A nurse is assisting with developing a discharge plan for a client who has a new diagnosis of diabetes mellitus. The client is independent and lives alone. Which of the following interventions should the nurse plan to include?

A. Apply continuous pulse oximeter: The infant’s oxygen saturation has declined from 94% to 92% with increasing respiratory distress and tachypnea, indicating worsening gas exchange. Continuous pulse oximetry is essential to monitor for hypoxemia in bronchiolitis, where airway inflammation and mucus plugging impair ventilation. Early detection of desaturation allows prompt oxygen administration to prevent respiratory failure.

B. Reinforce instructions for parent regarding use of breast pump to express milk: Although maintaining nutrition is important, the infant’s respiratory rate has increased to 70/min, and oral intake is restricted when the rate exceeds 60/min due to aspiration risk. Education about breast pumping does not address the immediate priority of airway and breathing compromise.

C. Administer acetaminophen: The infant has a temperature of 38.7°C, which meets criteria for antipyretic administration. However, fever management is secondary to stabilizing airway and breathing in a child showing escalating respiratory distress and declining oxygen saturation.

D. Assist with insertion of peripheral intravenous access device: The infant demonstrates poor breastfeeding, tachypnea, and signs of mild dehydration, increasing the risk of fluid deficit. IV access is necessary to initiate the prescribed maintenance fluids and maintain hydration when oral intake is unsafe. Establishing vascular access also prepares for potential rapid deterioration.

E. Suction the nares: Thick nasal secretions contribute to airway obstruction, especially in infants who are obligate nose breathers. Suctioning the nares reduces upper airway resistance, improves airflow, and may decrease work of breathing. Clearing secretions directly addresses the immediate respiratory compromise seen in bronchiolitis.

F. Apply urine collection bag: A urine specimen for culture is ordered, but obtaining it does not take priority over airway stabilization and oxygenation. While monitoring output is important for hydration status, it is not the most urgent intervention given the infant’s respiratory deterioration.

G. Obtain blood cultures: Blood cultures are indicated to evaluate for possible bacterial infection; however, they are not the immediate priority in a child with worsening respiratory distress. Stabilizing airway, breathing, and circulation takes precedence before diagnostic specimen collection.

A. Schedule the medication at meal times: Administering the medication with meals may improve tolerance for some drugs, but it does not address the ethical and legal issue of the client’s right to refuse. The nurse cannot override the client’s autonomy by adjusting timing without consent.

B. Request the family talk to the provider about administering the medication by injection: Changing the route of administration without the client’s informed consent raises ethical and legal concerns. Injectable administration may be appropriate only if the client consents or if there is a court order for involuntary treatment under specific circumstances.

C. Inform the family that the client has the right not to take the medication: Clients with decision-making capacity have the right to refuse treatment, including psychotropic medications. The nurse should educate the family about respecting the client’s autonomy while ensuring the client is informed about potential consequences of refusing treatment.

D. Ask the family what foods the client likes: While considering food preferences may support medication adherence in willing clients, it is inappropriate to use food to covertly administer medication. This practice violates informed consent and ethical principles and can undermine trust between the client, family, and healthcare team.