A nurse is conducting an admission assessment on a newborn. Which of the following findings should the nurse identify as an indication of sepsis?

Rationale:

A. Case manager: A case manager coordinates overall care and resources for clients but does not provide direct interventions to improve fine motor skills affected by neuropathy.

B. Physical therapist: Physical therapy focuses on improving gross motor function, strength, balance, and mobility, rather than fine motor activities like buttoning clothes.

C. Social worker: Social workers assist with psychosocial support, community resources, and counseling, but they do not address functional limitations caused by neuropathy.

D. Occupational therapist: Occupational therapy specializes in helping clients perform activities of daily living (ADLs) and can provide adaptive techniques or devices to improve fine motor function, such as buttoning clothes, which is appropriate for this client’s needs.

A. Assess the client’s breath sounds: Auscultation helps determine how well interventions like albuterol and oxygen are working. Detecting changes such as worsening wheezes, crackles, or diminished sounds ensures early recognition of complications. This is vital given the client’s chronic smoking history and respiratory distress.

B. Restrict the client’s fluid intake: Adequate hydration thins mucus, making it easier to clear. Unless there is heart or kidney failure, fluids should be encouraged. Restricting intake could worsen secretion retention and impair gas exchange.

C. Perform chest percussion and vibration: These techniques loosen mucus and promote clearance in clients with COPD or chronic bronchitis. Because the client has a productive cough and abnormal lung sounds, this intervention supports better airway patency. It also works well alongside bronchodilators for improved breathing.

D. Increase oxygen flow rate to 4 L/min: In clients with chronic CO₂ retention, too much oxygen can suppress respiratory drive. The current prescription of 2 L/min should be maintained unless the provider reassesses and orders changes based on ABGs.

E. Instruct the client to perform diaphragmatic breathing: This method enhances airflow to the lower lungs, reduces accessory muscle use, and improves oxygen exchange. For a COPD client, it helps conserve energy and improve ventilation. Combined with pursed-lip breathing, it strengthens respiratory efficiency.

F. Place the client in a supine position: Lying flat limits lung expansion and can worsen dyspnea in clients with lung disease. An upright or high-Fowler’s position promotes maximal ventilation and better oxygenation.