSEMINATED INTRAVASCULAR COAGULATION (DIC) ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) Mechanism: Mechanism: • Massive tissue injury releases thromboplastin • Triggers widespread clotting cascade Clinical Cues: • Inflammatory mediators damage alveolar-capillary membrane Clinical Cues: • Progressive dyspnea • Refractory hypoxemia (despite high O₂) • Oozing from IV sites, wounds • Petechiae, purpura • Hematuria, GI bleeding • Decreased platelets, fibrinogen • Elevated D-dimer, PT/PTT • Bilateral infiltrates on chest X-ray • PaO₂/FiO₂ ratio <300 (hallmark) • Decreased lung compliance Risk Factors: • Inhalation injury • Sepsis • Massive fluid resuscitation Systemic Complications of Severe Burns SEPSIS AND SEPTIC SHOCK Mechanism: Loss of skin barrier → bacterial entry Immunosuppression from burn injury Invasive lines/procedures Clinical Cues (Early Recognition Critical): SIRS criteria: Temp >38°C or <36°C, HR >90, RR >20, WBC >12,000 or <4,000 MULTIPLE ORGAN DYSFUNCTION SYNDROME (MODS) Progression: • Burn shock → prolonged hypoperfusion • Sepsis • ARDS • Acute kidney injury • Liver dysfunction • DIC • Progressive failure of 2+ organ systems Prevention Focus: • Early, aggressive fluid resuscitation • Infection prevention • Adequate nutrition • Early wound closure HYPOTHERMIA Mechanism: • Loss of skin barrier → heat loss through evaporation Systemic Complications of Severe Burns • Large TBSA exposure • Impaired thermoregulation Clinical Cues: • Core temperature <36°C (96.8°F) • Shivering (initially, then stops) • Decreased level of consciousness • Bradycardia, dysrhythmias • Coagulopathy worsens Prevention: • Increase ambient temperature (28-32°C / 82-90°F in burn unit) • Warming blankets • Warm IV fluids Early Recognition of Complications Priority Nursing Actions: Complication Early Cues Immediate Actions Shock Decreased UOP, tachycardia, hypotension Increase fluid rate, notify provider, assess perfusion ARDS Increasing O₂ requirement, dyspnea Notify provider, prepare for intubation, elevate HOB Sepsis Temperature change, altered mental status, ileus Blood cultures, notify provider, prepare for antibiotics AKI Oliguria, rising BUN/Cr, hyperkalemia Assess fluid status, strict I&O, prepare for dialysis Compartment Syndrome Progressive pain, paresthesias, pulselessness Elevate extremity, loosen dressings, prepare for escharotomy Question An adult patient is admitted with burns covering the entire anterior and posterior trunk and the entire left leg. Using the Rule of Nines, what is the patient's TBSA? Question A patient with 40% TBSA burns is receiving fluid resuscitation. Which assessment finding indicates inadequate fluid replacement? • A. Urine output 35 mL/hr • B. Heart rate 88 beats/min • C. Mean arterial pressure 72 mmHg • D. Urine output 18 mL/hr STOP THE BURNING PROCESS (First Priority) Thermal Burns: Pre-Hospital and Emergent Phase Care • Remove from heat source • Remove all clothing/jewelry (retains heat, causes constriction with swelling) • DO NOT cool large burns - risk of hypothermia • Cover with clean, dry cloth Chemical Burns: • Brush off dry chemicals before irrigation • Continuous irrigation with water/saline (20+ minutes) • Remove all contaminated clothing WHILE irrigating Electrical Burns: • Ensure scene safety - verify power source is OFF • Do not touch patient if still in contact with electrical source • Expect cardiac arrest - prepare for CPR/defibrillation Pre-Hospital and Emergent Phase Care AIRWAY ASSESSMENT CIRCULATION High Risk for Inhalation Injury: • Assess pulses, capillary refill • Burns in enclosed space • Facial burns • Singed nasal hairs, eyebrows • Remove