In the case of an open pneumothorax, what should the nurse do immediately upon noting respiratory distress and distended neck veins?

In the case of an open pneumothorax, immediate action is critical to manage the patient's breathing and prevent further complications. Upon observing respiratory distress and distended neck veins, the correct response is to remove the occlusive dressing. This action is vital because if the dressing is too tight or if air cannot escape properly from the pleural cavity, it can create a tension pneumothorax, exacerbating the patient's respiratory distress.

In an open pneumothorax, there is an opening in the chest wall allowing air to enter the pleural space. The occlusive dressing is intended to prevent air from flowing in through the chest wall during inhalation. If the patient exhibits signs of distress and distended neck veins, it indicates a compromised venous return or a buildup of pressure within the thoracic cavity. By removing the occlusive dressing, air can escape, relieving pressure and potentially improving the patient's breathing.

Checking blood pressure or contacting the healthcare provider are important actions, but they do not address the immediate life-threatening issue of possibly worsening the pneumothorax. Applying a larger dressing could further restrict airflow if not done correctly. Therefore, the priority is first to ensure that the airway is managed effectively by allowing for proper ventilation and pressure release.