A nurse is providing discharge teaching for a client who is postoperative following a simple mastectomy. The client is to begin outpatient radiation therapy the next day. Which of the following instructions about maintaining skin integrity should the nurse include?

Choice A: Sleep disturbances are the correct answer because they are a symptom of a heart attack observed in women. Sleep disturbances are problems that affect the quality or quantity of sleep, such as insomnia, nightmares, or snoring. They can indicate that the heart is not pumping enough blood and oxygen to meet the body's needs during sleep. About 48% of women who have had a heart attack report having sleep disturbances in the weeks before their event.

Choice B: Syncope is not the correct answer because it is not a symptom of a heart attack observed in women. Syncope is a condition that causes a temporary loss of consciousness due to a drop in blood pressure or blood flow to the brain. It can be caused by various factors such as dehydration, medication side effects, or cardiac arrhythmias. However, it is not a common sign of a heart attack in women, and only about 12% of women who have had a heart attack report having syncope before their event.

Choice C: Unusual fatigue is the correct answer because it is a symptom of a heart attack observed in women. Unusual fatigue is a feeling of extreme tiredness or exhaustion that is not relieved by rest or sleep. It can indicate that the heart is not pumping enough blood and oxygen to meet the body's needs during daily activities. About 70% of women who have had a heart attack report having unusual fatigue in the weeks before their event.

Choice D: Extreme hunger is not the correct answer because it is not a symptom of a heart attack observed in women. Extreme hunger is a feeling of intense or excessive appetite or craving for food. It can be caused by various factors such as diabetes, thyroid disorder, or stress. However, it is not a sign of a heart attack in women, and only about 4% of women who have had a heart attack report having extreme hunger before their event.

Choice E: Arm pain is the correct answer because it is a symptom of a heart attack observed in women. Arm pain is a feeling of discomfort or ache in one or both arms, especially the left arm. It can indicate that the heart muscle is not receiving enough blood and oxygen due to a blocked coronary artery. About 42% of women who have had a heart attack report having arm pain before their event.

Choice A reason: Brushing teeth does not require much strength or range of motion in the hand, so it should not be very difficult for the client.

Choice B reason: Buttoning a blouse can be done with one hand or with the help of the other hand, so it should not be very difficult for the client.

Choice C reason: Eating breakfast can be done with the left hand or with utensils that are easy to hold, so it should not be very difficult for the client.

Choice D reason: Combing hair requires lifting the arm above the shoulder and moving the hand through the hair, which can be painful and challenging for the client who had a mastectomy and may have impaired lymphatic drainage and nerve damage in the right arm.