Asked by Mykal Josie on Jul 22, 2024
Verified
A patient hospitalized in a long-term rehabilitation facility is immobile and requires mechanical ventilation with a tracheostomy.She has a pressure area on her coccyx measuring 5 cm by 3 cm.The area is covered with 100% eschar.What would the nurse identify this as?
A) Stage II pressure ulcer
B) Stage III pressure ulcer
C) Stage IV pressure ulcer
D) Unstageable pressure ulcer
Eschar
A slough or piece of dead tissue that is cast off from the surface of the skin, particularly after a burn injury.
Pressure Ulcer
A localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure, or pressure in combination with shear.
Coccyx
The small, triangular bone at the base of the spinal column, commonly referred to as the tailbone, which can be a source of pain if injured.
- Acquire insight into the management strategies and aims for diverse stages of pressure injuries.
Verified Answer
TT
Thaanushini ThanabalasingamJul 28, 2024
Final Answer :
D
Explanation :
An eschar is a black,leathery covering made up of necrotic tissue.An ulcer covered in eschar cannot be classified using a staging method because it is impossible to determine the depth.
Learning Objectives
- Acquire insight into the management strategies and aims for diverse stages of pressure injuries.