A nurse is caring for a preschooler who is terminally ill.
Which of the following reactions to death should the nurse expect?

Choice A rationale: Steatorrhea during stool analysis, characterized by greasy, foul-smelling stools due to excess fat, is typically associated with malabsorption syndromes such as cystic fibrosis or chronic pancreatitis. While this warrants further evaluation, it is not directly linked to acute respiratory symptoms such as difficulty breathing or coughing up blood. Thus, this finding does not necessitate immediate intervention compared to the urgent risks posed by hemoptysis.

Choice B rationale: Barrel chest, often associated with chronic obstructive pulmonary disease (COPD), reflects long-term structural changes due to chronic air trapping. While it is an important finding requiring ongoing management, it is not an acute issue demanding urgent intervention. It does not directly explain symptoms like hemoptysis or respiratory distress, which indicate more critical underlying conditions requiring immediate attention.

Choice C rationale: An oxygen saturation of 95% on 1 L oxygen via nasal cannula is within the acceptable range for most individuals, with normal oxygen saturation values typically between 95% and 100%. This finding does not indicate severe hypoxemia or a deteriorating respiratory status. As such, it does not require urgent intervention compared to significant bleeding in the respiratory tract.

Choice D rationale: Hemoptysis of 300 mL is a critical finding requiring urgent intervention. This volume of blood indicates severe hemorrhage in the respiratory tract, which can compromise the airway, lead to hypovolemic shock, and cause respiratory failure if not addressed promptly. Immediate evaluation is necessary to identify the source of bleeding and initiate lifesaving treatments such as airway stabilization and hemorrhage control.

Choice A rationale

Administering oxygen therapy addresses hypoxemia caused by cyanotic episodes and decreased oxygen saturation. Supplemental oxygen improves alveolar oxygenation and enhances oxygen delivery to tissues. Cyanosis during coughing episodes indicates compromised respiratory function due to mucus obstruction, increasing oxygen demand. Normal oxygen saturation for infants is 95%-100%. The immediate priority is stabilizing oxygen levels to prevent respiratory distress and hypoxic injury, ensuring the infant receives adequate oxygenation until further interventions are implemented.

Choice B rationale

Encouraging oral hydration helps alleviate dehydration and thin mucus secretions. The infant’s lack of wet diapers for 8 hours signifies potential dehydration due to vomiting and inadequate feeding. While hydration supports overall respiratory health, it does not directly address the acute hypoxemia observed during cyanotic episodes. Normal urine output for infants is at least 1 mL/kg/hour. Priority action targets the most critical symptoms, rendering hydration a secondary measure after oxygen administration.

Choice C rationale

Placing the infant in an upright position improves ventilation and drainage of mucus secretions, reducing airway obstruction. Upright positioning alleviates the work of breathing by optimizing lung expansion. While beneficial, positioning alone cannot resolve hypoxemia during cyanosis or acutely improve oxygen saturation. Infants with significant respiratory distress require interventions like oxygen therapy to stabilize life-threatening symptoms prior to supportive measures such as positioning.

Choice D rationale

Preparing for emergency intubation ensures airway patency during severe respiratory compromise. Intubation may become necessary if hypoxemia persists despite oxygen therapy or if mucus obstruction worsens. However, immediate intubation bypasses less invasive initial measures. Oxygen therapy is prioritized to stabilize oxygen levels, allowing reassessment of respiratory status before advancing to more aggressive interventions.