一位長期臥床病人薦骨處出現不可壓退性紅斑。護理師應包含哪些護理措施？（選所有適合的）
A nurse is caring for a client who is on strict bed rest and has developed an area of non-blanchable erythema on the sacrum. Which interventions should the nurse include in the care plan? (Select all that apply.)
- ATurn and reposition the client every 2 hours✓ 正解每兩小時翻身並重新擺放病人姿勢
- BMassage the reddened area to improve circulation按摩發紅區域以改善循環
- CApply a hydrocolloid dressing to the sacrum✓ 正解在薦骨處貼敷水膠體敷料
- DKeep the skin clean and dry✓ 正解保持皮膚清潔乾燥
- EPlace a donut-shaped pillow under the sacrum在薦骨下方放置甜甜圈形枕頭
第一期壓瘡（Stage 1 pressure injury）表現為不可壓退性紅斑。照護原則為減壓、皮膚防護與水分管理。翻身能分散壓力；hydrocolloid 敷料能提供潮濕癒合環境，防止表皮磨損；保持清潔可避免浸漬。按摩已證實有害（增加微血管受損風險），甜甜圈墊會加重組織受壓，現已禁止使用。此護理計畫能有效防止壓瘡惡化。
Stage 1 pressure injury presents as non-blanchable erythema. Care principles are pressure relief, skin protection, and moisture management. Repositioning redistributes pressure; a hydrocolloid dressing provides a moist healing environment and prevents epidermal abrasion; maintaining cleanliness prevents maceration. Massage has been proven harmful (it increases the risk of capillary damage), and donut-shaped pillows aggravate tissue compression and are now prohibited. This care plan effectively prevents progression of pressure injury.