A patient with a suspected gastrointestinal bleed is admitted to the emergency department. The patient presents with hypotension, tachycardia, and black tarry stools. Which initial intervention should the nurse prioritize?

Rationale:

A. Instructing the patient to perform diaphragmatic breathing exercises regularly is the priority intervention. Ankylosing spondylitis can cause rigidity of the thoracic spine and costovertebral joints, limiting chest expansion and reducing lung capacity. Diaphragmatic breathing encourages full lung inflation, improves oxygenation, and prevents respiratory complications such as atelectasis or pneumonia. Regular practice helps maintain chest mobility and respiratory function despite musculoskeletal limitations.

B. Advising the patient to avoid physical activity is contraindicated. While activity should be paced to prevent overexertion, complete inactivity can lead to decreased mobility, joint stiffness, and further respiratory compromise. Gentle exercises, including breathing techniques, are essential for maintaining function.

C. Using a lumbar support pillow may improve posture and comfort while sitting but does not directly enhance thoracic expansion or respiratory function. It is supportive but secondary to interventions targeting lung capacity.

D. Increasing fluid intake is generally beneficial for overall health and mucosal hydration, but it does not address impaired chest expansion or lung ventilation. It is not the priority intervention for improving respiratory function in ankylosing spondylitis.

Rationale:

A. Administering intravenous fluids is the immediate priority for a patient with signs of a significant gastrointestinal bleed such as hypotension, tachycardia, and melena, which indicate hypovolemia and possible hemorrhagic shock. Rapid fluid resuscitation helps restore circulating blood volume, improve blood pressure, and maintain perfusion to vital organs. According to emergency nursing priorities (ABCs and circulation), hemodynamic stabilization must occur before diagnostic or definitive treatments.

B. Preparing the patient for an endoscopic examination is important for identifying and treating the bleeding source; however, it is not the initial priority in an unstable patient. Endoscopy requires that the patient be hemodynamically stabilized first, as hypotension increases the risk of complications during the procedure.

C. Inserting a nasogastric tube may help assess for ongoing upper GI bleeding, but it is not a priority intervention in a patient who is already showing clear signs of significant bleeding and instability. NG tube placement can also cause discomfort and does not address the life-threatening issue of volume loss.

D. Proton pump inhibitors help reduce gastric acid secretion and promote clot stability, but they do not act immediately to correct hypotension or tachycardia. PPIs are typically administered after initial stabilization and often via the IV route, making them a secondary intervention rather than the first priority.