78 y/o female was admitted with heart failure to the icu from home. by day 3 of hospitalization, she had improved and was transferred to the medical cardiac unit. the pressure injury survey was conducted on day 4 of hospitalization and the survey team saw a stage 1 area of persistent, nonblanchable redness on her right heel. review of her hospital admission assessment record revealed that she had 4+ lower right leg edema and brown discoloration of the lower calf and ankle skin. a 2 cm by 4 cm wound with serous drainage also was also documented over her medial lower leg midpoint between her calf and ankle. the skin assessment documented on arrival to the medical cardiac unit noted a stage 1 pressure injury at this site in addition to the wound, edema, and brown discoloration on her left lower leg as noted on the admission assessment. for the pressure injury survey, this would be reported as: