A patient has a wound that is a shallow crater with surrounding ...

[crazycityslicker]

A patient has a wound that is a shallow crater with surrounding erythema and warmth. What stage pressure ulcer does the nurse chart?
 
  a. Stage I
  b. Stage II
  c. Stage III
  d. Stage IV

Question 2

A patient has a purulent, foul-smelling leg wound. What wound care practice is most appropri-ate?
 
  a. Leave the wound open to the air.
  b. Administer systemic antibiotics.
  c. Cleanse the wound with diluted povidone iodine.
  d. Prepare the patient for operative dbride-ment.

[CourtneyCNorton]

Answer to Question 1

B
Stage II is a partial thickness ulcer that looks like an abrasion, blister, or shallow crater. A stage I pressure ulcer is redness or mottled skin that does not blanch. Stage III ulcers are full thickness deep craters. Stage IV ulcers may extend into the fascia and may be necrotic.

Answer to Question 2

C
Antiseptics are not used on healthy granulating tissue. Povidone iodine must be diluted and only used short term. A moist environment is needed for healing; leaving the wound open to air will cause too much drying. The patient may eventually need operative dbridement. Systemic anti-biotics may or may not be needed.