all constricting items • Elevate burned extremities • Cover burns with clean, dry dressing • Hoarseness, stridor • Do NOT apply ice • Burns around mouth/nose Immediate Actions: • Do NOT apply ointments/creams IV Access: • 100% oxygen via non-rebreather mask (until CO levels known) • Position upright if no C-spine injury suspected • Two large-bore IVs (18-gauge or larger) • Prepare for early intubation (edema worsens rapidly) • DO NOT wait for respiratory distress - prophylactic intubation if high suspicion • Preferably through unburned skin • May use burned skin if necessary • Begin fluid resuscitation Emergent Phase of Burn (24-48 hrs) PRIMARY GOALS: 1.Secure airway and maintain oxygenation 2.Restore adequate circulating volume 3.Prevent burn shock 4.Preserve organ function 5.Prevent hypothermia Upper Airway Injury (Above Glottis): Manifestations: Hoarseness, stridor, dysphagia Airway Assessment for Inhalation Injury- Emergent phase •Intubate early (edema peaks at 24-48 hours) Lower Airway Injury (Below Glottis): Manifestations: Wheezing, rales, productive cough with carbonaceous sputum Carbon Monoxide (CO) Poisoning: •Manifestations: Headache, confusion, cherry-red skin (late), seizures, coma •Pulse oximetry falsely normal (cannot distinguish COHb from O₂Hb) •Diagnosis: Carboxyhemoglobin level >10% (smokers may be 5-10% baseline) Treatment: •100% oxygen via non-rebreather (reduces CO half-life from 4 hours to 40 minutes) •Hyperbaric oxygen if available and severe (COHb >25%) •Intubation and mechanical ventilation if altered mental status Total Fluid (mL) = 4 mL × Weight (kg) × % TBSA burned Emergent phase FLUID RESUSCITATION - Parkland Formula • Give 1st HALF in first 8 hours (from time of injury, NOT arrival) • Give 2nd HALF over next 16 hours • Use Lactated Ringer's solution (isotonic, contains buffer) 70 kg patient with 40% TBSA burns Parkland Formula Example Calculation • Total = 4 × 70 × 40 = 11,200 mL in 24 hours • First 8 hours: 5,600 mL (700 mL/hr) • Next 16 hours: 5,600 mL (350 mL/hr) CRITICAL TIMING: • Clock starts at time of injury, not hospital arrival • If patient arrives 2 hours after injury, first half must infuse over remaining 6 hours • Requires higher hourly rate to "catch up" MONITORING FLUID RESUSCITATION ADEQUACY Target Hemodynamic Goals: PARAMETER GOAL Urine Output 0.5 mL/kg/hr (30-50 mL/hr adult) - MOST IMPORTANT Mean Arterial Pressure (MAP) >65 mmHg Systolic Blood Pressure >90 mmHg Heart Rate <120 bpm Continuous Monitoring: • Vital signs every 15-30 minutes initially Emergent PhaseHemodynamic Stabilization • Cardiac monitoring • Central venous pressure (if available) • Arterial line Laboratory Monitoring: • Serial ABGs • Electrolytes every 4-6 hours (K⁺, Na⁺, Ca²⁺) • BUN/Creatinine • Hemoglobin/Hematocrit • Carboxyhemoglobin if inhalation injury • Myoglobin, CK if electrical/deep burns Understanding Fluid Spacing and Burn Management Fluid Spacing FIRST SPACING (Normal) • Fluid in intravascular compartment SECOND SPACING • Fluid in interstitial space (normal) THIRD SPACING (Pathologic) • Fluid trapped in body space where it's NOT easily exchangeable Clinical Impact on Burn Management: Emergent phase (0-48 hr): • Aggressive fluid resuscitation needed • Monitor for hypovolemia Acute phase (48 hr+): • Third-spaced fluid returns to circulation • Risk shifts to fluid overload • May need diuretics Escharotomy indications: (circumferential full-thickness burn) • Extremity: Decreased/absent pulses, delayed capillary refill, paresthesias, severe pain Escharotomy and Fasciotomy • Chest: Restricted chest wall expansion, decreased tidal volumes, hypoxemia • Eschar acts as