A nurse is caring for a patient who has developed a pressure ulcer after a period of immobility. The nurse assesses the wound and notes that there is an area under the skin that extends in one direction away from the wound bed and creates an opening to a different layer of skin. Which best describes this phenomenon?

 

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Correct

- Tunneling

- Undermining

- Maceration

- Epithelialization

Rationale

A nurse may notice tunneling as a phenomenon that occurs in a deep wound. Tunneling develops as an area of dead space that extends from the wound to another area. In some cases, tunneling may connect two wounds that are present but separate; the tunneling provides a channel between the two lesions that connects them under the skin.

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