The nurse provides care for a client diagnosed with pulmonary emphysema. The nurse observes the following: respiratory rate 20 breaths/minute, use of intercostal muscles, and decreased mental alertness. Which is the best explanation for these observations?

Choice A reason: Facial muscle atrophy is not the expected finding because it is a condition where the facial muscles lose their mass and strength, which can be caused by various factors, such as aging, nerve damage, or muscular dystrophy. Facial muscle atrophy is not a common manifestation of myxedema, which is a severe form of hypothyroidism, which is a condition where the thyroid gland does not produce enough thyroid hormones, which regulate the metabolism and growth of the body.

Choice B reason: Facial and periorbital edema is the expected finding because it is a characteristic manifestation of myxedema, which is caused by the accumulation of mucopolysaccharides, which are complex carbohydrates that are normally found in the connective tissues. Mucopolysaccharides can attract water and cause swelling of the tissues, especially in the face and around the eyes. Facial and periorbital edema can also cause the facial features to appear coarse and puffy, and the eyelids to droop.

Choice C reason: Facial muscle twitching is not the expected finding because it is a condition where the facial muscles contract involuntarily, which can be caused by various factors, such as stress, fatigue, or caffeine. Facial muscle twitching is not a common manifestation of myxedema, which can cause the facial muscles to become weak and slow, and the facial expressions to become dull and flat.

Choice D reason: Unilateral ptosis is not the expected finding because it is a condition where one eyelid droops lower than the other, which can be caused by various factors, such as nerve damage, stroke, or tumor. Unilateral ptosis is not a common manifestation of myxedema, which can cause bilateral ptosis, which is the drooping of both eyelids, due to the edema and weakness of the eyelid muscles.

Choice A reason: Lymph structures were removed and fluid cannot move out of the area easily is the correct explanation because a radical mastectomy involves the removal of the breast, the underlying chest muscles, and the lymph nodes in the axilla. The lymph nodes are part of the lymphatic system, which is responsible for draining excess fluid from the tissues and returning it to the bloodstream. When the lymph nodes are removed, the fluid cannot be drained properly and accumulates in the affected arm and hand, causing edema.

Choice B reason: There is still too much swelling in the area of the surgery and fluid is accumulating is not the correct explanation because it does not address the underlying cause of the edema. Swelling is a normal response to surgery, but it usually subsides within a few days or weeks. The edema caused by lymph node removal is chronic and persistent, and it does not improve with time.

Choice C reason: The veins were removed from the axilla during surgery and there is poor circulation now is not the correct explanation because it is not true. The veins are not removed during a radical mastectomy, only the lymph nodes are. The veins are part of the circulatory system, which carries blood throughout the body. The blood flow to the arm and hand is not affected by the surgery, unless there is a complication such as a blood clot or an infection.

Choice D reason: You will need to wear a compression bandage to help fluids move from the area is not the correct explanation because it is a treatment, not a cause. A compression bandage is a type of elastic bandage that applies pressure to the arm and hand, which helps to reduce the swelling and prevent further fluid accumulation. However, it does not address the root cause of the edema, which is the removal of the lymph nodes.