How should the nurse aim to reduce a client's risk of developing pressure ulcers?
a. Position the client directly on the trochanter when side-lying.
b. Use a doughnut device for the client when sitting up.
c. Position the client at a 30-degree lateral turn and limit head elevation 30 degrees.
d. Massage over bony prominences.
C
The client should be positioned at a 30-degree lateral turn with the head elevation limited to 30 degrees to prevent pressure ulcers.
Positioning the client directly on the trochanter is not recommended.
Doughnut-shaped cushions are contraindicated because they reduce blood supply to the area, re-sulting in wider areas of ischemia.
Bony prominences should not be massaged. Massaging reddened areas increases breaks in the capillaries in the underlying tissues and increases the risk of injury to underlying tissue and pressure ulcer formation.
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