Melanoma and TNM Classification Quiz

ABCDEs of Melanoma

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

TNM Classification

• T (Tumor): Describes the primary tumor's size and extent.
  • TO: No primary tumor evidence.
  • T1-T4: Increasing tumor size and extent.
• N (Node): Indicates lymph node involvement.
  • NO: No lymph node involvement.
  • N1-N3: Increasing lymph node involvement.
• M (Metastasis): Presence of distant metastasis.
  • M0: No metastasis.
  • M1: Metastasis present.

Chemotherapy Effects on Stem Cells and Bone Marrow

• Impact: Bone marrow suppression reduces red blood cell, white blood cell, and platelet production.
• Complications: Anemia, neutropenia, thrombocytopenia.
• Assessment: Monitor CBC, assess for infection, bleeding, and fatigue.

Neutropenia: Assessment Findings to Report

• Fever: Even low-grade (≥100.4°F or 38°C).
• Chills or sweating.
• Signs of infection: Sore throat, cough, redness, swelling, pain.
• Decreased/absent WBC count: Absolute neutrophil count (ANC) <500 cells/mm³.

Spinal Cord Compression Interventions

• Administer corticosteroids to reduce inflammation.
• Prepare for radiation or surgery if necessary for decompression.
• Maintain proper body alignment and use supportive devices to avoid worsening neurological symptoms.

Pain Management for the Cancer Patient

• Use a multimodal approach: NSAIDs, opioids, and adjuvants for pain relief.
• Implement non-pharmacological methods: Relaxation techniques, massage, acupuncture.
• Regularly assess and re-evaluate pain control.

Secondary Measures to Prevent Cancer

• Screenings: Mammograms, colonoscopies, Pap smears, HPV vaccination.
• Lifestyle changes: Smoking cessation, limit alcohol, practice sun protection.

Prostate Cancer Risk Factors

• Age: >50 years.
• Family history: of prostate cancer.
• Ethnicity: African American.
• Lifestyle: High-fat diet and obesity.

Skin Cancer Risk Factors and Characteristics

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

Fluid, Electrolyte, and Acid-Base Imbalances

• Interventions delegated to UAP: Measuring intake/output, vital signs, assisting with ambulation or hygiene, reporting abnormal findings.

Giving Hypotonic Solution Interventions

• Monitor for fluid shifts: Cerebral edema.
• Assess for signs of overhydration: Confusion, lethargy.
• Use cautiously: In patients with head injuries or increased ICP.

Lasix (Furosemide) Interventions

• Monitor electrolytes (especially potassium).
• Assess for hypovolemia: Dizziness, hypotension.
• Encourage potassium-rich foods or supplementation.
• Interpreting ABGs: pH <7.35 & HCO3 <22 or pH >7.45 & HCO3 >26. pH <7.35 & PaCO2 >45 or pH > 7.45 & PaCO2 <35.

Electrolyte Replacement for DKA

• Replace potassium when levels are low.
• 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—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.
• Melanoma: Dark brown/black patches/nodules with irregular edges, rapid growth, bleeding, itching, or ulceration.
• Actinic Keratosis: Rough, scaly patches/plaques on sun-exposed areas, precancerous lesions.
• Basal Cell Carcinoma: Pearly, waxy bumps/flat lesions with rolled edges, slow-growing.

Burns

• Rule of Nines: Calculates burn percentages.
• Classification: Superficial, partial thickness, full thickness—based on severity.
• Priority nursing interventions: Airway management, fluid resuscitation, wound care, pain control.
• Electrical burns: Cardiac monitoring, assess entry & exit wounds, monitor for compartment syndrome.
• Emergency Interventions: Remove patient from source of burn, cool with lukewarm water, cover the burn (avoid ice), assess airway & circulation.
• Complications: Infection, sepsis, hypovolemic shock.

Parkland Formula for Burns

• Formula: 4 mL × % TBSA × weight (kg).
• Half of the total fluid is given over the first 8 hours; the other half over the next 16 hours.

Hormone Alterations in Burns

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

Diabetes Mellitus

• Type 1: Polyuria, polydipsia, polyphagia, weight loss, fatigue, blurred vision, ketoacidosis symptoms
• Type 2: Polyuria, polydipsia, polyphagia, fatigue, recurrent infections, poor wound healing
• Interventions: Screen for gestational diabetes, monitor fetal growth, monitor maternal blood glucose
• Hyperglycemia: Polyuria, polydipsia, dry mouth

Endocrine Problems

• Hypopituitarism: Fatigue, weight gain.
• SIADH: Fluid restriction (500-1000 mL/day), administer diuretics & hypertonic saline (if severe)
• Diabetes Insipidus: Low urine osmolality (<200 mOsm/kg), high serum osmolality (>295 mOsm/kg), hypernatremia (Na >145 mEq/L)
• Assessing medication effectiveness for hypothyroidism; Addison's Disease Interventions in Times of Stress: Monitor for hypotension and electrolyte imbalances, administer IV hydrocortisone if necessary
• Cushing Syndrome; Acromegaly Assessment: Enlarged hands, feet & facial features, joint pain, thickened skin, sleep apnea & hypertension