A nurse is caring for an older adult client. The nurse informs the client that straining while defecating can cause which of the following?

A) Exposed bone: Exposed bone is a manifestation of a stage 4 pressure ulcer, where full-thickness skin loss occurs, exposing muscle, tendon, or bone. In stage 3 pressure ulcers, the skin loss extends into the subcutaneous tissue, but it does not reach the level of exposing underlying structures like bone.

B) Blood-filled blisters: Blood-filled blisters can occur in various stages of pressure ulcers, but they are not specific to stage 3. They may be present in stage 1 or stage 2 pressure ulcers as well.

C) Necrotic subcutaneous tissue: This is the correct manifestation of a stage 3 pressure ulcer. Stage 3 pressure ulcers involve full-thickness skin loss with visible necrosis or damage to the subcutaneous tissue. The ulcer may appear as a deep crater with or without undermining of adjacent tissue.

D) Partial-thickness skin loss: Partial-thickness skin loss is characteristic of stage 2 pressure ulcers, where the ulcer extends through the epidermis and into the dermis but does not involve deeper tissue layers like the subcutaneous tissue.

A) Dysrhythmias:
Straining while defecating can trigger the Valsalva maneuver, which involves taking a deep breath and bearing down. This can lead to increased intrathoracic pressure, decreased venous return to the heart, and subsequently a sudden drop in blood pressure when the strain is released. These changes can cause cardiac dysrhythmias, particularly in older adults or those with underlying heart conditions.

B) Dilated pupils:
Dilated pupils are not a known consequence of straining while defecating. Pupillary dilation is typically associated with responses to low light, certain medications, or neurological conditions, rather than gastrointestinal strain.

C) Gastric ulcer:
Gastric ulcers are caused by factors such as Helicobacter pylori infection, prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs), or excessive stomach acid. Straining during defecation does not contribute to the development of gastric ulcers.

D) Diarrhea:
Straining while defecating is more likely to be associated with constipation rather than diarrhea. Diarrhea involves frequent, loose, or watery stools, whereas straining typically occurs due to hard stools and difficulty passing them.