A nurse is caring for a 78-year-old patient who has been bedridden for 10 days following hip fracture surgery. The patient has developed a stage 2 pressure injury on the sacrum. Which nursing intervention should be the priority to prevent further deterioration of the pressure injury?

For a 78-year-old bedridden patient with a stage 2 pressure injury, the immediate nursing priority is to eliminate the root cause of the tissue damage. A stage 2 injury involves partial-thickness skin loss with exposed dermis, and it remains reversible if the causative factors—primarily unrelieved pressure and shear—are removed. The foundational evidence underscores that without addressing the mechanical forces at play, any topical wound treatment will fail to prevent deterioration.

The systematic review by Meng et al. (2026) identifies repositioning and the use of support surfaces as core components of "targeted preventive measures" for long-term bedridden patients. These interventions directly counteract the pathophysiological cascade of pressure injury development: sustained external pressure exceeding capillary closing pressure (typically around 32 mmHg) leads to localized ischemia, tissue hypoxia, and eventual necrosis . Repositioning every 2 hours effectively redistributes this pressure away from bony prominences like the sacrum, allowing for reperfusion of the affected tissues.

Peterson et al. (2025) reinforce this by emphasizing that pressure injuries are a "major source of preventable morbidity" in individuals with impaired mobility, and that management must be built on a foundation of pressure redistribution ^[1]. The randomized controlled trial by Delui et al. (2026) further supports this principle, demonstrating that specialized surfaces (in their study, sheep-felt mattresses) designed to redistribute pressure can significantly reduce the incidence of new injuries in at-risk hospitalized patients ^[2]. Applying this evidence, the nurse's first action is to implement a systematic turning schedule and ensure the patient is on an appropriate pressure-redistributing surface to halt the progression of the existing sacral wound.

Option 1 (Apply a hydrocolloid dressing and change it every 7 days): While a hydrocolloid dressing is an appropriate choice for a stage 2 pressure injury to maintain a moist wound environment and protect against contamination, it is a secondary intervention. A dressing alone cannot mitigate the ongoing tissue ischemia caused by unrelieved pressure. Applying a dressing without first implementing a pressure-relief plan addresses the symptom (the wound) but not the cause (pressure), and therefore does not take priority in preventing further deterioration [1,3].

Option 2 (Massage the area around the pressure injury to improve circulation): Massaging the tissue surrounding a pressure injury is a contraindicated and harmful practice. The underlying pathophysiology involves damaged capillaries and fragile, ischemic tissue. Manual massage can cause further trauma to the microvasculature, increase inflammation, and extend the zone of tissue destruction, potentially converting a partial-thickness injury into a deeper, full-thickness injury ^[1].

Option 3 (Keep the wound area dry and expose it to air for healing): This approach is outdated and counterproductive. Modern wound care principles dictate that a moist wound environment is essential for cellular migration, granulation tissue formation, and re-epithelialization. Allowing a wound to dry out and form a crust leads to cellular desiccation and significantly delays the healing process. The standard of care for a stage 2 injury involves a moisture-retentive dressing, not air-drying .