A nurse evaluates the healing of a full-thickness skin tear on a 92-year-old resident of a long-term care facility. Which of the following would support the continuation of the current treatment plan?
A) The wound with redness surrounding at 12 days
B) The wound draining serosanguinous drainage at 14 days
C) The wound showing 50% healing at 16 days
D) Pain at the wound site at 19 days
Ans: C
About 50% healing at 16 days is acceptable. Full-thickness skin tears take an average of 21 days to healing in older adults. The treatment plan needs to be changed if there is redness (at 12 days), pain (at 19 days), or draining plasma (at 14 days).
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