A nurse is providing education to a group of caregivers about preventing pressure ulcers in bedridden patients.

Which interventions should the caregivers implement? (Select three).

Choice A rationale:

Administering antibiotics to prevent infection is not the primary nursing intervention for a stage 3 pressure ulcer.

While infection prevention is important, optimizing nutrition and hydration (Choice D) takes precedence in this case.

Proper nutrition and hydration are essential for tissue healing and preventing further deterioration of the wound.

Infection prevention measures like antibiotics may be considered if there are signs of infection, but they are not the first-line intervention.

Choice B rationale:

Assessing the patient's pain level and providing appropriate pain management (Choice B) is an important aspect of care for a patient with a stage 3 pressure ulcer, but it is not the highest priority.

Pain management should be addressed, but it should not take precedence over optimizing nutrition and hydration (Choice D), which is crucial for wound healing.

Choice C rationale:

Educating the patient on the importance of mobility exercises (Choice C) is an essential aspect of preventing pressure ulcers, but for a patient with an existing stage 3 pressure ulcer, the priority should be on wound management and nutrition.

While mobility exercises are beneficial, they should not be prioritized over optimizing nutrition and hydration (Choice D) to support the healing process.

Choice D rationale:

Optimizing the patient's nutrition and hydration (Choice D) is the most appropriate nursing intervention for a patient with a stage 3 pressure ulcer.

Proper nutrition and hydration are essential for tissue repair and wound healing.

Inadequate nutrition can delay healing and increase the risk of complications, making this the highest priority intervention.

Choice A rationale:

The wound's warmth to the touch is not a primary factor to consider when selecting a dressing for a pressure ulcer.

The choice of dressing should primarily be based on the wound's characteristics, such as its depth, exudate level, and tissue involvement.

Choice B rationale:

The presence of a foul odor from the wound is an important factor to consider when selecting a dressing.

Malodorous wounds may indicate infection or necrotic tissue, and appropriate wound dressings can help manage odor and promote healing.

Choice C rationale:

The extent of tissue damage, including muscle and bone involvement, is a critical factor in choosing an appropriate dressing for a pressure ulcer.

Dressings should be selected based on the depth of the wound and the extent of tissue damage to support healing and prevent complications.

Choice D rationale:

The patient's mobility and pressure on vulnerable areas are essential considerations when selecting a dressing.

Dressings should help offload pressure from vulnerable areas and promote mobility while providing optimal wound care.

The choice of dressing should support the overall management of the patient's condition.