A nurse is working at a community summer camp and observes a pediatric client that appears unsteady and excessively sweaty during a game of soccer.
Which of the following actions should the nurse take?

This question addresses pediatric respiratory management and oxygen therapy protocols. Knowledge of the American Heart Association 2020 guidelines is required to identify the target oxygen saturation levels that balance tissue oxygenation while avoiding the physiological risks of hyperoxia or hypoxia.

Choice A rationale

The guidelines recommend maintaining oxygen saturation at 94 percent or higher. This level ensures adequate arterial oxygen content for systemic delivery while minimizing the risks of lung injury or oxidative stress associated with excessive supplemental oxygen administration in children.

Choice B rationale

A saturation of 90 percent is generally considered hypoxic for a stable pediatric patient. Lower levels can trigger pulmonary vasoconstriction and impair metabolic processes, potentially leading to cellular dysfunction or cardiovascular instability if the underlying cause of hypoxia is not corrected.

Choice C rationale

While 99 percent is within normal limits, the guidelines emphasize titrating oxygen to maintain at least 94 percent. Aiming for 99 percent often involves unnecessary high-flow oxygen, which can cause hyperoxic tissue damage and suppress the natural respiratory drive.

Choice D rationale

An SpO2 of 85 percent indicates significant hypoxemia and requires immediate intervention. Normal ranges are typically 95 to 100 percent. Prolonged levels at 85 percent result in anaerobic metabolism, lactic acidosis, and potential end-organ damage due to insufficient oxygen supply.

Pediatric anatomy differs significantly from adult physiology regarding ossification and skeletal structure. Knowledge of bone development, including the transition from cartilage to mineralized bone and the fusion of growth centers, is required to differentiate between newborn and adult skeletal systems.

Choice A rationale

The cranial plates do not fuse prior to birth; they remain separated by fontanels and sutures to allow for brain growth and passage through the birth canal. The posterior fontanel closes at two months, while the anterior fontanel closes later.

Choice B rationale

Growth plates, or epiphyseal plates, are areas of active longitudinal bone growth consisting of hyaline cartilage. They do not function to fuse bones together until the end of puberty when they ossify completely, marking the end of physical height increase.

Choice C rationale

This statement is factually reversed; newborns have approximately 300 bones, many of which are cartilaginous. As the child grows, these structures fuse into the 206 distinct mineralized bones found in the typical adult skeletal system following complete ossification.

Choice D rationale

Infants have more bones than adults because many skeletal segments have not yet fused. As the child reaches one or two years, several bones begin the process of fusion, resulting in a lower total count compared to birth.