tourniquet → compromised circulation or ventilation Procedure: • Surgical incision through eschar (NOT fascia) Nursing Care: • Monitor perfusion frequently • Assess for signs of compartment syndrome • Control bleeding • Sterile dressing application • Pain management FASCIOTOMY Indication: • Compartment syndrome (particularly with electrical burns, crush injury with burns) • Intracompartmental pressure >30 mmHg • 6 Ps: Pain (out of proportion), Pressure, Paresthesias, Pallor, Pulselessness (late), Paralysis (late) Procedure: • Surgical incision through fascia to relieve pressure Nursing Care: Escharotomy and Fasciotomy • Immediate intervention if suspected - permanent damage occurs within 6 hours • Monitor neurovascular status every 30-60 minutes • Assess pain • Maintain extremity elevation • Prepare for OR urgently Priority Action: Immediate notification of provider/surgeon - this is a surgical emergency Question A 75 kg patient with 30% TBSA burns arrives at the ED 2 hours after injury. Using the Parkland formula, how much Lactated Ringer's should the patient receive in the first 8 hours from time of injury? Question The nurse assesses a patient with circumferential full-thickness burns to the right arm. Which finding requires immediate intervention? • A. Absent pain when the burned area is touched • B. Blistering of surrounding partial-thickness burns • C. Capillary refill of 5 seconds and absent radial pulse • D. Heart rate of 115 beats/min Primary Goals • Wound closure • Infection prevention • Nutritional support • Pain management • Prevention of complications WOUND CARE Assessment & Debridement: • Mechanical: Wet-to-dry dressings, hydrotherapy, irrigation Acute Phase (48-72 hrs) • Enzymatic: Topical enzymes (collagenase) • Surgical: Excision of eschar and devitalized tissue • Early excision (within 48-72 hours) improves outcomes Topical Antimicrobials: Agent Advantages Disadvantages Nursing Considerations Monitor WBC; apply 12x daily; do not use on face Silver sulfadiazine (Silvadene) Broad-spectrum; painless; soothing Poor eschar penetration; can cause leukopenia; contraindicated in sulfa allergy Mafenide acetate (Sulfamylon) Excellent eschar penetration; broadspectrum PAINFUL on application; metabolic acidosis (carbonic anhydrase inhibitor) Monitor ABGs; pain management before application Silver-impregnated dressings Sustained antimicrobial release; less frequent changes Expensive Can leave in place 3-7 days Skin Grafting: • Autograft (Gold Standard)- pts own skin • Split-Thickness Skin Graft- epidermis and parts of dermis • Full-Thickness Skin Graft- epidermis and entire dermis Acute PhaseGrafting • Allograft- cadaver skin • Xenograft- pig skin • Biosynthetic/Cultured Skin Post-Graft Care: • Immobilize grafted area 3-7 days • Donor site care: Keep covered, monitor for infection Wound care Sepsis prevention: Acute PhaseInfection Prevention • strict sterile technique for wound care • Topical antimicrobials • Early wound closure • Hand hygiene • Isolation precautions as needed • Remove invasive devices when no longer needed • Nutritional support (immune function) Caloric Needs: • Formula: 25 kcal/kg + 40 kcal/% TBSA burned Protein Needs: • 1.5-3 g/kg/day (extremely high) Route: • Enteral preferred (maintains gut integrity, prevents bacterial translocation) Acute PhaseNutritional Support • Parenteral if enteral not tolerated Nursing Interventions: • Daily weights (same time, same scale) • Calorie counts • Monitor pre-albumin • Small, frequent, high-calorie/high-protein meals • Supplements between meals • Pain control before meals Background Pain: • Continuous, low-level discomfort • Managed