Which factors place patients at higher risk of developing pressure injuries or skin integrity issues? (Select all that apply.)

Choice A rationale Incontinence is a significant risk factor for pressure injuries because it exposes the skin to chronic moisture and chemical irritants found in urine and feces. This leads to skin maceration, which softens the tissue and makes it more susceptible to damage from friction and shear. Maintaining a dry environment and using moisture barrier creams are essential nursing interventions. Normal skin pH is slightly acidic, and the alkaline nature of ammonia in urine can disrupt this protective barrier. Choice B rationale Immobility is a primary cause of pressure injuries as it results in prolonged pressure over bony prominences. This pressure exceeds the capillary closing pressure, which is approximately 32 mmHg, leading to localized ischemia and tissue hypoxia. If the pressure is not relieved through regular repositioning, the lack of oxygen and nutrients leads to cell death and the formation of an ulcer. Patients who cannot move independently rely entirely on nursing staff to maintain their skin integrity. Choice C rationale Malnutrition, specifically a deficiency in protein, vitamins, and minerals, impairs the body's ability to maintain and repair skin tissue. Low serum albumin levels, with a normal range being 3.5 to 5.0 g/dL, are often associated with increased skin fragility and edema. Without adequate nutrition, the inflammatory and proliferative phases of wound healing are compromised, making the skin more likely to break down under minimal stress and making existing injuries much harder to treat or heal. Choice D rationale A high protein diet is actually a protective factor rather than a risk factor for pressure injuries. Protein is essential for collagen synthesis and tissue regeneration. Patients at risk for skin breakdown are often prescribed increased protein intake to support the structural integrity of the dermis and epidermis. Therefore, a high protein diet would decrease risk rather than increase it. This choice does not fit the criteria of a factor that places a patient at higher risk. Choice E rationale Frequent physical activity increases circulation and ensures regular relief of pressure on tissues, which significantly reduces the risk of developing pressure injuries. Physical activity promotes muscle tone and cardiovascular health, both of which contribute to healthy skin and rapid healing. Unlike immobility, active movement prevents the prolonged ischemia that leads to ulceration. Therefore, this is a protective behavior and does not represent a risk factor for a patient experiencing skin integrity issues or injuries. Choice F rationale Decreased sensory perception, often seen in patients with diabetes, spinal cord injuries, or stroke, is a major risk factor for pressure injuries. These patients cannot feel the discomfort or pain caused by prolonged pressure, which is the body's natural signal to shift position. Without this feedback loop, they may remain in one position long enough for significant tissue damage to occur. Normal sensation allows for self-protection, and its loss requires vigilant monitoring and scheduled turning by caregivers.