Asked by Shary Matthews on Apr 27, 2024
Verified
The nurse is caring for a patient with a healing Stage III pressure ulcer. Upon entering the room, the nurse notices an odor and observes a purulent discharge, along with increased redness at the wound site. What is the next best step for the nurse?
A) Complete the head-to-toe assessment, including current treatment, vital signs, and laboratory results.
B) Notify the health care provider by utilizing Situation, Background, Assessment, and Recommendation (SBAR) .
C) Consult the wound care nurse about the change in status and the potential for infection.
D) Check with the charge nurse about the change in status and the potential for infection.
Purulent Discharge
A thick, often yellowish or greenish fluid produced at sites of infection, indicating the presence of pus and bacteria.
Stage III Pressure Ulcer
A pressure injury where the damage has reached the subcutaneous tissue layer, often presenting as a deep, open wound.
Infection
The invasion and multiplication of microorganisms in body tissues, causing illness.
- Practice effective communication and nursing interventions for wound care management.
Verified Answer
Learning Objectives
- Practice effective communication and nursing interventions for wound care management.
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