The client's expected outcome is The client will maintain skin integrity by discharge. Which of the following measures is best in evaluating the outcome?
A) The client's ability to reposition self in bed.
B) Pressure-relieving mattress on the bed.
C) Percent intake of a diet high in protein.
D) Condition of the skin over bony prominences.
Ans: D
During evaluation, the nurse collects data and makes a judgment summarizing the findings. In making a decision about how well the outcome was met, the nurse examines client data or behaviors that validate whether the outcome is met. The condition of the skin, especially over bony prominences, provides the best measure of whether skin integrity has been maintained.
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