Marcus Lee is a 34-year-old male admitted after a motorcycle accident resulting in a thoracic spinal cord injury (T6). He reports paralysis from the waist down and relies on staff for turning and transfers. Marcus reports decreased sensation in the buttocks and lower extremities. Over the last 48 hours, Marcus has had multiple episodes of bowel and bladder incontinence due to neurogenic dysfunction. His linens were noted to be damp overnight. Marcus has not been eating well, consuming only 30-40% of meals. His albumin level is low, and he has lost weight over the past month. During the nurse's skin assessment of the sacral area, the following is observed: A shallow open area with a pink wound bed Partial-thickness skin loss involving the epidermis and part of the dermis No slough visible Surrounding erythema Medical history includes: Newly diagnosed neurogenic bladder and bowel Paraplegia MVA Based on the Braden Scale, which factors place Marcus at increased risk for developing a pressure injury?

A. Moisture from bowel and bladder incontinence: Constant moisture from incontinence leads to maceration of the skin, weakening its integrity and making it more prone to breakdown. Damp linens overnight further increase exposure. B. High sensory perception in the lower body: Marcus has decreased sensation in the buttocks and lower extremities, not high sensory perception. High sensory perception would actually protect against injury because he could feel discomfort and reposition. C. Paralysis with limited mobility: Paralysis prevents Marcus from repositioning independently, leading to prolonged pressure over bony prominences (e.g., sacrum). Immobility is one of the strongest predictors of pressure injury. D. Poor nutritional intake: He consumes only 30–40% of meals, has low albumin, and recent weight loss. Poor nutrition impairs wound healing, reduces tissue tolerance, and increases susceptibility to pressure injury. | E. Strong ability to reposition independently: Marcus cannot reposition independently due to paralysis. If he had strong ability, it would reduce risk. F. Decreased sensation: Loss of sensation means Marcus cannot feel pain or discomfort from pressure, moisture, or friction, so he doesn’t initiate protective movements. This contributes to unrecognized tissue damage.