A nurse is reinforcing teaching with a client on measures to promote their sleep. Which of the following instructions should the nurse include in the teaching?

A. Active movement is present: The presence of active movement in the fingers and toes of the affected arm indicates that nerve and muscle function are intact, which is a positive finding. It indicates there is no impairment in function of the affected arm.

B. Pain is 4 on scale of 0 to 10: A pain level of 4 is moderate pain and might be expected after a fracture. As long as pain is being managed appropriately with prescribed medications and no other concerning symptoms are present, it does not necessarily require immediate reporting.

C. Capillary refill is less than 2 seconds: A capillary refill time of less than 2 seconds is normal. This suggests good blood flow to the affected arm and is not an issue that needs reporting.

D. Skin is cool to the touch: A cool skin temperature on the affected arm could indicate impaired circulation, possibly due to swelling or tightness of the cast, which could lead to compartment syndrome—a serious condition that requires immediate intervention. Therefore, this finding should be reported to the provider immediately.

A. "I limit my time spent out in the sunlight.": While moderate sun exposure can be beneficial for psoriasis, excessive sun exposure can worsen the condition or increase the risk of skin cancer. Limiting sunlight is generally a safe practice unless the client is avoiding it entirely, which is not indicated here.

B. "I try not to look at the scales on my body.": This statement suggests significant emotional distress or poor coping related to body image. Psoriasis can have profound psychological effects, including depression and anxiety, which must be reported to the provider to address the client’s mental health needs alongside physical treatment.

C. "I remove old medication on my skin before applying a new dose.": Proper application of topical medications includes cleaning old residue to promote better absorption of the new dose. This practice is appropriate and demonstrates an understanding of correct medication use.

D. "I do not use fabric softener when I wash my clothing.": Avoiding fabric softeners is a helpful strategy for clients with psoriasis because softeners can leave residues that irritate sensitive skin. This statement reflects good self-care behavior rather than a concern needing provider intervention.