A nurse is caring for a client on a medical-surgical unit. Exhibits The nurse is planning the client's care. Which of the following actions should the nurse include? Select the 4 actions the nurse should include in the plan of care.

Rationale A. Reposition the client every 3 hr: Repositioning should be done every 2 hours for clients at risk of skin breakdown, not every 3 hours. Longer intervals increase the risk of pressure injuries, particularly in clients with limited mobility and incontinence. B. Place the client on a donut-shaped cushion: Donut-shaped cushions can actually increase pressure on surrounding tissue and contribute to skin breakdown. Pressure-redistribution surfaces are safer and more effective for preventing pressure injuries. C. Elevate the head of the bed to 45°: Elevating the head of the bed to no more than 30–45° reduces the risk of shear and friction on the sacral area while promoting comfort. Proper positioning helps protect skin integrity, especially in incontinent clients. D. Request a consult with a registered dietitian: Adequate nutrition is essential for skin health and healing. A dietitian can provide recommendations to ensure sufficient protein, calories, and nutrients to support skin integrity and prevent pressure injuries in clients with diabetes and limited mobility. E. Provide a support pressure-redistribution surface: Specialty mattresses or overlays redistribute pressure over bony prominences, reducing the risk of pressure injuries. These surfaces are critical for clients who are immobile or incontinent. F. Perform a skin risk assessment weekly: Skin assessments should be performed daily, not weekly, for clients at high risk. Frequent assessment allows early detection of pressure injury development. G. Use a moisture barrier ointment after cleaning the client's skin: Barrier ointments protect the skin from moisture associated with urinary and fecal incontinence. Regular application after cleansing helps prevent moisture-associated skin damage and breakdown.