LP 4 Case Studies Student copy
Skin Cancer Screening and Prevention
Patient Profile
S.N., a 30-year-old white woman, comes to the clinic for a physical examination. She is fair skinned
with blue eyes. She works as a waitress and loves outdoor sports.
Subjective Data
 Wants a “checkup” because her father recently died of melanoma
 Wants to know if she will get this cancer
 Loves the “outdoors” and swims every day
Objective Data
 Blood pressure 112/68, pulse 60, temperature 97.6°F, respirations 16
 Height 5’5, weight 125 lb
 Arms, legs, and face are darkly tanned
 Skin examination within normal limits, no evidence of lesions, rashes, or pigment changes
Discussion Questions
1. What is the priority of care for S.N. and why?
- The priority care is to educate her on risk for melanoma. An example is genetics. Nursing
would want to recommend her to go to a dermatologist for regular skin exams.
2. Along with the physical examination, what other form of nursing assessment is indicated?
- Nursing should palpate the lymph nodes. Nursing should also get an extensive history of the
patient’s occupational hazards and lifestyle.
3. How do you distinguish between a normal mole and malignant melanoma?
- You will distinguish between the two by keeping track of appearance, shape, size, color,
and/or elevation. Melanoma borders tend to be uneven and might have notched or
scalloped edges. And a common mole tends to be a single shade of brown while a
melanoma may have different shades of brown, tan, or black.
4. List 7 risk factors for the development of skin cancer. What factors does S.N. have?
- Some factors S.N have are lighter skin color, family history, personal history, excessive
exposure to the sun, history of sunburns, indoor tanning, easily burning skin, blue eyes, and
blonde hair.
5. What would you include in a teaching plan for S. N. to reduce her risk of developing
precancerous and cancerous lesions?
- I would do self-care. I would educate her to do skin examinations using the ABCDE’s of
moles. Avoid the sun as much as possible. When out in the sun wear appropriate sunscreen,
wear a hat, and some type of covering for her arms and legs if able.
Fractured Femur
Patient Profile
N.E. is a 32-year-old man who sustained a closed, complete, oblique fracture of the left femur in a single
vehicle motor vehicle accident. He is being admitted to the orthopedic floor from the emergency
department (ED) and is scheduled to have surgery tomorrow afternoon. He states he had asthma as a
child and denies any other health problems.
Subjective Data
 Rates pain in left leg as 4 on a 0 to 10 pain scale after receiving 4 mg of intravenous (IV)
morphine in the ED 30 minutes before arrival on the orthopedic unit
 States his parents and girlfriend saw him in the ED and have gone home for the night and will
come back tomorrow before his surgery
Objective Data
 Temperature 98.9°F, pulse 88, respirations 18, blood pressure 132/70
 Alert and oriented x 3
 Abrasion to forehead and multiple abrasions to arms and legs
 Left leg to 10 lb of Buck’s traction
 Bilateral feet and toes warm and pink with movement and sensation equal and within normal
limits
 Dorsalis pedis and posterior tibial pulses palpable at 3+
Interprofessional Care
Admitting Orders
 Bedrest
 10 lb of Buck’s traction to left lower extremity
 NPO
 IV Lactated Ringer’s @ 125 mL/hr
 Morphine sulfate 4 mg IV every 2 hours PRN for pain
 Cefazolin 1 mg IV on call to the operating room
Discussion Questions
1. What does N.E.’s diagnosis of a closed, complete, oblique fracture of the left femur mean?
- A closed break means that the skin has not been broken by the bone, a complete break
mean that the break goes completely through the bone, and oblique means the break of the
bone is at an angle.
2. What is the primary purpose of applying Buck’s traction? What interventions do you employ to
maintain the traction system?
- Buck’s traction immobilizes the break; keeps the bone from moving. This also helps stopping
soft tissue damage and reduces pain and muscle spasms. A couple interventions include, to
prevent external rotation of the left hip from the traction a pillow is placed along the femur.
Also, ensure that he is in the proper position in the bed and the weights are always hanging
freely.
3. What specific assessments do you need to be performed?
-
Check pulses to ensure proper blood flow to left foot, determine dorsiflexion and plantar
flexion to assess motor function, assess tibial nerve by stroking the sole of the foot, assess
skin frequently for redness and possible development of pressure ulcers that can develop
due to decreased mobility from being in traction.
4. What potential complications is N.E. at risk for because of his reduced mobility? Describe
interventions to include in his plan of care to prevent each complication.
- At risk for impaired skin integrity, examine the skin for open wounds, rashes, bleeding,
discoloration, duskiness, blanching. Massage skin and bony prominences, keep the bed
linens dry and free of wrinkles. Place water pas or padding under elbows or heels as
indicated.
- At risk for peripheral neurovascular dysfunction, assess capillary return, skin color, and
warmth to left foot. Maintain elevation of injured extremities unless contraindicated by the
confirmed presence for compartmental syndrome. Encourage the N.E to exercise digits and
joints distal to the injury routinely.