The nurse admits a patient with a history of human immunodeficiency virus (HIV). Patient reports severe diarrhea, vomiting for the past 6 days. Which action will the nurse perform first?

A. Assess nutritional status with height, weight, blood urea nitrogen, transferrin, hemoglobin, and hematocrit level: This option focuses on assessing the patient's nutritional status, which is important for planning appropriate interventions. However, in a patient presenting with severe diarrhea and vomiting, the priority is to address immediate physiological needs and stabilize the patient's condition before conducting comprehensive assessments. While assessing nutritional status is important for long-term management, it is not the first action the nurse should take in this acute situation.

B. Consult with a dietitian to determine the patient's nutritional needs: Consulting with a dietitian is an important step in addressing the patient's nutritional needs, especially in cases of prolonged diarrhea and vomiting. However, in this scenario, the patient is experiencing severe symptoms that require immediate attention. Before consulting with a dietitian, the nurse should address the patient's acute symptoms and initiate interventions to manage fluid and electrolyte imbalances.

C. Encourage the patient to prepare simple meals or to obtain assistance with meal preparation if possible: This option addresses the immediate need to provide nutritional support to the patient. Encouraging the patient to consume simple, easily digestible meals or to seek assistance with meal preparation helps ensure that the patient receives adequate nutrition despite experiencing symptoms of diarrhea and vomiting. Providing practical advice on meal preparation empowers the patient to take control of their nutritional intake, which can be beneficial in managing symptoms and promoting recovery.

D. Encourage the patient to eat meals with visitors or others when possible: While social support and companionship can have a positive impact on the patient's overall well-being, including their nutritional intake, this option is not the first priority in this scenario. The patient's severe symptoms of diarrhea and vomiting require immediate attention to address fluid and electrolyte imbalances and prevent complications such as dehydration. Once the patient's condition stabilizes, encouraging social interaction during meals can be beneficial for promoting nutritional intake and emotional support.

A. Having the primary provider prescribe a CT:
Prescribing a CT scan is not the initial action for assessing nonpalpable pedal pulses. CT scans are typically used for imaging purposes and are not the primary diagnostic tool for assessing peripheral pulses.

B. Apply a tourniquet for 3 to 5 minutes and then reassess:
While applying a tourniquet may increase the visibility of pulses in some cases, it is not the recommended method for assessing pedal pulses, especially if they are nonpalpable. Tourniquet use carries risks, such as tissue damage or ischemia, and is not a standard practice for assessing pulses.

C. Elevate the extremity and attempt to palpate the pulses:
Elevating the extremity may improve blood flow and make pulses easier to palpate, but if the pulses are nonpalpable, simply elevating the extremity may not be sufficient for assessment. Additionally, palpation alone may not accurately detect pulses in some cases.

D. Use the doppler ultrasound to detect pedal pulses:
This is the most appropriate action. Doppler ultrasound is a non-invasive diagnostic tool commonly used to assess peripheral pulses, especially when they are nonpalpable. It uses sound waves to detect blood flow and can provide accurate information about the presence and strength of pedal pulses. Using a doppler ultrasound can help confirm the status of pedal pulses and guide further management.