Medical-Surgical Nursing 9th Edition by Sharon Lewis ,Shannon Ruff Dirksen,Margaret McLean Heitkemper,Linda Bucher

Exercise 1

Patient Profile
G.L. is a 59-year-old white fair-skinned man who is a long-distance truck driver. In his leisure time, he enjoys swimming. He comes to the clinic for evaluation of a changing lesion on his left arm.
Subjective Data
• History of a basal cell carcinoma (BCC) on his left ear in the last 4 years
• Father treated for metastatic malignant melanoma in the last 2 years
• First noted the lesion 5 months ago when it started changing size
• Anxious the lesion might have spread and require extensive, disfiguring surgery
Objective Data
Physical Examination
• Has a 4-mm lesion, dark brown, scalloped with vaguely defined borders
• Four dysplastic nevi found on back
Diagnostic Studies
• Excisional biopsy confirmed malignant melanoma.
• Sentinel node biopsy results were negative.
• Diagnostic tests indicate melanoma stage I.
1. What risk factors for malignant melanoma does he have
2. What are the usual clinical manifestations associated with malignant melanoma
3. What is the prognosis for a patient with this stage of malignant melanoma
4. What treatment options are available for him
5. How would you help G.L. deal with his anxiety over the treatment outcomes
6. Priority Decision: What is the priority of care for G.L.
7. What would you include in his patient teaching plan to address future sun exposure
8. Delegation Decision: Which of the following nursing personnel should be responsible for teaching G.L.: RN, LPN/LVN, or UAP
9. Priority Decision: Based on the assessment data presented, what are the priority nursing diagnoses Are there any collaborative problems
10. Evidence-Based Practice: G.L. wants to know whether regularly applying sunscreen will reduce his risk for developing a second melanoma. How would you reply