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The nurse is caring for a patient who has an open wound and is evaluating the progress of wound healing. Which priority action will the nurse take?

a.Ask the nursing assistive personnel if the wound looks better.
b.Document the progress of wound healing as ""better"" in the chart.
c.Measure the wound and observe for redness, swelling, or drainage.
d.Leave the dressing off the wound for easier access and more frequent assessments.

User Ldavid
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Final answer:

When caring for a wound, it is vital to keep it clean and bandaged, not open and unprotected, to avoid infection and promote healing. The nurse should monitor for signs of infection and follow standard procedures for treating and assessing wound healing.

Step-by-step explanation:

The priority action a nurse should take when caring for a patient with an open wound is to assess the wound carefully while keeping it clean and appropriately bandaged. This clinical practice is crucial for promoting wound healing and minimizing the risk of infection. Frequent assessments are important, but it is not advisable to leave the dressing off for easier access, as the wound could become contaminated, leading to infections like purulent wounds which may indicate a bacterial infection.

Symptoms such as increased redness, swelling, and pain can be signs of infection and should be monitored closely. Moreover, it is standard procedure to obtain a sample for laboratory analysis if infection is suspected, while ensuring the patient applies prescribed treatments, such as a topical antibiotic ointment, and keeps the wound clean. This vigilant approach to wound management is a testament to the nurse's role in ensuring a safe recovery, as seen in scenarios involving the potential for aggressive infections like necrotizing fasciitis.

User Hartmut Pfarr
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