Question

A nurse is caring for an older adult client who is at risk for developing pressure ulcers. Which of the following interventions should the nurse use to help maintain the integrity of the client's skin? (Select all that apply.)

A. Keep the HOB elevated 30 degrees
B. Massage the client's bony prominences frequently
C. Apply cornstarch liberally to the skin after bathing
D. Have the client sit on a gel cushion when in a chair
E. Reposition the client at least every 3 hr while in bed

Answer 1

The nurse should implement the following interventions to help maintain the integrity of the client's skin:

Keep the HOB elevated 30 degrees.

Reposition the client at least every 3 hr while in bed

Have the client sit on a gel cushion when in a chair.

Options A, D and E are correct

The nurse should not massage the client's bony prominences frequently or apply cornstarch liberally to the skin after bathing. These interventions can actually damage the skin and increase the risk of pressure ulcers.

Cornstarch can absorb moisture from the skin, which can make the skin dry and more susceptible to tearing. Massaging the client's bony prominences can also damage the skin, especially if the skin is already dry or fragile.