A nurse is teaching a client who is scheduled to receive radioactive iodine therapy for treatment of hyperthyroidism. Which of the following instructions should the nurse include in the teaching?

Rationale:

• Location of pain: Severe pain out of proportion to the injury, especially with passive stretch, is a classic sign of compartment syndrome. DVT also presents with localized pain in the affected limb, typically worsening over time due to venous congestion.
• Temperature of extremity (Compartment Syndrome & DVT): A cool extremity in compartment syndrome indicates compromised arterial blood flow due to increased pressure within the fascial compartment. In DVT, the extremity may be warm early on, but impaired circulation can eventually result in coolness and cyanosis.
• Nail bed assessment (Compartment Syndrome): Cyanotic or dusky nail beds reflect inadequate oxygen delivery from restricted blood flow, commonly seen in advanced compartment syndrome. This is a late and critical sign requiring urgent intervention to prevent permanent tissue damage.
• Location of edema (Compartment Syndrome & DVT): Localized swelling occurs in compartment syndrome due to rising intracompartmental pressure. In DVT, venous obstruction leads to fluid accumulation and unilateral leg edema, often accompanied by warmth and discomfort.
• Respiratory assessment (Fat Embolism Syndrome): FES often presents with sudden onset dyspnea, tachypnea, and hypoxemia due to fat globules entering the pulmonary circulation. These respiratory symptoms typically arise 24–72 hours after long bone trauma.
• Skin assessment (Fat Embolism Syndrome): A petechial rash, especially on the chest, upper arms, and neck, is a distinguishing feature of FES. It results from occlusion of dermal capillaries by fat globules and is considered a hallmark sign of the condition.
• Neurological status (Fat Embolism Syndrome): Altered mental status, confusion, and decreased alertness can occur in FES due to cerebral fat embolization. Neurologic involvement differentiates FES from other conditions like DVT or compartment syndrome, which typically do not cause cognitive changes.

Rationale:
A. Vitiligo: Vitiligo is an autoimmune condition characterized by depigmented patches of skin due to melanocyte destruction. It is more commonly associated with Addison's disease, not Cushing’s syndrome, which involves cortisol excess rather than deficiency.

B. Osteoporosis: Cushing's syndrome causes prolonged exposure to high cortisol levels, which inhibits bone formation and accelerates bone resorption. This leads to decreased bone density, making osteoporosis a common and expected finding in affected clients.

C. Myxedema: Myxedema refers to the severe hypothyroid state marked by non-pitting edema, dry skin, and slowed metabolism. It is associated with thyroid hormone deficiency, not the glucocorticoid excess seen in Cushing's syndrome.

D. Heat intolerance: Heat intolerance is a symptom more commonly linked to hyperthyroidism, where an increased metabolic rate leads to overheating. Clients with Cushing’s syndrome typically experience weight gain, fatigue, and cold intolerance rather than heat sensitivity.