Which action best prevents skin breakdown in immobile patients?

• A. Repositioning to relieve pressure on bony prominences
• B. Massaging over reddened area
• C. Prolonged bed rest
• D. Increasing caffeine intake

Answer: (A)

Relieving pressure on the skin over bony prominences is the most effective way to prevent skin breakdown in immobile patients. When movement is limited, constant pressure compresses small blood vessels, cutting off oxygen and nutrients to the skin and underlying tissues. This ischemia can lead to tissue death and ulcers if it lasts too long. Repositioning regularly redistributes pressure away from vulnerable areas such as the heels, sacrum, ischial tuberosities, hips, and elbows, allowing blood flow to return and tissues to recover. A planned turning schedule, typically every two hours, plus the use of pressure-relieving surfaces (special mattresses and cushions) helps keep pressure off those spots and reduces risk. Also important is moving with minimal shear and friction, keeping skin clean and dry, and monitoring for early signs of redness.

Massaging a reddened area isn’t advised because it can damage delicate capillaries and worsen tissue injury by increasing local pressure or friction. Prolonged bed rest isn’t a protective strategy for preventing ulcers—it maintains high pressure on same areas unless accompanied by careful repositioning. Increasing caffeine intake doesn’t aid prevention and may contribute to dehydration, which can compromise skin integrity.