The nurse is caring for a client one week post-surgery. Which finding should the nurse expect to see if the surgical incision is healing properly?
A.
Eschar and slough in the wound.
B.
A well-approximated incision site.
C.
Beefy red granulation tissue.
D.
Erythema and serosanguineous exudate.
The correct answer and Explanation is :
The correct answer is B. A well-approximated incision site.
Explanation:
One week post-surgery, a properly healing surgical incision should generally show signs that the edges of the wound are aligned and coming together as expected. This means that the incision site should be well-approximated, indicating that the wound edges are close together and there is no significant separation. This is an important indicator of proper healing and helps reduce the risk of wound complications, such as dehiscence or infection.
Here’s a brief overview of the other options:
A. Eschar and slough in the wound:
Eschar and slough are types of necrotic tissue that can appear in chronic or non-healing wounds. Eschar is a dry, black or brown necrotic tissue, while slough is a moist, yellow or white necrotic tissue. These are typically not expected in a healing surgical wound and may suggest the presence of a complication or poor wound healing.
C. Beefy red granulation tissue:
Granulation tissue is a healthy sign of wound healing and is usually beefy red and moist, representing new tissue growth and capillary formation. While granulation tissue is a positive sign, it is more typically observed in later stages of healing, particularly in wounds that have been open for longer periods. One week post-surgery might still show a healing process in early stages with a well-approximated incision rather than full granulation tissue.
D. Erythema and serosanguineous exudate:
Erythema (redness) and serosanguineous exudate (a mix of serum and blood) can be normal in the early stages of wound healing. However, excessive erythema, warmth, and increased serosanguineous or purulent drainage might indicate inflammation or infection, which would be concerning at this stage.
In summary, a well-approximated incision site at one week post-surgery is a key sign of proper healing, showing that the surgical wound is closing and the initial stages of healing are progressing as expected.