A nurse is instructing a client who has a new diagnosis of Raynaud's disease about preventing the onset of manifestations. Which of the following client statements should indicate to the nurse the need for additional teaching?

A. Cleanse the skin prior to the procedure: Cleansing the skin before applying the transdermal analgesic cream is essential to remove any dirt, oils, or contaminants that could interfere with its absorption. This step helps ensure optimal drug delivery and effectiveness.
B. Apply the medication an hour before the procedure begins: Applying the transdermal analgesic cream an hour before the procedure allows sufficient time for the medication to be absorbed through the skin and reach its therapeutic effect. This timing ensures that the analgesic properties are in place when the IV insertion procedure starts.
C. Use a visual pain rating scale to evaluate the effectiveness of the treatment: Using a visual pain rating scale can help assess the child's pain level before and after applying the transdermal analgesic cream. This evaluation provides valuable feedback on the cream's effectiveness in providing pain relief.
D. Apply to intact skin: Transdermal medications are designed to be absorbed through intact skin. Applying the cream to intact skin ensures proper absorption and effectiveness of the analgesic medication.
E. Spread the cream over the lateral surface of both forearms. This option might not be necessary or appropriate for the intended purpose. The choice of application site for transdermal analgesic cream depends on the specific medication and the area of pain. While the lateral surface of the forearms can be a suitable site, it may not always be necessary or feasible to apply the cream to both forearms, especially if the intended IV insertion site is on one arm.

A. Clubbing of the fingers: Clubbing of the fingers is a common finding in clients with advanced emphysema. It is characterized by bulbous enlargement of the fingertips and nail changes, including increased curvature and softening of the nail beds. Clubbing results from chronic hypoxia and tissue oxygen deprivation, which leads to vascular changes and tissue proliferation in the fingertips.
B. Deep respirations: Deep respirations are not typically associated with emphysema. Instead, clients with emphysema often exhibit shallow, rapid respirations due to decreased lung elasticity and air trapping, which impair effective ventilation. As a compensatory mechanism, clients may adopt a pursed-lip breathing pattern to facilitate expiration and reduce airway collapse.
C. Bradycardia: Bradycardia is not a characteristic finding in clients with emphysema. Instead, clients with emphysema commonly experience tachycardia, which is a compensatory response to hypoxia and increased work of breathing. Tachycardia helps maintain cardiac output and tissue perfusion in the setting of impaired gas exchange.
D. Barrel chest: Barrel chest is a classic physical finding in clients with emphysema. It results from hyperinflation of the lungs and loss of lung elasticity, leading to a permanent increase in the anteroposterior diameter of the chest. This change in chest shape contributes to the characteristic appearance of a rounded, barrel-like chest.
E. Dyspnea: Dyspnea, or shortness of breath, is a hallmark symptom of emphysema. Clients with emphysema often experience dyspnea, especially with exertion, due to air trapping, decreased lung function, and impaired gas exchange. Dyspnea can significantly impact the client's quality of life and functional status, requiring careful management and symptom relief interventions.