When changing the client's sterile dressings on the second postoperative day, the nurse notes that the suture line is red and slightly inflamed. The nurse recognizes these findings are:
A)
abnormal and need to be reported to the charge nurse.
B)
signs of infection and need to be reported to the physician.
C)
normal signs of the inflammatory response.
D)
abnormal and need to be documented.
C
Explanation:
A)
Slight redness and inflammation is a normal sign of the inflammatory process, caused by increased blood flow to site of tissue trauma.
Analysis
Assessment
Physiological Integrity: Physiological Adaptation
B)
Slight redness and inflammation is a normal sign of the inflammatory process, caused by increased blood flow to site of tissue trauma.
Analysis
Assessment
Physiological Integrity: Physiological Adaptation
C)
Slight redness and inflammation is a normal sign of the inflammatory process, caused by increased blood flow to site of tissue trauma.
Analysis
Assessment
Physiological Integrity: Physiological Adaptation
D)
Slight redness and inflammation is a normal sign of the inflammatory process, caused by increased blood flow to site of tissue trauma.
Analysis
Assessment
Physiological Integrity: Physiological Adaptation
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