Question

The nurse is performing a dressing change for a client and notices that there is a new area of skin breakdown near the site of the dressing. On closer examination, it appears to be caused from the tape used to secure the dressing. This would be an example of which phase of the nursing process?

a. Assessment
b. Diagnoses
C. Implementation
D. Evaluation

Answer 1

The nurse noticing new skin breakdown caused by the dressing tape represents the evaluation phase of the nursing process, where the outcomes of interventions are assessed and care plans are adjusted accordingly.

Step-by-step explanation:

Noticing a new area of skin breakdown near the site of the dressing, caused by the tape used to secure the dressing, would be an example of the evaluation phase of the nursing process. During the evaluation phase, the nurse assesses the outcomes of the care provided, determines the effectiveness of the interventions, and identifies any new issues that need to be addressed. In this case, the nurse's observation of skin breakdown would lead to re-evaluating and possibly changing the care plan to prevent further skin injury.