Nurse May is caring for an elderly bedridden adult. To prevent pressure ulcers, which intervention should the nurse include in the plan of care?
a. Turn and reposition the client at least once every 8 hours.
b. Vigorously massage lotion into bony prominences.
c. Post a turning schedule at the client’s bedside.
d. Slide the client, rather than lifting, when turning.
Answer C.
A turning schedule with a signing sheet will help ensure that the client gets turned and, thus, help prevent pressure ulcers. Turning should occur every 1 to 2 hours - not every 8 hours - for clients who are in bed for prolonged periods. The nurse should apply lotion to keep the skin moist but should avoid vigorous massage, which could damage capillaries. When moving the client, the nurse should lift - rather than slide - the client to avoid shearing.
a. Turn and reposition the client at least once every 8 hours.
b. Vigorously massage lotion into bony prominences.
c. Post a turning schedule at the client’s bedside.
d. Slide the client, rather than lifting, when turning.
Answer C.
A turning schedule with a signing sheet will help ensure that the client gets turned and, thus, help prevent pressure ulcers. Turning should occur every 1 to 2 hours - not every 8 hours - for clients who are in bed for prolonged periods. The nurse should apply lotion to keep the skin moist but should avoid vigorous massage, which could damage capillaries. When moving the client, the nurse should lift - rather than slide - the client to avoid shearing.