A nurse is caring for a client with a tracheostomy. The client’s partner has been taught to perform suctioning. Which of the following actions by the partner should indicate to the nurse a readiness for the client’s discharge?

Choice A rationale
A WBC count of 2300/mm³ is significantly lower than the normal range (4500-11000/mm³) and indicates leukopenia, which increases the risk of infection. This finding should be reported to the provider.
Choice B rationale
A platelet count of 155,000/mm³ is within the lower end of the normal range (150,000- 450,000/mm³) and does not require immediate reporting.
Choice C rationale
An RBC count of 5 million/mm³ is within the normal range for females (4.2-5.4 million/mm³) and does not require immediate reporting.
Choice D rationale
A hemoglobin level of 12 g/dL is within the normal range for females (12-16 g/dL) and does not require immediate reporting.

Choice A rationale
The skin assessment reveals bruising and petechiae, which are signs of thrombocytopenia, a condition where the blood has a lower than normal number of platelets. This is significant in a child with leukemia as it may indicate a relapse or bone marrow suppression. The presence of petechiae and unexplained bruising should be reported to the provider as they can be indicative of bleeding disorders or a decrease in platelet count.
Choice B rationale
Oxygen saturation of 92% on room air is below the normal range (95-100%) for a child. This indicates hypoxemia, which can be a sign of respiratory distress or other underlying conditions. Given the child’s history of an upper respiratory infection and leukemia, this finding is critical and should be reported to the provider to ensure appropriate interventions are taken to improve oxygenation.
Choice C rationale
The WBC count is crucial in a child with leukemia. An abnormal WBC count can indicate an infection, relapse, or bone marrow suppression. Monitoring the WBC count helps in assessing the child’s immune status and the effectiveness of the leukemia treatment. Any significant changes in the WBC count should be reported to the provider for further evaluation and management.
Choice D rationale
Subcostal retractions are a sign of increased work of breathing and respiratory distress. This finding, along with the child’s statement of feeling like they can’t breathe, indicates that the child is struggling to maintain adequate ventilation. Reporting this to the provider is essential for timely intervention to prevent further respiratory compromise.
Choice E rationale
An ongoing upper respiratory infection for the last 2 months that has not resolved is concerning, especially in a child with a history of leukemia. This could indicate an underlying immunodeficiency or a more serious infection that requires further investigation and treatment. Reporting this to the provider is necessary to address the persistent infection and prevent complications.
Choice G rationale
The respiratory rate is an important vital sign that can indicate respiratory distress or other underlying conditions. An abnormal respiratory rate, whether too high or too low, can be a sign of respiratory or metabolic issues. Monitoring and reporting the respiratory rate to the provider helps in assessing the child’s respiratory status and determining the need for further intervention.