A patient diagnosed with small bowel obstruction (SBO) develops sudden severe abdominal pain and a rigid abdomen. What is the nurse's priority action?

Rationale:

A. Scheduling serological testing for Lyme disease may be part of the diagnostic process, but early testing is often unreliable because antibodies may not be detectable in the first few weeks after infection. Waiting for test results can delay treatment and increase the risk of complications.

B. Assessing for neurological involvement, such as facial palsy, is important in later stages of Lyme disease. While the nurse should monitor for these signs, it is not the immediate priority in a client with early localized disease and a characteristic rash.

C. Administering a prescribed dose of doxycycline is the most appropriate initial action. Early antibiotic treatment for Lyme disease, especially when a bull’s-eye rash (erythema migrans) is present, is critical to prevent progression to more serious systemic manifestations, including neurological, cardiac, or musculoskeletal complications. Prompt initiation of therapy is more important than waiting for confirmatory testing.

D. Initiating a discussion about safe hiking practices is valuable for health promotion and prevention, but it does not address the client’s immediate need for treatment. Education can be provided after initiating therapy.

Rationale:

A. Preparing the patient for surgical intervention may eventually be necessary for a large bowel obstruction, but immediate stabilization and symptom management take priority. Surgery is not the first intervention unless there is evidence of perforation, ischemia, or complete obstruction.

B. Inserting a nasogastric (NG) tube to decompress the bowel is the priority nursing intervention. NG decompression relieves pressure, reduces vomiting, and prevents further distention, which helps prevent complications such as perforation or ischemia. It also helps manage fluid and electrolyte imbalances while preparing the patient for definitive treatment.

C. Encouraging oral intake is contraindicated in a patient with a suspected large bowel obstruction. Oral fluids can worsen distention, increase vomiting risk, and exacerbate the obstruction.

D. Administering a laxative is unsafe in the setting of a suspected large bowel obstruction. Laxatives can increase intestinal pressure, risk perforation, and worsen the patient’s condition.