A 45-year-old patient with ankylosing spondylitis presents with increased thoracic pain and limited chest expansion. Which nursing intervention should be prioritized to improve the patient's respiratory function?

A. Applying a warm compress is not appropriate as an initial intervention when a patient reports sudden severe burning during chemotherapy infusion. The priority is to stop the infusion immediately and assess the site. In addition, the use of warm versus cold compresses depends on the specific chemotherapeutic agent involved. Some vesicants require cold compresses to limit tissue spread, while others require warmth to promote drug dispersion. Applying any compress before stopping the infusion and assessing the site could delay critical intervention and worsen tissue injury.

B. Severe burning pain at the IV site during chemotherapy administration is abnormal and highly suggestive of infiltration or extravasation, particularly with vesicant or irritant drugs. Reassuring the patient and continuing to monitor without action can result in progressive tissue damage, necrosis, blistering, infection, and potential loss of limb function. Prompt recognition and intervention are essential to prevent permanent injury.

C. Stopping the infusion immediately is the most appropriate and highest-priority nursing action. Sudden pain, burning, or swelling at the PIV site during chemotherapy strongly indicates possible infiltration or extravasation, which is considered an oncologic emergency. Stopping the infusion prevents further drug leakage into surrounding tissues and allows the nurse to assess the site for redness, swelling, blanching, or decreased blood return. Early intervention reduces the risk of severe tissue necrosis and long-term complications.

D. Increasing the infusion rate is dangerous and contraindicated. If infiltration or extravasation is occurring, a faster infusion would force more of the chemotherapeutic agent into the surrounding tissue, significantly worsening tissue injury and pain. This action directly contradicts safe chemotherapy administration practices and could lead to irreversible damage.

Rationale:

A. Recommending complete bed rest is contraindicated in patients with ankylosing spondylitis. Prolonged immobility can worsen spinal stiffness, postural deformities, and chest wall restriction, increasing the risk of respiratory complications such as atelectasis and pneumonia. Maintaining mobility is essential to preserve lung expansion and functional ability.

B. Encouraging deep breathing exercises regularly is the priority nursing intervention to enhance respiratory function. Ankylosing spondylitis can cause fusion of the costovertebral joints, leading to decreased chest wall expansion and reduced lung capacity. Deep breathing exercises promote maximal lung expansion, improve oxygenation, and help prevent complications such as atelectasis and respiratory infections.

C. NSAIDs are a cornerstone of treatment for pain and inflammation in ankylosing spondylitis, but they do not directly address respiratory function. While important for symptom control, medication administration is a secondary priority compared to interventions that prevent potentially serious respiratory complications.

D. Applying heat packs to the lower back may help relieve muscle tension and pain, but it does not improve chest expansion or lung function. Heat therapy is a comfort measure and should not take precedence over interventions aimed at preserving respiratory capacity.