The client has rheumatoid arthritis, is prone to skin breakdown, and i

The client has rheumatoid arthritis, is prone to skin breakdown, and is also somewhat immobile because of arthritic discomfort. Which of the following is the best intervention for the client’s skin integrity?

1. Having the client sit up in a chair for 4-hour intervals
2. Keeping the head of the bed in a high-Fowler’s position to increase circulation
3. Keeping a written schedule of turning and positioning
4. Encouraging the client to perform pelvic muscle training exercises several times a day

ANSWER

ANS: 3
The frequency of repositioning should be individualized for the client; however, clients should be repositioned at least every 2 hours. The Agency for Healthcare Research and Policy (AHRQ) guidelines recommend that a written turning and positioning schedule be used. Clients able to sit in a chair should be limited to sitting for 2 hours or less. Elevating the head of the bed to 30 de-grees or less will decrease the chance of pressure ulcer development from shearing forces. Pelvic muscle training may help prevent incontinence, but it is not the best intervention for maintaining the client’s skin integrity.