A nurse is reinforcing discharge teaching with a client who has heart failure. Which of the following instructions should the nurse include in the teaching? (Select all that apply.)

A. "Establish a daily exercise routine." Regular physical activity helps regulate the sleep-wake cycle and promotes deeper sleep. Exercising earlier in the day enhances sleep quality, but vigorous exercise close to bedtime should be avoided as it can be stimulating.
B. "Keep the television volume low while you are trying to fall asleep." Watching television before bed can interfere with melatonin production due to blue light exposure, making it harder to fall asleep. A dark, quiet environment is recommended for better sleep.
C. "Remain in bed until you fall asleep." Staying in bed while struggling to sleep can reinforce insomnia. It is recommended to get out of bed and engage in a relaxing activity if unable to sleep within 20 minutes, then return when drowsy.
D. "Sleep longer hours on the weekend." Sleeping in on weekends disrupts the body's internal clock and can worsen sleep difficulties. Maintaining a consistent sleep schedule, even on weekends, helps regulate circadian rhythms and improve sleep quality.

Anticipated:

• Apply a cool compress to the extremity. A cool compress can reduce swelling, relieve discomfort, and help minimize the tightness in the skin caused by edema. The cold temperature helps constrict blood vessels, reducing fluid buildup in the tissues. This intervention is appropriate for managing IV infiltration-related symptoms.
• Assist in inserting a new IV catheter in a site distal to the infiltration site. If the IV site becomes infiltrated, the correct approach is to stop the current infusion and insert a new catheter in a different location, preferably distal to the infiltration site. This ensures continued IV access without further aggravating the infiltrated site.
• Elevate extremity. Elevating the affected extremity can help reduce swelling by promoting venous return. Elevation improves circulation and decreases the pressure caused by fluid accumulation in the tissues. This is an effective intervention for managing swelling in the right upper extremity due to infiltration.

Not Anticipated:

• Phytonadione (vitamin K) is typically used to reverse the effects of anticoagulation medications or treat vitamin K deficiency. This is not indicated for the client, as there is no evidence of bleeding or an anticoagulation issue that requires vitamin K. The client's current problem is an IV infiltration, not a clotting disorder.
• Send the catheter tip for culture. At this point, there are no signs of infection such as redness, warmth, or discharge from the IV site. The primary concern is managing the infiltration, so sending the catheter tip for culture is unnecessary unless infection is suspected. Culture collection is reserved for cases where an infection is present.
• Suggest irrigating the IV catheter. Irrigating an infiltrated IV catheter could worsen the situation by pushing fluids further into the surrounding tissue or introducing bacteria. The proper action is to discontinue the infusion, remove the IV, and insert a new catheter at a different site rather than attempting to irrigate an already compromised catheter.