Books


Skin Problems

Introduction

  • the cancer patient is at risk for numerous treatment and disease-related skin impairments, including:
    • effects of chemotherapy, radiation and surgery
    • pressure sores
    • edema, ascites and lymphedema
    • alopecia
    • pruritus
    • infection
    • cutaneous metastases
  • some effects of chemotherapy include: hyper pigmentation, hypersensitivity, photosensitivity, rash, nail changes
  • some effects of radiation include: dry or moist desquamation, edema, radiation recall
  • alopecia is a particularly distressing side effect for some cancer patients

Assessment

  • focus on the patient's current skin condition and any significant past skin problems
  • observe color, vascularity, evidence of bleeding or bruising, presence of lesions, pressure sores , edema
  • describe any skin changes carefully, including location, duration, onset, aggravating and relieving factors, treatments and characteristics
  • review all medications as potential causes

Intervention

  • the goal is to maintain skin's natural integrity
  • encourage meticulous hygiene, keep skin clean and dry
  • assess high risk areas daily
  • promote adequate nutritional intake
  • protect affected areas from trauma
  • encourage patients to get a wig prior to anticipated hair loss, if possible
    • identify sources of funding and places to obtain wigs, scarves and other head coverings; the American Cancer Society can help with this
    • minimize hair loss with baby shampoos, soft hairbrush, infrequent washings, hair net in bed (in some cases, these measures may not make a difference)
    • encourage use of sunscreens, hats to protect scalp
    • encourage verbalization of feelings, fears about hair loss

References

Couillard-Getreuer, DL and Heery, ML (1994) "Protective Mechanisms - Skin" in Gross, J. and Johnson, BL (eds) Handbook of Oncology Nursing, 2nd ed., Boston: Jones and Bartlett, p. 421-463.

DeSpain, JD (1992)" Dermatologic Toxicity" in Perry, MC (ed) The Chemotherapy Source Book, Baltimore: Williams and Wilkins, p. 531-547.

Goodman, M, Hilderley, LJ, Purl, S. (1997). "Integumentary and Mucus Membrane Alterations" in Groenwald, SL, Frogge, MH, Goodman, M, Yarbro, CH, Cancer Nursing: Principles and Practice, 4th ed Boston: Jones and Bartlett, p. 768-822.

Sitton, E. (1992) Early and late radiation-induced skin alterations: Part II Nursing care of irradiated skin. Oncology Nursing Forum, 19: 907-912.






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