A nurse is completing discharge teaching with a patient who has irritable bowel syndrome (IBS). Which of the following instructions should the nurse include?

Choice A rationale

Providing mittens might prevent scratching and subsequent skin damage, but it does not address the underlying cause of the pruritus, which is likely residual irritation from the scabies treatment or the scabies mites themselves. While preventing secondary infection from scratching is important, alleviating the itch is the priority for client comfort.

Choice B rationale

Encouraging the client to gently rub the affected area can actually worsen the pruritus. Rubbing can stimulate nerve endings in the skin, further intensifying the sensation of itching and potentially leading to skin irritation and excoriation. Gentle patting or cool compresses are generally more soothing for itchy skin.

Choice C rationale

Applying additional scabicide after the initial treatment is usually not indicated for pruritus following scabies treatment, unless there is evidence of ongoing infestation. Pruritus can persist for several weeks after successful treatment due to the inflammatory response of the skin to the dead mites and their products. Overuse of scabicides can cause further skin irritation.

Choice D rationale

Assisting the client to take a cool shower can help to relieve pruritus by causing vasoconstriction of the superficial blood vessels and reducing the release of histamine and other inflammatory mediators in the skin. The cool temperature can also have a soothing effect on the nerve endings, temporarily alleviating the sensation of itching.

Choice A rationale

While it is understandable that a client with a patch on one eye after cataract surgery might express fear of falling due to altered depth perception, this comment reflects anxiety and a potential safety concern that the nurse should address with safety measures and reassurance, but it is not necessarily an unexpected complication requiring immediate reporting to the provider.

Choice B rationale

Reporting severe eye pain to the provider is crucial following cataract surgery. While some mild discomfort is expected, significant pain can indicate a potential complication such as increased intraocular pressure, infection (endophthalmitis), or corneal abrasion, all of which require prompt medical evaluation and intervention to prevent vision loss.

Choice C rationale

Mild itching after cataract surgery can be related to the healing process or the surgical dressing. Instructing the client not to rub the eye is appropriate to prevent infection or disruption of the surgical site. While the nurse should reinforce this instruction, the itching itself, without other signs of complications, does not necessarily warrant immediate reporting to the provider.

Choice D rationale

Sensitivity to bright light (photophobia) is a common occurrence after cataract surgery due to pupillary dilation during the procedure and the eye's adjustment to the new lens. Providing sunglasses or dimming the lights can help alleviate this discomfort. While the nurse should address this concern, it is a common and expected symptom that does not usually require immediate reporting to the provider unless it is severe or accompanied by other concerning symptoms. .