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NUR 643 Health Assessment Topic 4 Reflection

NUR 643 Health Assessment Topic 4 Reflection

 

The issue of assessing patients suffering from musculoskeletal pain is one that is the most challenging in the assessment undertaking. The most prevalent difficulty in a situation wherein a patient suffers from pain would be related to their cooperativeness. In most instances, there are certain questions that such patients fail to answer especially when they would force them to conduct a genetic test. For instance, some patient feel uncomfortable answering questions related to their family history. As such, a conundrum presents itself to the provider as relates to the next course of action. Herein, the challenge is whether to probe further or respect the patient’s autonomy. Also, ethically, it becomes important to not appear to be coaxing the patient to answer questions as they would then lie about them.

            Whereas the patient refusing to provide certain pertinent details is commonplace in certain situations, the provider needs to formulate strategies of overcoming the matter. One of the ways that they can do that is through deductive reasoning. In most cases, when a patient refuses to answer a question, it implies that they are positive for the issue that the provider is questioning them about. In addition, the provider can elucidate to the patient the significance of answering the questions in order to make them enlightened as to the import of the same.

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A skin lesion can either be benign (non-cancerous) or malignant (cancerous) based on the characteristics outside the lesion, physical,

NUR 643 Health Assessment Topic 4 Reflection

NUR 643 Health Assessment Topic 4 Reflection

and histologic characteristics of the lesion. A cancerous skin lesion is categorized based on its physical features which have an acronym of ABCDE. A stand for asymmetry, B for border, C is color, D is diameter and E for evolving (Bansal, 2018). Cancerous skin lesions are asymmetrical with two halves of the lesion having different appearances and characteristics. Conversely, non-cancerous lesions are symmetrical such that if the lesion is divided into half, the two sides have the same appearance and characteristics (Bickley & Szilagyi, 2017). Lesions can also be differentiated by the nature of their border, whether smooth or irregular. Cancerous lesions have irregular borders while benign have a regular border and smooth surfaces.

Lesions have different color variations, which correlate with the primary pathophysiologic changes such as dilation of blood vessels, extravasated blood, necrotized skin, and cyanosis (Bansal, 2018). A lesion can be hyperpigmented meaning that it has a darker shade than the body skin color or hypopigmented when it has a lighter shade. Cancerous lesions have a black, brown, blue, purple, or white color and often have a shiny appearance while non-cancerous have a red-vascular, waxy, and scaly appearance (Nast et al., 2016). Malignant lesions are itchy, resulting in bleeding and ulcerations, unlike benign lesions which do not itch.

Malignant lesions have moles having a diameter of more than 6 mm, while moles in benign lesions have a diameter less than 6 mm (Nast et al., 2016). Moreover, evolving involves the cancerous lesions having a fast growth rate and elevating above the skin while non-cancerous lesions do not grow fast and remain below or slightly elevated (Bickley & Szilagyi, 2017). Cancerous lesions have a tendency to multiply rapidly, and this characteristic differentiates them from benign lesions which have a slow evolution and change. Furthermore, malignant lesions do not heal with appropriate wound care and dressing as compared to benign that improve fast when appropriately cleaned and dressed.

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