A client with a history of inflammatory bowel disease develops severe ulcerative colitis and is admitted to the intensive care unit after surgery for a fistula repair. Which intervention is most important for the nurse to include in the plan of care?

A. Record the amount of daily wound drainage: Monitoring wound drainage is important to track healing and detect infection, but it is secondary to maintaining fluid and electrolyte balance, which can be severely disrupted after bowel surgery. B. Replace fluids IV based on intake and output: Clients with severe ulcerative colitis and recent surgery are at high risk for fluid volume deficit due to diarrhea, drainage, and third-spacing. Accurately replacing fluids based on measured losses is critical to maintaining perfusion and preventing hypovolemic shock. C. Assess skin condition and turgor for breakdown: Skin assessment helps monitor hydration and prevent pressure injuries, but this is supportive care. Without addressing fluid replacement first, skin integrity will continue to deteriorate due to systemic dehydration. D. Turn every 2 hours around the clock from side-to-side: Repositioning is essential for preventing pressure ulcers but does not address the acute physiological threats posed by fluid loss and instability in the immediate postoperative period.