臥床病人出現哪些評估結果，顯示發生壓力性損傷的風險較高？（選所有適合的）
Which assessment findings in a bedridden client indicate a high risk for developing pressure injuries? (Select all that apply.)
- AIncontinence✓ 正解大小便失禁
- BSerum albumin of 2.2 g/dL✓ 正解血清白蛋白 2.2 g/dL
- CSensory impairment✓ 正解感覺障礙
- DHemoglobin of 14 g/dL血紅素 14 g/dL
- EImmobility✓ 正解活動力受限
壓力性損傷（Pressure Injury）的形成與長期受壓、皮膚潮濕、營養不良及感覺缺失息息相關。護理評估需全面考量病人的活動能力與生理狀態。血清白蛋白（Albumin）是反映長期營養狀況的指標，低於 3.5 g/dL 即顯示營養不良，增加組織修復困難。失禁與感覺缺失則會直接破壞皮膚屏障並影響壓力緩解。
Risk factors for pressure injuries include immobility, sensory impairment, incontinence-induced skin maceration, and low serum albumin indicating malnutrition. These conditions compromise skin integrity and tissue perfusion, increasing susceptibility to tissue damage. Normal hemoglobin levels do not indicate increased risk, whereas the other factors significantly elevate the potential for developing pressure injuries.
美國臨床廣泛使用 Braden Scale 進行壓瘡風險評估，並將評估結果納入護理紀錄與照護計畫中，以符合品質保證要求。