While inspecting the pressure ulcer of a 90-year-old client, the nurse observes new tissue growth around the area, which is pinkish-red in color. The nurse should document the presence of:
1. epithelialization.
2. slough.
3. granulation.
4. eschar.
Answer: 3
1. Epithelialization is a process of new cell growth.
2. Slough is the semi-liquid white and yellow tissue seen in a wound bed.
3. The pinkish-red tissue is new tissue growth in the wound bed, called granulation tissue.
4. Eschar appears as black or brown, dried, hardened necrotic tissue.
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