A client with massive esophageal variceal hemorrhage requires balloon tamponade. What is the highest-priority goal in planning care?

• A. Relieving the client's anxiety
• B. Maintaining the airway
• C. Controlling bleeding
• D. Maintaining fluid volume

Answer: (D)

Airway protection. In a massive esophageal variceal bleed with balloon tamponade, the immediate priority is keeping the patient’s airway open and ensuring adequate oxygenation and ventilation. Blood, vomitus, and the tamponade device can all threaten airway patency and raise the risk of aspiration. Securing the airway (ready for suction, positioning, and potential intubation) takes precedence so you can safely ventilate and oxygenate the patient while other measures are taken to control bleeding and restore hemodynamics.

Once the airway is secured, attention then shifts to stopping the bleed with the balloon tamponade and to fluid resuscitation or transfusion as needed. Anxiety relief, while beneficial for comfort, is not the priority when the airway is at risk. Maintaining fluid volume is important but secondary to first ensuring the patient can breathe and be oxygenated. Controlling bleeding is essential, but its effectiveness depends on having a secure airway to support ventilation and perfusion.