VINCENT MELANOMA CASE STUDY
Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages To Order 5-10 Pages Description/Paper Instructions
GENDER Male
AGE 32
SETTING Primary care
ETHNICITY White American
CULTURAL CONSIDERATIONS
PREEXISTING CONDITION
COEXISTING CONDITION
COMMUNICATION
DISABILITY
Mr. Vincent
SOCIOECONOMIC Married for five years; physical education teacher for ten years
SPIRITUAL/RELIGIOUS
PHARMACOLOGIC
Oxycodone and acetaminophen 5/325 (Percocet); bacitracin ointment; interferon alpha-2b recombinant (INF-alpha 2b, Intron A)
LEGAL
ETHICAL
ALTERNATIVE THERAPY
PRIORITIZATION
DELEGATION
Overview: This case requires the nurse to recognize the risk factors and characteristics of melanoma. The diagnostic process and treatment options for a malignant skin lesion are discussed. The nurse considers the client’s need for emotional support.
Client Profile
Mr. Vincent is a 32-year-old man who has scheduled an appointment with a dermatologist to have a black spot on his right ear assessed. Mr. Vincent states, “My wife noticed a black circular area on my ear about two weeks ago and she suggested I get it looked at since she did not remember the spot being there before. I know that too much time in the sun is not very good for your skin. I’m a physical education teacher so I am out in the sun a lot, and I admit that I do not always remember to apply sunscreen.”
Case Study
There is a dark area on Mr. Vincent’s right ear approximately 0.4 cm by 0.4 cm round in size. The color of the surrounding skin is normal. Mr. Vincent says that he noticed the spot about four months earlier but did not think much of it. “I figured it was a mole. Since it did not hurt, I really didn’t give it much thought.”
Questions
You are the nurse working with the dermatologist. Make a list of questions you could ask regarding the area of concern to help determine if the site on Mr. Vincent’s ear could be melanoma.
Explain the ABCD criteria for assessing a skin lesion.
The pathology report from the punch biopsy states, “deep penetrating nevi with atypical features worrisome for melanoma.” The dermatologist suggests that Mr. Vincent have a sentinel lymph node mapping and biopsy procedure. How might the nurse explain what this procedure is, why it is done, and potential common and serious adverse effects/ complications?
Mrs. Vincent says, “How did this happen? My husband has dark hair and olive skin. I thought only fair-skinned redheads got skin cancer.” Is there any truth to Mrs. Vincent’s assumption? List five risk factors the nurse should include in an explanation of what puts individuals at greater risk for skin cancer.
Discuss the incidence of dark-skinned individuals diagnosed with melanoma.
The results of the sentinel lymph node mapping and biopsy reveal that the most proximal lymph node near Mr. Vincent’s parotid gland is positive with a 0.1 mm micrometastasis. Given that the punch biopsy was suspicious for melanoma and that there is a positive sentinel lymph node, the dermatolo-gist prescribes a CT scan of the head, chest, neck, abdomen, thorax, and pelvis, a MRI of the brain, and a PET scan of the body to determine the extent of Mr. Vincent’s melanoma. Mr. Vincent asks, “What gland is it near?” and then states, “I know what a CT scan and MRI are but what is a PET scan?” What function does the parotid gland serve? Explain a PET scan to Mr. Vincent?
What does it mean to explain cancer according to its “stage” using the TNM system? Melanoma may be staged according to a “clinical stage” and a “pathological stage.” Briefly discuss the difference.
It has been six weeks since his initial visit to the dermatologist and Mr. and Mrs. Vincent are meeting with the dermatologist today to get results of the diagnostic tests. They learn that Mr. Vincent has been diagnosed with “Stage IIIA T1a, N1a, M0” malignant melanoma. What does this stage mean?
Mr. Vincent asks the dermatologist, “What is my prognosis?” What is Mr. Vincent’s five-year survival rate?
Identify two nursing diagnoses the nurse should consider for Mr. Vincent when he learns of his diag-nosis of melanoma.
Discuss what the nurse can do to reduce the fear and anxiety that Mr. Vincent may feel upon learning that he has melanoma.
Results of Mr. Vincent’s CT scan, MRI, and PET scan are negative. The suggested intervention is a curative lymph node dissection. There are no postoperative complications and Mr. Vincent is being discharged home. He is given a prescription for oxycodone and acetaminophen 5/325 one to two tablets every four to six hours as needed for postsurgical incisional pain. He has staples at his incision site to which Bacitracin is applied and the site is covered with a sterile dressing. He will return to the surgeon’s office two days after discharge to have the dressing removed and a postoperative incision check. The nurse is providing discharge teaching. What are the common adverse effects of oxycodone and acetaminophen 5/325 and instructions for safe administration? What warning signs indicate that Mr. Vincent should call his surgeon?
Identify two nursing diagnoses the nurse should consider for Mr. Vincent following his lymph node dissection.
Four weeks later, Mr. Vincent sees an oncologist to discuss recommendations regarding adjunct treatment. The oncologist explains that the only FDA-approved therapy for stage III melanoma is high-dose interferon (INF)-alpha 2b, which offers a modest survival benefit with the risk of adverse effects. What are the adverse effects of high-dose interferon (INF)-alpha 2b?
The oncologist suggests Mr. Vincent also con-sider treatment offered through participation in a clinical trial. What is a clinical trial and what are the three phases of a clinical trial?
Mr. Vincent does some research and takes some time to consider the treatment options and discuss them with his wife. He decides that presented with only the possibility, and not a guarantee, of an increase in survival rate with the interferon therapy, the benefit does not outweigh the risk of the adverse effects. He declines interferon treatment and is going to explore clinical trials. As Mr. Vincent’s nurse, how should you respond to Mr. Vincent’s decision?
What will Mr. Vincent require in terms of follow-up care? Discuss how often Mr. Vincent will need to see the dermatologist, the symptoms to report, precautions to take, and the need for emotional support.
RUBRIC
QUALITY OF RESPONSE NO RESPONSE POOR / UNSATISFACTORY SATISFACTORY GOOD EXCELLENT Content (worth a maximum of 50% of the total points) Zero points: Student failed to submit the final paper. 20 points out of 50: The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. 30 points out of 50: The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately. Elements of the required response may also be lacking. 40 points out of 50: The essay illustrates solid understanding of the relevant material by correctly addressing most of the relevant content; identifying and explaining most of the key concepts/ideas; using correct terminology; explaining the reasoning behind most of the key points/claims; and/or where necessary or useful, substantiating some points with accurate examples. The answer is complete. 50 points: The essay illustrates exemplary understanding of the relevant material by thoroughly and correctly addressing the relevant content; identifying and explaining all of the key concepts/ideas; using correct terminology explaining the reasoning behind key points/claims and substantiating, as necessary/useful, points with several accurate and illuminating examples. No aspects of the required answer are missing. Use of Sources (worth a maximum of 20% of the total points). 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