護理師應將哪些措施納入高壓瘡風險病人的照護計畫中？（選所有適合的）
Which interventions should the nurse include in a plan of care for a client at high risk for pressure ulcers? (Select all that apply.)
- AReposition the client every 2 hours✓ 正解每兩小時為病人翻身
- BKeep the head of the bed elevated at 45 degrees將床頭抬高至 45 度
- CEnsure skin is kept clean and dry✓ 正解確保皮膚保持清潔乾燥
- DUse a foam or gel cushion for the wheelchair✓ 正解使用泡沫或凝膠坐墊
- EMassage reddened bony prominences to improve blood flow按摩發紅的骨突處以促進血液循環
壓瘡（Pressure Ulcer）的預防關鍵在於消除壓力、剪力與摩擦力。高風險病人需透過定期翻身（Q2H）來轉移受壓點，並保持皮膚清潔乾燥以防潮濕導致的皮膚浸潤（Maceration）。減壓輔具（如氣墊床、凝膠墊）能有效分散骨突處的壓力。按摩紅腫處則是錯誤的，因為這會導致皮下微血管受損與炎症加劇。
The key to preventing pressure ulcers is eliminating pressure, shear, and friction. High-risk clients require regular repositioning (every 2 hours) to shift pressure points, and the skin must be kept clean and dry to prevent moisture-induced skin maceration. Pressure-relieving devices (such as air mattresses or gel cushions) effectively distribute pressure over bony prominences. Massaging reddened areas is incorrect because it damages subcutaneous capillaries and aggravates inflammation.