A nurse is caring for a client who is incontinent and has a stage 2 pressure injury on their coccyx. Which of the following interventions should the nurse implement?
Explanation & Rationale
Rationale: A. Routine application of lotion is not recommended as a primary intervention for pressure injury management. Some lotions may also increase moisture or break down skin integrity if not used appropriately. The priority is reducing pressure and protecting skin from moisture, not frequent lotion application. B. Sliding a client increases friction and shear forces, which can worsen a stage 2 pressure injury or contribute to new skin breakdown. The correct technique is to lift the client using a draw sheet or mechanical lift rather than sliding. C. The 30-degree lateral position is recommended to reduce pressure over the coccyx and sacrum while also minimizing pressure on trochanters. This positioning helps offload bony prominences and promotes healing of pressure injuries by improving tissue perfusion and reducing prolonged pressure. D. Clients with pressure injuries should typically be repositioned at least every 2 hours (or more frequently depending on condition and risk level). A 3-hour interval is too long and increases risk of worsening tissue breakdown.