A nurse is developing a plan of care to prevent skin breakdown for a client with a spinal cord injury and paralysis. Which of the following nursing actions are appropriate? (Select all that apply.)

Choice A reason: Minimizing skin exposure to moisture is essential in preventing skin breakdown. Moisture from incontinence, perspiration, or wound drainage can lead to maceration of the skin, weakening its integrity and increasing the risk of pressure injuries. Using moisture barriers and prompt cleansing helps maintain skin resilience. Choice B reason: Keeping the skin dry with absorbent materials such as moisture-wicking pads or briefs helps reduce the risk of skin breakdown. These materials draw moisture away from the skin, preventing prolonged exposure that can compromise the epidermal barrier and promote bacterial growth. Choice C reason: Massaging over erythematous bony prominences is contraindicated. Redness over a bony area may indicate early pressure injury, and massaging can exacerbate tissue damage by increasing capillary rupture in already compromised skin. This practice can worsen ischemia and lead to deeper tissue injury. Choice D reason: Turning every 4 hours is insufficient for a client with impaired mobility and sensation. The standard of care recommends repositioning at least every 2 hours to relieve pressure and promote circulation. Extending intervals to 4 hours increases the risk of pressure ulcer development. Choice E reason: Using pillows to elevate the heels off the bed surface is a key intervention to prevent pressure ulcers. The heels are particularly vulnerable due to minimal subcutaneous tissue and proximity to bone. Elevation reduces direct pressure and promotes circulation, aiding in tissue viability.