with long-acting opioids, non-opioids Procedural Pain: Acute PhasePain Management • Managed with short-acting opioids, anxiolytics Breakthrough Pain: • Unexpected, severe pain Nursing Interventions: • Scheduled pain medication • Multimodal analgesia (opioids + non-opioids) • IV route preferred in acute phase • Adequate dosing (often higher doses) • Non-pharmacologic: Distraction, music, relaxation, virtual reality The nurse is caring for a burn patient 36 hours post-injury. Which assessment finding indicates the patient is transitioning from the emergent phase to the acute phase? • A. Decreasing blood pressure and increasing heart rate Question • B. Increasing urine output and decreasing edema • C. Worsening confusion and decreasing oxygen saturation • D. Increasing temperature and decreasing white blood cell count Rehabilitative Phase (Wound closure to return to function)- Months-years Primary Goals: • Maximize functional recovery • Prevent/minimize contractures • Promote psychosocial adjustment • Facilitate community reintegration A patient with burns to bilateral arms is being positioned in bed. Which position demonstrates proper anti-deformity positioning? • A. Arms abducted with elbows and wrists extended Question • B. Arms at sides with elbows flexed at 90 degrees • C. Arms crossed over chest with hands on shoulders • D. Arms supported on pillows in position of comfort A patient in the rehabilitation phase of burn recovery asks why they must wear pressure garments 23 hours per day. What is the nurse's best response? • A. "They prevent infection by protecting the healing skin." Question • B. "They apply constant pressure to reduce scarring and improve appearance." • C. "They help your skin retain moisture and prevent itching." • D. "They are required by insurance for 6 months after discharge." Chronic, immune-mediated inflammatory skin disease Triggers: • Infections (especially streptococcal pharyngitis) • Stress • Trauma to skin (Koebner phenomenon) • Certain medications (beta-blockers, lithium, antimalarials, NSAIDs) • Cold, dry weather • Alcohol consumption • Smoking Clinical Presentation Hallmark Finding: PLAQUE PSORIASIS (80-90% of cases) Psoriasis Classic Appearance: • Well-demarcated, raised, erythematous plaques • Thick, silvery-white scales (hallmark) • Symmetrical distribution Common locations: • Extensor surfaces (elbows, knees) • Scalp (hairline) • Lower back • Nails (pitting, onycholysis, thickening) TOPICAL THERAPIES (First-Line for Mild-Moderate) Corticosteroids: • Most commonly prescribed • Anti-inflammatory, antipruritic PsoriasisMedical Management • Limit duration (skin atrophy, tachyphylaxis with prolonged use) Vitamin D Analogues (Calcipotriene) • Slows skin cell growth Topical Retinoids (Tazarotene): • Normalizes cell differentiation Coal Tar: • Anti-inflammatory, antiproliferative Salicylic Acid: • Keratolytic (removes scales) Psoriasis- Medical Management PHOTOTHERAPY (ModerateSevere) SYSTEMIC THERAPIES (Moderate-Severe, Resistant) BIOLOGIC THERAPIES (Targeted Immune Modulators) ASSESSMENT: • Skin assessment: Location, extent, appearance of lesions • Nail changes • Joint pain/swelling (psoriatic arthritis in 30%) INTERVENTIONS: • Skin Integrity: • Gentle skin care (avoid harsh soaps, hot water) • Moisturize frequently (thick emollients, fragrance-free) • Apply after bathing while skin damp (traps moisture) • Avoid trauma to skin (Koebner phenomenon) Infection Prevention: Psoriasis- Nursing Process Application • Assess for secondary infection (increased erythema, warmth, purulent drainage) • Intact skin barrier compromised → bacterial entry • Proper hand hygiene • Avoid scratching (keep nails trimmed) The nurse is assessing a patient newly diagnosed with psoriasis. Which finding is most characteristic of plaque psoriasis? • A. Small, drop-like lesions on the trunk Question • B. Smooth, red patches in the axillae • C. Raised, erythematous plaques with silvery scales on the elbows • D. Pus-filled blisters on the palms and soles Risk Factors (All Types): • Chronic sun exposure (UV radiation) - #1 modifiable risk factor • Fair skin, light hair, light eyes Skin Cancer • History of sunburns (especially childhood/adolescence) • Family history of skin cancer • Age >50 • Immunosuppression • Previous skin cancer • Occupational exposures (arsenic, coal tar) • Artificial tanning beds BASAL CELL CARCINOMA (BCC) • Most common skin cancer (70-80%) Skin Cancer TypesBCC • Least aggressive - rarely metastasizes Appearance: • Pearly, translucent nodule with rolled borders (classic) Clinical Presentation: • Often asymptomatic • May crust, bleed, heal partially then recur Treatment: • Surgical Excision • Mohs Micrographic Surgery • Electrodesiccation and Curettage (ED&C) • Cryotherapy • Topical Therapies • Radiation Therapy SQUAMOUS CELL CARCINOMA (SCC) • Second most common skin cancer (20%) Skin Cancer TypesSCC • More aggressive than BCC - can metastasize (2-5% risk) Appearance: • Scaly, rough, erythematous patch or plaque • Firm nodule with central ulceration or crust • Indurated (hard, firm) Precursor Lesion: Actinic Keratosis (AK) • Rough, scaly patches on sun-exposed skin • Considered pre-malignant (5-10% transform to SCC) Skin Cancer TypesSCC Treatment: Surgical Excision: • Standard treatment • Wide margins (4-6 mm minimum) • Mohs surgery for high-risk locations Radiation Therapy: • Primary treatment if surgery not feasible Lymph Node Dissection: • If lymph node involvement Systemic Therapy: • Advanced/metastatic disease Skin Cancer TypesMelanoma • 5-10% of skin cancers • MOST DEADLY skin cancer - responsible for 75% of skin cancer deaths Risk Factors (In Addition to General): • >50 nevi (moles) • Atypical/dysplastic nevi • History of melanoma (20× increased risk for second melanoma) • Family history (8-12% have familial melanoma) • Blistering sunburns in childhood/adolescence • Tanning bed use (especially <35 years old) Pathophysiology: • Arises from melanocytes (pigment-producing cells) • Can develop from existing mole ABCDE Criteria for Melanoma Detection Skin Cancer TypesMelanoma A = ASYMMETRY • Melanoma: Irregular, asymmetrical B = BORDER • Normal mole: Smooth, even border • Melanoma: Poorly defined, scalloped edges C = COLOR • Normal mole: Single, uniform color • Melanoma: Variegated, multiple colors D = DIAMETER • >6 mm (size of pencil eraser) E = EVOLVING • Any change in size, shape, color, elevation • MOST IMPORTANT CRITERION ASSESSMENT: Nursing Care for Skin Cancer Patients • Document location, size, appearance of all lesions • Photography for monitoring changes • Use ABCDE criteria PATIENT EDUCATION - PREVENTION: • Sun Protection Avoid sun during peak hours (10 AM - 4 PM) Sunscreen SPF 30+ • Self examination Monthly skin self-exams Use ABCDE criteria • Annual Dermatology exams The nurse is conducting a skin cancer screening clinic. Which patient requires immediate referral to dermatology? • A. 45-year-old with a 3 mm brown mole on the back that has been present since childhood Question • B. 62-year-old with a pearly, translucent nodule on the nose with visible blood vessels • C. 38-year-old with a 7 mm irregularly shaped, multicolored lesion on the leg that has changed size over 2 months • D. 55-year-old with multiple rough, scaly patches on the forearms