What nursing interventions decrease the risk of pressure injuries? (Select all that apply.)

Choice A reason: Providing active range of motion (ROM) is not a treatment that the nurse can perform for a quadriplegic client. Active ROM means that the client moves their own joints without assistance. A quadriplegic client has paralysis of all four limbs and cannot move their joints voluntarily.

Choice B reason: Providing passive range of motion (ROM) is a treatment that the nurse can perform for a quadriplegic client. Passive ROM means that the nurse moves the client's joints through their full range of motion without resistance. This helps prevent joint contracture, which is the loss of joint movement and flexibility due to muscle shortening and stiffness. It also helps maintain joint mobility, which is the ability of the joint to move smoothly and freely.

Choice C reason: Turning the client every 2 hours is not a treatment that the nurse can perform to decrease the risk of joint contracture and promote joint mobility. Turning the client every 2 hours is a preventive measure to avoid pressure ulcers, which are skin injuries caused by prolonged pressure on the skin. It does not directly affect the joint function or movement.

Choice D reason: Administering glucosamine supplements is not a treatment that the nurse can perform to decrease the risk of joint contracture and promote joint mobility. Glucosamine supplements are dietary supplements that may help reduce the pain and inflammation of osteoarthritis, which is a degenerative joint disease that causes the breakdown of the cartilage and bone in the joints. It does not affect the muscle or nerve function or movement.

Choice A reason: Stage 1 is a wound that involves only the epidermis, the outermost layer of the skin. It appears as a nonblanchable redness, warmth, or hardness on intact skin. It does not have any breakage or ulceration of the skin.

Choice B reason: Stage 2 is a wound that involves the epidermis and the dermis, the second layer of the skin. It appears as a shallow, open, reddened ulcer with a partialthickness loss of skin. It may have some serous exudate, but no slough or eschar. It may also present as a blister or abrasion.

Choice C reason: Stage 3 is a wound that involves the epidermis, the dermis, and the subcutaneous tissue, the third layer of the skin. It appears as a deep, open, reddened ulcer with a fullthickness loss of skin. It may have some slough or eschar, but no exposed bone, tendon, or muscle. It may also have tunneling or undermining of the wound edges.

Choice D reason: Stage 4 is a wound that involves the epidermis, the dermis, the subcutaneous tissue, and the underlying structures, such as bone, tendon, or muscle. It appears as a deep, open, reddened ulcer with a fullthickness loss of skin and tissue. It has exposed bone, tendon, or muscle, which may be visible or palpable. It may also have slough, eschar, necrosis, infection, or osteomyelitis.