The nurse is inspecting the fingernails of an 18-month-old girl. What finding indicates chronic hypoxemia?

A. Check tube placement: Tube placement should be verified before administering any medication to ensure that the tube is in the stomach and not the respiratory tract. Checking placement afterward does not prevent complications from incorrect placement.

B. Retape the tube: Retaping may be necessary if the tube is loose, but it is not the priority action after giving medication. The immediate concern is maintaining tube patency and preventing clogging.

C. Flush the tube: Flushing the orogastric tube with sterile or tap water after medication administration is the priority. It ensures that the full dose of the drug enters the stomach, prevents drug interactions or residue buildup in the tubing, and maintains patency.

D. Remove the tube: The orogastric tube should not be removed unless specifically ordered or if there is a clinical reason. Removal immediately after medication administration would prevent ongoing nutritional or medication use and is not a standard practice.

A. Nails that curve inward: Inward curving, or spoon-shaped nails (koilonychia), are typically associated with iron deficiency anemia rather than hypoxemia. They reflect nutritional or hematologic issues rather than oxygen deprivation.

B. Clubbing of the nails: Clubbing, characterized by a bulbous enlargement of the fingertips and loss of the normal nail angle, indicates chronic hypoxemia. It results from prolonged low oxygen levels causing vascular and connective tissue changes in the fingers.

C. Nails that curve outward: Outward curving nails are usually a normal shape variation and do not necessarily indicate disease. They lack the bulbous appearance and softening of the nail bed seen in clubbing.

D. Dry, brittle nails: Brittle nails are commonly linked to dehydration, nutritional deficiencies, or thyroid disorders, not chronic hypoxemia. Oxygen deprivation primarily affects soft tissue rather than nail strength or moisture.