AEB question

aeb stands for "as evidenced by". it is your evidence, or proof, that you have of the nursing problem which in this case is impaired tissue integrity (damage to mucous membrane, corneal, integumentary, or sucutaneous tissues). how do you prove the damage to this patient's sacrum? well, you would have looked at their sacrum when you were doing an exam and inspection. what would you have seen? your mind didn't say, "oh, that's a stage iv decubitus ulcer!" you saw a wound that had a length, width and depth that you, hopefully, measured and can describe in terms of it color, presence of any drainage and its amount and any odor as well as any redness or swelling of the wound edges. that is objective evidence of the ulcer. stage iv sacral decubitus ulcer is just a name for it.

see http://www.nursingquality.org/ndnqipressureulcertraining/module1/default.aspx - pressure ulcer training tutorial (includes photos) and http://ame-medical.com/staging_ulcers_guidelines.pdf - staging pressure ulcers

the construction of the 3-part diagnostic statement follows this format:

• problem - this is the nursing diagnosis. a nursing diagnosis is actually a label. to be clear as to what the diagnosis means, read its definition in a nursing diagnosis reference or a care plan book that contains this information. the appendix of taber's cyclopedic medical dictionary has this information.
  
• etiology - also called the related factor by nanda, this is what is causing the problem. pathophysiologies need to be examined to find these etiologies. it is considered unprofessional to list a medical diagnosis, so a medical condition must be stated in generic physiological terms. you can sneak a medical diagnosis in by listing a physiological cause and then stating "secondary to (the medical disease)" if your instructors will allow this.
  
• symptoms - also called defining characteristics by nanda, these are the abnormal data items that are discovered during the patient assessment. they can also be the same signs and symptoms of the medical disease the patient has, the patient's responses to their disease, and problems accomplishing their adls. they are evidence that prove the existence of the nursing problem. if you are unsure that a symptom belongs with a nursing problem, refer to a nursing diagnosis reference. these symptoms will be the focus of your nursing interventions and goals.
  

impaired tissue integrity r/t impaired physical mobility aeb sacral wound. . .but i also know i cant write a aeb giant hole in sacrum. my professor told me i wasnt allowed to use aeb sacral wound vac

• impaired physical mobility
  - this is not the cause of sacral decubitus ulcers. read the tutorial weblink. read about pressure ulcers in your nursing textbooks. you are responsible for knowing the pathophysiology of this condition if you are going to care for the patient:
  
  
  • http://www.merck.com/mmpe/sec10/ch126/ch126a.html
    - pressure ulcers
    
    
    • "pressure ulcers are areas of necrosis and ulceration where tissues are compressed between bony prominences and hard surfaces; they result from pressure alone or pressure in combination with friction, shearing forces, or both."
      
      

• sacral wound
  - yes, this is the proof, but it needs to be objectively described
  
  
• giant hole in sacrum
  - and you know this isn't right
  
  
• sacral wound vac
  - this is a medical treatment ordered by the physician and
  not
  evidence of damage to mucous membrane, corneal, integumentary, or subcutaneous tissues.