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.)

Rationale: A. Massaging reddened skin can damage underlying tissues and worsen skin breakdown. B. Moisture from incontinence, perspiration, or wound drainage increases the risk of skin breakdown. Keeping the skin clean and dry reduces this risk. C. Powder can cause skin irritation and does not effectively protect against pressure ulcers. Moisture-barrier creams are recommended instead. D. Clients at risk for skin breakdown should be repositioned at least every 2 hours, not 4. E. Elevating the heels prevents direct pressure on them, which are common sites for pressure injuries.