# A nurse is assessing a chronic pressure ulcer on a bedridden patient. Which finding would indicate that the wound is progressing normally through the proliferative phase of healing? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=540883 > language: ko > subject: Adult Health ## 문제 A nurse is assessing a chronic pressure ulcer on a bedridden patient. Which finding would indicate that the wound is progressing normally through the proliferative phase of healing? ## 보기 1. Presence of bright red bleeding and clot formation 2. Wound edges that are widely separated with purulent drainage 3. Thick, dry scab covering the entire wound surface 4. Pink, granular tissue filling the wound bed with new capillary formation **✔ 정답** **정답: 4** ## 해설 The proliferative phase (days 3-21) is characterized by pink, granular granulation tissue with new capillary formation. Other options describe inflammatory phase or abnormal findings. ## 심화 해설 Understanding the Proliferative Phase The healing of a chronic pressure ulcer, like any full-thickness wound, follows a predictable sequence of phases. After the initial hemostasis and inflammation subside, the wound enters the proliferative phase. This stage is critical for rebuilding tissue structure and is characterized by cellular expansion, angiogenesis (new capillary formation), and extracellular matrix reconstruction [1,2]. The clinical hallmark of a wound progressing normally through this phase is the development of healthy granulation tissue. Analysis of the Correct Answer (Option 4) Option 4 describes pink, granular tissue filling the wound bed with new capillary formation. This is the textbook description of granulation tissue. The pink color is due to the rich network of newly formed capillaries (angiogenesis), and the granular, bumpy appearance comes from the proliferation of fibroblasts and the deposition of new collagen matrix. This finding indicates that the immune-stromal interactions are successfully coordinating the repair process, a key goal of the proliferative phase . It visually confirms that the wound is actively filling in with new, viable tissue, moving toward closure. Analysis of Incorrect Options **Option 1: Presence of bright red bleeding and clot formation.** This finding is characteristic of the hemostasis phase, which occurs immediately after injury. While some bleeding can occur if fragile new capillaries in a healing wound are disrupted, the primary description of active clot formation points to the very first stage of healing, not the proliferative phase . **Option 2: Wound edges that are widely separated with purulent drainage.** This finding is a classic sign of wound infection and a failure to heal. Purulent drainage indicates a high bacterial burden. As described in the framework of infection-driven proliferative phase impairment (IDPPI), pathogenic microbial communities can establish themselves and specifically disrupt the cellular activities of the proliferative phase, halting angiogenesis and tissue formation . This is a sign of wound deterioration, not normal progression. **Option 3: Thick, dry scab covering the entire wound surface.** A thick, dry scab (eschar) is composed of dehydrated, necrotic tissue and dried exudate. While a scab can form over a superficial wound healing by primary intention, in a chronic full-thickness pressure ulcer, a thick, dry covering impedes healing. It blocks the migration of epithelial cells across the wound bed, prevents wound contraction, and can serve as a reservoir for bacteria, thereby stalling the proliferative phase . Normal progression requires a moist wound environment to support cell migration and function. ## 임상 시나리오 Wound Assessment: Proliferative PhaseIdentifying Healthy Granulation Tissue The proliferative phase is marked by the formation of granulation tissue, which appears pink and granular due to angiogenesis and collagen deposition. This tissue fills the wound bed from the bottom up. A wound progressing normally will show a beefy red or pink base. Document the percentage of granulation tissue, noting it should gradually increase as the wound contracts and fills in. CautionDo not confuse healthy granulation tissue with hypergranulation (proud flesh), which rises above the wound edges and impedes epithelialization. Also, a dark red color that bleeds easily may indicate infection or trauma. ## 핵심 개념 - **Proliferative Phase** — The second phase of wound healing involving angiogenesis, granulation tissue formation, and epithelialization to rebuild tissue. - **Granulation Tissue** — New vascular tissue formed during the proliferative phase, appearing pink/red and bumpy due to new capillaries and collagen. - **Angiogenesis** — The formation of new blood vessels from pre-existing ones, essential for supplying nutrients and oxygen to the healing wound. - **Hemostasis Phase** — The immediate first phase of wound healing focused on stopping bleeding through clot formation and vasoconstriction. - **Pressure Ulcer** — Localized injury to the skin and underlying tissue, usually over a bony prominence, resulting from prolonged pressure. ## 같은 주제 문제 - [A nurse is assessing a surgical wound on postoperative day 5 and observes granulation tiss…](https://mymerci.kr/pages/nclex_q.php?qn_id=540881) - [A nurse is assessing a surgical wound on postoperative day 3. 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