The emergency department team is performing cardiopulmonary resuscitation on a patient when the patient’s spouse arrives. What is the first action the nurse should take?

Choice A rationale:
Incorrect. Deep-breathing exercises could potentially worsen stridor. Stridor is a high-pitched, wheezing sound caused by a partial obstruction of the upper airway. Deep breathing can increase airflow through the narrowed airway, making the stridor more pronounced and potentially worsening the obstruction. In severe cases, it could lead to complete airway obstruction and respiratory distress.
Risk of aggravation: Deep-breathing exercises could aggravate the underlying cause of stridor, such as laryngeal edema or vocal cord dysfunction, by increasing inflammation or muscle tension in the airway.
Delay in definitive treatment: Focusing on deep-breathing exercises might delay more definitive interventions, such as intubation, which might be necessary to secure the airway and prevent respiratory failure.
Choice B rationale:
Incorrect. While albuterol nebulizer therapy can be helpful for bronchospasm, it is not the first-line treatment for stridor. Stridor is typically caused by an upper airway obstruction, and albuterol primarily targets the lower airways (bronchioles).
Limited effectiveness: Albuterol might not be effective in reducing stridor caused by upper airway obstruction, as it does not directly address the narrowing of the airway.
Potential for adverse effects: Albuterol can cause tachycardia, tremors, and anxiety, which could further complicate the patient's condition.
Choice C rationale:
Not the most immediate action. While calling a Rapid Response might be necessary if the patient's condition deteriorates, the first priority is to secure the airway and ensure adequate ventilation.
Time-consuming: Activating a Rapid Response team can take several minutes, and the patient's condition might not allow for that delay.
Choice D rationale:
Prioritizes airway management: Intubation is the most effective way to secure the airway and ensure adequate ventilation in a patient with stridor. It bypasses the obstruction and allows for controlled delivery of oxygen and ventilation.
Addresses potential for deterioration: Stridor can rapidly progress to complete airway obstruction, so prompt preparation for intubation is crucial to prevent respiratory failure.
Involves the primary healthcare provider: Consulting the primary health care provider ensures timely decision-making, appropriate medication administration (such as sedatives or paralytics for intubation), and coordination of care.

Choice A rationale:

Assessing the patient's adherence to the drug regimen is the most crucial first step in this situation. Here's a comprehensive explanation:

1. Significance of Adherence in HIV Treatment:

Viral Suppression and Disease Progression: Adherence to antiretroviral therapy (ART) is paramount in HIV management. It directly impacts viral suppression, preventing disease progression, and reducing the risk of opportunistic infections and complications. Non-adherence can lead to viral rebound, increased viral load, and potential disease advancement.

Primary Cause of Treatment Failure: Suboptimal adherence is the leading cause of treatment failure in HIV patients. It can result in:

Reduced effectiveness of ART Development of drug resistance Increased healthcare costs Increased risk of transmission

2. Rationale for Prioritizing Adherence Assessment:

Direct Link to Viral Load and Health Status: A sudden decline in health status and a significant increase in viral load strongly suggest potential non-adherence. Assessing adherence early on can:

Identify the root cause of the clinical deterioration

Inform timely interventions to address adherence barriers Prevent further complications

3. Assessing Adherence Thoroughly:

Non-Judgmental Approach: Creating a supportive and non-judgmental environment is essential for honest and accurate assessment.

Open-Ended Questions: Utilize open-ended questions to explore potential challenges and barriers to adherence, such as: Difficulties with medication schedules

Side effects Financial constraints Forgetfulness

Mental health concerns Substance abuse

Lack of social support

Objective Measures: Complement patient reports with objective measures like:

Pill counts

Pharmacy refill records

Medication Event Monitoring Systems (MEMS)

4. Addressing Adherence Barriers:

Tailored Interventions: Based on the assessment findings, develop individualized strategies to enhance adherence, such as: Simplifying medication regimens

Addressing side effects

Providing medication reminders

Offering counseling and support services

Connecting patients with resources

5. Reassessing and Monitoring:

Continuous Evaluation: Regularly reassess adherence and viral load to ensure treatment effectiveness and make adjustments as needed.

Conclusion:

While other options (B, C, D) may provide valuable information, prioritizing adherence assessment is critical to promptly identify and address potential adherence issues, optimize treatment outcomes, and prevent further health decline in HIV patients experiencing viral rebound.