ABCDEs of Melanoma and TNM Classification

ABCDEs of Melanoma

• Asymmetry: One half of the lesion doesn't match the other.
• Border: Irregular, ragged, or blurred edges.
• Color: Varies, including shades of tan, brown, black, white, red, or blue.
• Diameter: Larger than 6 mm (pencil eraser size).
• Evolving: Changes in size, shape, color, or symptoms (itching, tenderness, bleeding).

TNM Classification

• T (Tumor): Describes the size and extent of the primary tumor.
  • TO: No primary tumor present.
  • T1-T4: Increasing size and/or extent of the tumor.
• N (Node): Indicates if cancer has spread to lymph nodes.
  • NO: No lymph node involvement.
  • N1-N3: Increasing lymph node involvement.
• M (Metastasis): Presence of distant metastasis.
  • M0: No metastasis.
  • M1: Presence of metastasis.

Chemotherapy Effects on Stem Cells and Bone Marrow

• Impact: Bone marrow suppression (myelosuppression) reduces RBC, WBC, and platelet production.
• Complications: Anemia, neutropenia, and thrombocytopenia.
• Assessment: Monitor CBC, infections, bleeding, and fatigue.
• Neutropenia: Report fever (≥100.4°F or 38°C), chills/sweating, or signs of infection (sore throat, cough, redness, etc.). Decreased or absent WBC count (ANC <500 cells/mm³).

Interventions to Combat Fatigue Related to Radiation Therapy

• Encourage short naps and frequent rest breaks.
• Encourage physical activity (e.g., walking).
• Provide suitable nutritional support to combat weight loss.
• Promote adequate hydration and a regular sleep schedule.

Interventions to Combat Nausea Related to Chemotherapy

• Administer antiemetics (e.g., ondansetron) 30-60 minutes before treatment.
• Provide small, frequent meals.
• Avoid strong odors, spicy, or greasy foods.
• Encourage hydration with clear fluids.

Spinal Cord Compression Interventions

• Administer corticosteroids for inflammation reduction.
• Prepare for radiation or surgical decompression if needed.
• Maintain proper body alignment and use supportive devices.
• Monitor for worsening neurological symptoms.

Pain Management for the Cancer Patient

• Use a multimodal approach (NSAIDs, opioids, adjuvants).
• Implement non-pharmacological methods (relaxation, massage, acupuncture).
• Regularly evaluate and reassess pain control effectiveness.

Secondary Measures to Prevent Cancer

• Screenings (mammograms, colonoscopies, Pap smears, HPV vaccination).
• Cessation of smoking.
• Limit alcohol intake and practice sun protection.

Prostate Cancer Risk Factors

• Age >50 years
• Family history of prostate cancer
• African American ethnicity
• High-fat diet and obesity

Skin Cancer Risk Factors and Characteristics

• Risk factors: Fair skin, excessive UV exposure, family history, hx of sunburns.
• Characteristics: Persistent non-healing sores, pearly/waxy bumps, or scaly patches.

Fluid, Electrolyte, and Acid-Base Imbalances

• Interventions for UAP: Measure intake/output, obtain vital signs, assist with ambulation/hygiene, report abnormal findings.
• Hypotonic Solution Interventions: Monitor for fluid shifts and cerebral edema; assess for overhydration (confusion, lethargy); use cautiously in patients with head injuries or increased ICP.
• Lasix (Furosemide) Interventions: Monitor electrolytes (esp. potassium); assess for hypovolemia (dizziness, hypotension); encourage potassium-rich foods/supplementation.
• Interpreting ABGs:
  • Metabolic Acidosis: pH <7.35, HCO3¯ < 22 mEq/L.
  • Metabolic Alkalosis: pH > 7.45, HCO3¯ > 26 mEq/L.
  • Respiratory Acidosis: pH <7.35, PaCO2 > 45 mmHg.
  • Respiratory Alkalosis: pH >7.45, PaCO2 < 35 mmHg.
• Electrolyte Replacement for DKA: Replace potassium once levels fall below normal; administer IV fluids (0.9% NS or 0.45% NS); administer insulin to lower blood glucose.
• Fluid Replacement for Diarrhea: Use isotonic fluids (0.9% NS or LR).

