The nurse, caring for a patient with a large abdominal wound, suspects the patient has necrotizing fasciitis because of which of the following clinical findings?
1. multiple blisters that have a grey-colored foul smelling exudate
2. wound is red and edematous
3. wound is warm and the patient has an elevated temperature
4. patient is complaining of thirst and is becoming agitated
1
Rationale: The development of bullae, or blisters, is important in the differential diagnosis of necrotizing fasciitis because they are rarely associated with other skin infections. The serous or hemorrhagic fluid inside them can turn into a grey foul smelling fluid that is commonly described as "dishwater pus.". A red and edematous appearing wound is not an indicator of necrotizing fasciitis. A warm wound, elevated temperature, or complaints of thirst are not indicators of necrotizing fasciitis. The patient could be agitated for a variety of reasons other than the onset of a wound infection.
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