A nurse is reviewing potential provider orders for a client with respiratory syncytial virus (RSV). Which of the following orders should the nurse anticipate?

Choice A rationale

A nasopharyngeal specimen is crucial for confirming RSV infection. This test detects viral antigens or RNA through assays like immunofluorescence or polymerase chain reaction. Such diagnostic accuracy guides treatment decisions and minimizes misdiagnosis.

Choice B rationale

Sterile suctioning clears nasal secretions, improving airway patency and oxygenation. This intervention is especially necessary before feeding to prevent aspiration, which can exacerbate respiratory distress. Suctioning supports effective feeding by maintaining a clear nasal passage.

Choice C rationale

Nebulized albuterol sulfate is primarily indicated for bronchospasm related to conditions like asthma. While RSV can cause wheezing, bronchodilators are not typically effective for viral-induced airway inflammation and are not a standard treatment for RSV.

Choice D rationale

Administering oxygen to maintain SaO2 above 90% is essential for managing hypoxemia in RSV cases. Oxygen therapy ensures adequate tissue oxygenation, preventing complications like respiratory failure. This is a cornerstone of supportive care for RSV.

Choice E rationale

Chest percussion and drainage are not standard RSV treatments. This intervention targets mucus mobilization in chronic or bacterial respiratory conditions. RSV management focuses on supportive measures like suctioning and hydration rather than percussion.

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.