Lab Values and Interventions

• Potassium: 3.5-5.0 mEq/L (hypokalemia: cautious IV or oral administration).
• Sodium: 135-145 mEq/L (monitor for hyper/hyponatremia).
• Calcium: 8.5-10.5 mg/dL (monitor for tetany in hypocalcemia).

Integumentary Problems

• Atypical Nevi: Irregular borders, uneven pigmentation; larger than normal moles, may be raised or flat with mixed colors (brown, tan, pink, black).
• Melanoma: Dark brown/black patches/nodules with irregular edges; rapid growth/changes; bleeding, itching, or ulceration.
• Actinic Keratosis: Rough, scaly patches on sun-exposed areas; often pink, red, or brown; considered precancerous (squamous cell carcinoma).
• Basal Cell Carcinoma: Pearly, waxy bump or flat lesion with a rolled edge; may have visible blood vessels (telangiectasia); slow-growing; often on sun-exposed areas.

Burns

• Rule of Nines: Estimates burn surface area.
• Classification: Superficial (red, painful, dry), Partial-thickness (blisters, red, moist, painful), Full-thickness (white, charred, leathery, painless).
• Priority Nursing Interventions: Airway management (smoke inhalation assessment), fluid resuscitation (Parkland formula), wound care (aseptic techniques). Pain control (IV opioids).
• Electrical Burns Intervention: Cardiac monitoring for arrhythmias, assess entry and exit wounds, monitor for compartment syndrome and kidney function (rhabdomyolysis).
• Emergency Interventions: Remove patient from burn source, cool burn with lukewarm water, cover burn with clean, dry cloth, assess airway and circulation.

Hormone Alterations in Burns

• Increased cortisol and catecholamines (stress response)
• ADH secretion leading to fluid retention
• Insulin resistance and hyperglycemia

Diabetes Mellitus

• Type 1: Polyuria, polydipsia, polyphagia, weight loss, fatigue, blurred vision, ketoacidosis.
• Type 2: Polyuria, polydipsia, polyphagia (less common than Type 1), fatigue, recurrent infections, poor wound healing, gradual onset.
• Gestational Diabetes: Screen for gestational diabetes (OGTT). Provide dietary counseling and education, monitor fetal growth and maternal blood glucose.
• Interventions for Type 1 Diabetes After Insulin Administration: Monitor for hypoglycemia (sweating, shakiness, confusion); ensure patient consumes a meal within 15-30 mins of rapid-acting insulin.
• Hyperglycemia: Polyuria, polydipsia, dry mouth.
• Somogyi Effect: Nocturnal hypoglycemia leading to rebound hyperglycemia in the morning. Intervention: adjust evening insulin or provide bedtime snack.

Dietary Patient Teaching for New Diabetic Patients

• Carbohydrate counting, balanced meals, avoid sugary/processed carbs, include high-fiber foods.

Diabetic Patients and Contrast Administration

• Hold metformin 24-48 hours before and after contrast. Monitor renal function (BUN/creatinine), ensure adequate hydration.

DKA Interventions

• Fluid replacement (0.9% or 0.45% NS).
• Administer insulin drip, monitor glucose hourly, correct electrolyte imbalances (e.g., potassium).

Patient Education for Type 2 Diabetes

• Encourage physical activity/weight loss, teach self-monitoring of blood glucose (SMBG), stress the importance of medication adherence.

Endocrine Problems

• Hypopituitarism: Fatigue, weight gain, infertility, hypotension, low libido, cold intolerance.
• SIADH: Fluid restriction (500-1000 mL/day); administer diuretics and hypertonic saline if severe; monitor for hyponatremia (confusion).

Diabetes Insipidus Lab Values to Monitor

• Low urine osmolality (<200 mOsm/kg).
• High serum osmolality (>295 mOsm/kg).
• Hypernatremia (Na >145 mEq/L).

Assessing Medication Effectiveness for Hypothyroidism

• TSH levels normalize (decrease if elevated). Improvement in symptoms (fatigue, cold intolerance).

Addison's Disease Interventions in Times of Stress

• Increase glucocorticoid dosing as prescribed.
• Monitor for hypotension and electrolyte imbalances.
• Administer IV hydrocortisone if necessary.

Cushing Syndrome

• Increased cortisol levels (24-hour urine cortisol test).
• Hyperglycemia, hypokalemia.

Acromegaly Assessment

• Enlarged hands, feet, and facial features.
• Joint pain, thickened skin.
• Sleep apnea and hypertension.