WCC Exam Prep

Wound Care Certified Certification

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Assessment

During a routine diabetic foot examination, the nurse observes a small area of redness on the patient's heel. Upon applying gentle pressure to the area, the nurse notices that the redness does not blanch. The skin in this area also feels warmer than the surrounding tissue. What does this finding most likely indicate?

The presence of nonblanchable erythema (redness that doesn't disappear when pressed) and increased skin temperature are early warning signs of tissue damage in diabetic feet. These symptoms are similar to the initial stages of pressure injuries and require immediate attention to prevent further complications. In diabetic patients, such findings could indicate the beginning of ulceration or other serious foot problems due to compromised circulation and neuropathy.