Which nursing action is most appropriate for a patient who is at high risk for impaired skin integrity on the heels?

• A. Place a pillow under the calves
• B. Order a standard foam mattress
• C. Avoid prolonged elevation of the head of the bed
• D. Consider an alternating pressure support surface

Answer: (D)

The main idea is preventing pressure-related skin damage by redistributing pressure away from vulnerable areas like the heels. The heels are at high risk because they have little padding and are directly against the bed when lying flat, so prolonged compression can quickly lead to ischemia and breakdown.

An alternating pressure support surface works by cycling pressure through the mattress or overlay, lifting and relieving pressure on different areas, including the heels. This continuous pressure redistribution reduces the time tissue spends under high pressure and improves local blood flow, which is especially helpful for someone at high risk for heel ulcers.

The other options don’t address the problem as effectively. A pillow under the calves can offload the heels partially, but it isn’t a consistent, comprehensive pressure-relief strategy and can introduce other issues with positioning. A standard foam mattress offers some relief but isn’t dynamic and doesn’t provide ongoing pressure redistribution. Avoiding prolonged head-of-bed elevation helps with shear protection in some scenarios, but it doesn’t directly relieve heel pressure like a dedicated pressure-relief surface does.

So, using an alternating pressure support surface is the best action to protect the heels from impaired skin integrity.