Nursing Care of the Patient with

Complex Sensory/Perceptual
Alterations and Disorders of the
Integumentary System
Heather LaPoint, RN, BSN, CCRN
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Objectives

Discuss the normal anatomy, physiology, and functions of the skin.

Identify the variations in skin assessment findings for the older adult.

Identify primary and secondary skin lesions with their pattern and
distribution.

Explain the etiology, clinical manifestations, and collaborative care of

patients with benign and malignant dermatological disorders.

Discuss nursing interventions and rationale for the nursing diagnoses of

Impaired Tissue Integrity.

Discuss the skin tests and procedures used in diagnosing skin and related
disorders.

Plan health teaching for discharge planning and home maintenance for the
patients who have malignant or benign skin disorders.

Summarize the psychologic and physiologic effects of chronic dermatologic

conditions.
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Quick Review - Skin

Structures (Epidermis, Dermis,

Subcutaneous layer, Appendages)

Functions

Effects of Aging

Quick Review - Skin

Assessment

Subjective vs. Objective

Primary vs. Secondary Lesions

Cultural Considerations

Risk Factors

A, B, C, D, E s of Melanoma
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Pre-Malignant and Malignant

Disorders of the Integumentary
System

Actinic Keratosis

Atypical Nevi

Carcinoma (Basal Cell/Squamous Cell)

Pre-Malignant and Malignant

Disorders of the Integumentary
System

Melanoma

Cutaneous T-Cell Lymphoma

Pre-Malignant and Malignant

Disorders of the Integumentary
System
Disorder

Manifestations

Treatment/Prognosi
s

Actinic Keratosis
(Pre-Malignant)

Seen in older, white patients as

sun damage. Flat, elevated, dry,
patches. Rough with red base and
populate in sun-exposed areas.

Cryoablation, peels, resurfacing,

topicals, but all treatments may still lead
to a reoccurrence. Encourage patient to
document lesion and follow up care.

Atypical Nevi
(Pre-Malignant)

May lead to Malignant Melanoma. Irregular

border, varying shade of color from pink to
black, mole. Can be located anywhere, but
commonly located on back with at least one
flat and one raised edge.

Familial link. Careful history

assessment. Biopsy of the nevi
encouraged. Assess atypical areas
including between toes and hairlines
for other nevi.

Basal - most common in middle aged or older,

slowly growing papule with rolled, well-defined,
pearly borders and erosion/depression in
center

Basal - most common - least lethal, likely to

stay as a locally invading tumor with a 90%
cure rate, surgical excision, chemo, surgery,
cryotherapy.

Squamous - sun exposed areas, firm nodules

with scaly ulcerations, more common on face
and hands, may be exacerbated on the lips by
smoking.

Squamous - highly aggressive, may

metastasize, will become lethal if not treated
early and correctly., surgery, cryotherapy,
radiation, chemo

Can begin anywhere there is a melanocyte.

Common colors of lesions are brown/black
with size <1 cm. Check the back, chest and
legs.

Highest skin cancer related morbidity.

Highly metastatic. Combination of genetics
and environmental. Poor prognosis if not
treated early. Surgical excision and then
chemo if depth >1.5 mm or if metasis
noted.

Slow disease, originates in skin. ?

environmental in nature. More common in
men. Looks similar to psoriasis in
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presentation, but presents
as indurated
patches, then plaques, and eventually

Treatment not curative, but can help to

control some of the symptoms, such as the
intense pruritus. Topical dermatologic
drugs, radiation therapy, interferon, and
chemotherapy. Despite this, 10% of

Carcinoma
(Basal/Squamous
Cell)
*epidermal cells
Malignant Melanoma
*melanocytes
Lymphoma

Diagnostic Testing for Malignant

Disorders of the Integumentary System

Curettage

Biopsy (punch/excisional)

Cryosurgery

Nursing Management for Malignant

Disorders of the Integumentary
System

Prevention

Procedures

Wound Care

Pharmacology

Psychologic Effects
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Benign Disorders of the

Integumentary System

Bacterial vs. Viral vs. Fungus

Infestations

Allergic reactions

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0

Benign Disorders of the

Integumentary System

Psoriasis

Acne

Lipoma

Lentigo (Liver Spots/Age Spots)

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Sample Care Plan

Medical Diagnosis: suspected malignant melanoma

Nursing Diagnosis: Impaired Tissue Integrity

Impaired Tissue Integrity r/t surgical excision site aeb open

wound with wet to dry dressing application.

By the end of the shift, the patient will:

1. Report any pain at the site of impaired tissue integrity on a

0-10 scale.

2. Participate in wound care by verbalizing the steps of the

dressing change as the nurse performs the procedure.

3. Consume 80% of protein provided on all 3 meal trays.

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Wrapping Up

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References
Ackley, B.J. & Ladwig, G.B. (2014). Nursing Diagnosis Handbook: An Evidence-based Guide to
Planning Care: Interventions and Rationales for Adult, Geriatrics, Mental Health, Pediatrics,
Maternal/Child Health, Multicultural, Home Care, Client/Family Teaching and Discharge Planning
(10th ed). Maryland Heights, MO: Elsevier.
Castillo, S. (2014). Strategies, Techniques, Approaches to Critical Thinking: A Clinical Reasoning
Workbook for Nurses (5th Ed). St. Louis, MO: Elsevier.
Habel, M. & Tatliff, C. (2015). Providing relief for patients with malignant wounds. Retrieved online
nurse.com/ceu/south.
Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L., & Harding, M. (2014). Medical-Surgical Nursing:
Assessment and Management of Clinical Problems (9th Ed). St. Louis, MO: Elsevier.
Lilley, L., Collins, S., & Snyder, J. (2014). Pharmacology and the Nursing Process (7th Ed). St.
Louis, MO: Elsevier.
Lutz, C, Mazure, D. & Litch, N. (2015). Nutrition and Diet Therapy (6th Ed). Philadelphia, PA: G.A.
Davis Company.

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