Basic Nursing SkillsQuestion 81 of 200

Pressure injury prevention for an immobile resident includes:

a.Place a doughnut-shaped cushion under the sacrum and reposition every four hours
b.Massage reddened bony prominences vigorously to restore circulation to the area
c.Reposition at least every 2 hours, off-load heels (heel float), keep skin clean and dry, use pressure-redistribution surfaces, maintain nutrition/hydration
d.Leave the resident in one position for six hours overnight so that sleep is not interrupted, then reposition her every two hours during the day and evening shifts

Explanation

Per NPUAP/EPUAP guidelines, prevention requires turning at least every 2 hours, off-loading heels (pillow under calf, not under heel itself), keeping skin clean and dry, using pressure-redistribution mattresses, and maintaining nutrition/hydration. Prolonged single position (d) causes ischemia; massaging reddened areas (b) damages capillaries; doughnut cushions (a) concentrate pressure on a ring and worsen tissue damage.

Law Reference: NPUAP/EPUAP pressure injury prevention

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