Which assessment is most supportive of the nursing diagnosis, - ProProfs Discuss
Topics
Products
Follow Us:

Which assessment is most supportive of the nursing diagnosis, Impaired skin integrity related to purulent wound drainage?



A. A heart rate of 88 beats/minute
B. Wound healing by primary intention
C. Oral temperature of 101° F (38.3° C)
D. Dry and intact wound dressing

This question is part of

Basic Physical care (Part 2)
Asked by Bradon, Last updated: Apr 09, 2020

+ Answer
Request

2 Answers

J. Shatner

J. Shatner, Content writer, Boston

Answered Aug 29, 2018

The answer to this is letter C. The fact that the patient has a high temperature may indicate that there is an infection that is taking place. When a patient has a heart rate of 88, this is actually normal especially when the person is at rest. A person who has dry dressing means that there is nothing wrong with the wound.

Wound healing by primary intention will also not work with the assessment of the nurse. Once the assessment has been done, further inspection of the patient may be necessary so that the right treatments will be given to the patient at the soonest possible time.

 

John Smith

John Smith

Answered Sep 09, 2016

1. oral temperature of 101f (38.3c)-rationale: the nursing diagnosis indicates that the clients wound, which has purulent drainage, is infected. in response to the infection, the clients temperature would be elevated. a heart rate of 88 beats/minute, healing by primary intention, and a dry, intact dressing demonstrate normal assessment findings.\r\n\r\nclient needs category: physiological integrity\r\nclient needs subcategory: physiological adaptation\r\ncognitive level: application\r\n\r\nreference: taylor, c., et al. fundamentals of nursing: the art and science of nursing care, 6th ed. philadelphia: lippincott williams & wilkins, 2008, p. 1192.

 

Search for Google images
Select a recommended image
Upload from your computer
Search for Google images
Select a recommended image
Upload from your computer
Search for Google images
Select a recommended image
Upload from your computer

Email Sent
We have sent an email to your address "" with instructions to reset your password.