Question

The nurse is caring for a client with a nursing diagnosis of impaired skin integrity related to a stage iii pressure ulcer. what would be the most important outcome for this client?

Answer 1

The nurse is caring for a client with a nursing diagnosis of impaired skin integrity related to a stage iii pressure ulcer. The most important outcome for this client is to complete the head-to-toe assessment and include current treatment such as monitoring vital signs and laboratory results.

What is a stage III pressure ulcer?

Corresponds to necrosis or damage to the subcutaneous tissue due to the loss of skin thickness, with stage III being the stage in which the wound may be larger than it appears on the skin surface, and may extend to the granulation tissue and epibole of the wound.

Therefore, in stage 3, the ulcer continues to develop, and may extend to the muscles, and this condition must be continuously monitored by nurses to reduce the infection in the wound that, if left untreated, can have serious consequences for the patient in the future.

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