The nurse is caring for a group of clients in a medical/surgical unit. Which client does the nurse understand to be at highest risk for developing decubitus ulcers?
a 27-year-old client who fractured her arm playing volleyball
a 6-year-old client on pelvic skin traction for muscle spasms
a 42-year-old obese client with controlled atrial fibrillation who uses a wheelchair
a 70-year-old client with heart failure who uses a cane for ambulation in the room and hall
Number 2 is correct.
The client in pelvic traction is on bed rest wearing a traction belt around the pelvis. This client is the most immobile of the clients listed. The client who fractured her arm playing volleyball is able to get up and easily change positions, even with an arm brace. The client who uses a wheelchair is able to be out of the bed. The client who uses a cane for ambulation is walking in the room and hall and is active. The client’s condition, medical diagnosis, and treatment plan—not age—determine how great the risk is for developing decubitus ulcers. The greater the immobility, the greater the risk.
