Fundamentals of Nursing Q 28
Mrs. Lim begins to cry as the nurse discusses hair loss. The best response would be:
A. “Don’t worry. It’s only temporary”
B. “Why are you crying? I didn’t get to the bad news yet”
C. “Your hair is really pretty”
D. “I know this will be difficult for you, but your hair will grow back after the completion of chemotherapy”
Correct Answer: D. “I know this will be difficult for you, but your hair will grow back after the completion of chemotherapy”
“I know this will be difficult” acknowledges the problem and suggests a resolution to it. The term alopecia means hair loss regardless of the cause. It is not exclusive to the scalp; it can be anywhere on the body. As an individual grows older, they will lose hair. The difference between male hair loss and female hair loss is the pattern. Men generally lose hair in the front and the temporal region, while women tend to lose hair from the central area of the scalp. Also, female hair loss will not end up with complete baldness, whereas male hair loss can end up with complete baldness.
Option A: “Don’t worry..” offers some relief but doesn’t recognize the patient’s feelings. The epidemiology is variable depending on the cause of alopecia and the type. In alopecia areata, the prevalence is 0.2% with no racial or sexual predilection, and it may affect any age group. Androgenetic alopecia is a common disorder affecting 50% of men and 15% of women, especially postmenopausal women.
Option B: “..I didn’t get to the bad news yet” would be inappropriate at any time. Pathophysiology is dependent on the type of alopecia. In alopecia areata, it is unknown, but the most common hypothesis involves autoimmunity in the form of a T-cell–mediated pathway. In androgenetic alopecia, both genetic and hormonal androgens play a role in pathogenesis. In telogen effluvium, the shedding of hair is under the influence of hormone or stress, but sometimes the trigger is not very clear.
Option C: “Your hair is really pretty” offers no consolation or alternatives to the patient. During the physical examination, it is essential to notice the pattern of hair loss. In a patient with androgenetic alopecia, patients tend to lose hair from the frontal and temporal area (male type) and the central scalp area (female type). In alopecia areata, the patient may lose hair from a single area (alopecia areata classical type), the whole scalp and eyebrows (alopecia totalis), or from the entire body (alopecia universalis). In tinea capitis, the classic presentation is black dots associated with broken hair, while the inflammatory type (favus) correlates with the scarring type of alopecia.