The nurse is contributing to the plan of care for an immobile patient. Which of the following would the nurse recognize as increasing the patient's risk of developing a pressure ulcer on the heels? (Select all that apply.)
a. Elevating legs on pillows
b. Impaired circulation
c. Being obese
d. Turning every hour
e. Wearing oxygen at 2 L per nasal cannula
f. Lying on wet linens
ANS: B, F
Pressure ulcers are caused by ischemia, which results from the continuous pressure that reduces blood flow to the area. Those with impaired circulation are at greater risk of developing a pressure ulcer. Linens should be kept clean, dry, and wrinkle-free.
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