A nurse is caring for four clients. Which client should the nurse assess first? The client with a/an
a. eviscerated abdominal wound from surgery yesterday.
b. infected lower leg ulcer and diabetes, who needs a blood sugar measurement.
c. large open infected wound and temperature of 99.9° F.
d. operative incision covered with a clean, dry dressing from surgery 8 hours ago.
A
An abdominal wound that has eviscerated has opened up with abdominal contents exposed. This is a surgical emergency and this is the client the nurse should see first. The blood sugar mea-surement can be delegated to the unlicensed assistive personnel. The client with the temperature of 99.9° F will not need antipyretics as even small temperature elevations are beneficial. The operative incision sounds normal.
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