A nurse in the emergency department is assessing a preschooler who was brought in by a parent and has injuries consistent with physical maltreatment. Which of the following actions should the nurse take when interviewing the child?

Suctioning an infant with an endotracheal tube requires careful technique to maintain airway patency while minimizing complications such as hypoxia, trauma, and bradycardia. Infants are especially vulnerable to rapid oxygen desaturation because of their smaller airway size and limited oxygen reserves. Pre-oxygenation and post-oxygenation are essential to reduce the risk of hypoxemia during suctioning. Suctioning should be performed only when indicated and with the least invasive approach possible.

Rationale:
A. Administering supplemental oxygen before and after suctioning is correct because suctioning temporarily removes oxygen along with secretions and can rapidly cause hypoxemia. Pre-oxygenation helps increase oxygen reserves before the procedure, while oxygen after suctioning helps restore normal oxygen saturation. This is especially important in infants due to their high oxygen demand and limited respiratory reserve.

B. Advancing the suction catheter until resistance is felt is not recommended because it can cause trauma to the airway mucosa and damage the delicate tracheal tissues. The catheter should be inserted only to the predetermined appropriate depth based on tube length and institutional guidelines. Forcing the catheter increases the risk of bleeding and irritation.

C. Suctioning for intervals of 10 seconds is too long for an infant and increases the risk of hypoxia and bradycardia. Suction passes should generally be limited to about 5 seconds or less to minimize oxygen loss and physiologic stress. Short, efficient suctioning is safer and better tolerated.

D. Routine suctioning is not appropriate because suctioning should only be performed when clinically indicated, such as visible secretions, decreased oxygen saturation, coarse breath sounds, or increased work of breathing. Unnecessary suctioning increases the risk of airway trauma, infection, and hypoxemia without providing benefit.

A vaso-occlusive crisis in sickle cell disease occurs when sickled erythrocytes obstruct blood flow in small vessels, leading to ischemia, severe pain, and tissue hypoxia. Management prioritizes relieving pain, improving oxygenation, maintaining hydration, and preventing further sickling episodes. Pain control is a cornerstone of therapy because uncontrolled pain increases stress responses, which can worsen vaso-occlusion. Nursing care focuses on timely and consistent analgesia along with supportive measures.

Rationale:
A. Ambulating the child in the halls four times each day is inappropriate during an acute vaso-occlusive crisis because physical activity increases oxygen demand and can worsen tissue hypoxia and pain. During crisis, the child should be encouraged to rest to reduce metabolic demands and prevent further sickling of red blood cells.

B. Restricting the child’s fluid intake is contraindicated because dehydration increases blood viscosity and promotes sickling of red blood cells. Adequate hydration is essential to improve circulation and reduce vaso-occlusion. Fluid restriction would worsen the condition and increase pain and complications.

C. Applying cold compresses to painful extremities is inappropriate because cold causes vasoconstriction, which can further reduce blood flow and worsen ischemia in already compromised tissues. Warm compresses are generally preferred to promote vasodilation and improve circulation in affected areas.

D. Administering prescribed pain medication around the clock is correct because consistent analgesia is essential in managing vaso-occlusive crisis. Scheduled pain control prevents pain escalation, reduces physiologic stress, and helps minimize further sickling triggered by stress responses. Effective pain management is a priority intervention in sickle cell crisis care.