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 moisture prevents maceration, which weakens skin and increases breakdown risk. In paralyzed patients, incontinence or sweating exacerbates pressure ulcers, making moisture control essential for skin integrity. Choice B reason: Using pillows to elevate heels reduces pressure on bony prominences, common ulcer sites. Offloading pressure prevents tissue ischemia, making this an effective intervention for skin breakdown prevention. Choice C reason: Massaging erythematous bony prominences risks tissue damage, as it increases pressure on compromised areas. Gentle repositioning is preferred, making this an incorrect action for preventing skin breakdown. Choice D reason: Powder can cake and irritate skin, increasing breakdown risk, especially in moist areas. Proper drying and barrier creams are safer, making powder use an incorrect intervention for skin protection. Choice E reason: Turning every 4 hours is insufficient; paralyzed patients require repositioning every 2 hours to prevent pressure ulcers. This frequency is too low, making it an incorrect choice for effective prevention.