A nurse is caring for a client with a spinal cord injury who has been immobile for 1 week. Which nursing intervention should be the priority to prevent complications related to immobility?

For a client with a spinal cord injury who has been immobile for one week, the priority is to prevent pressure injuries through a systematic repositioning schedule. The standard of care is to reposition the client at least every 2 hours, using a written turning schedule to ensure consistency across all shifts. During each turn, perform a thorough skin assessment, paying close attention to all bony prominences such as the sacrum, heels, elbows, and occiput. Document skin condition meticulously using a validated tool like the Braden Scale.

• Use lift sheets or assistive devices to avoid dragging the client across the bed surface, which creates friction and shear forces that significantly increase injury risk.
• Maintain proper spinal alignment at all times, using log-rolling techniques if the spinal injury is unstable or per surgeon's orders.
• Utilize pressure-redistributing support surfaces, such as high-specification foam mattresses, as an adjunct to, not a replacement for, manual repositioning.
• Inspect the skin under and around medical devices, such as cervical collars or braces, as these create additional pressure points.

Communicate any findings of non-blanchable erythema or skin breakdown immediately to the healthcare provider and wound care specialist. Integrate the repositioning plan into the overall rehabilitation goals, coordinating with physical and occupational therapy to ensure mobility exercises complement the pressure injury prevention strategy.