A client who is near death appears to be having difficulty breathing. What is the nurse's highest-priority intervention?
a. Teach the family how to perform naso-tracheal suctioning.
b. Request that the physician order morphine sulfate.
c. Document the finding in the client's chart.
d. Call a respiratory therapist to intubate the client.
B
Morphine sulfate is the standard treatment for dyspnea near death; it relieves the psychological and physiologic distress that accompanies breathlessness. Suctioning or intubation may cause the client discomfort. Documentation is important, but it is not the priority intervention because it does nothing to relieve the client's distress.
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