A client with newly diagnosed small cell lung cancer reports progressive facial swelling, distended neck and chest wall veins, and dyspnea worse when leaning forward. Which nursing action is the priority?
1Elevate the head of the bed to 45 degrees and prepare for emergent airway management✓ Correct answer
2Place the client in a supine position to enhance cerebral venous drainage and reduce edema
3Commence large-volume intravenous fluids to decrease blood viscosity and ease venous return
4Apply graduated compression stockings to both legs to improve systemic venous circulation
Explanation
SVC syndrome from mediastinal mass causes obstruction of venous return with facial/upper-extremity swelling, distended chest-wall collaterals, and dyspnea. Stridor and orthopnea signal airway compromise — elevation of the head of bed reduces venous pressure and facilitates breathing. Emergent oncology and radiation oncology consult is required; treatment is radiation therapy, chemotherapy (especially small cell), or endovascular stenting. Supine positioning WORSENS venous engorgement. Aggressive fluids increase central venous pressure and edema. Compression stockings have no role in SVC obstruction.