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Foreign body aspiration is unlikely because symptoms of airway obstruction such as sudden coughing, localized wheezing, or stridor occur immediately after aspiration. The delayed onset (48 hours later) and diffuse bilateral infiltrates do not support this diagnosis.

Aspiration pneumonia typically shows localized infiltrates, often in the dependent lobes of the lung, not diffuse bilateral involvement. Fever and localized crackles are usually present, which are not mentioned here.

Bronchopneumonia usually caused by bacterial infection, presenting with fever, cough, purulent sputum, and patchy infiltrates, not diffuse ones. The temporal relationship to the near-drowning event and lack of infection history make this less likely.

Although hypoglycemia can occur in preterm infants, monitoring blood glucose every 4 hours does not directly improve respiratory status. It’s part of general care, not a specific intervention to enhance oxygenation.

Inspired gases should be warmed and humidified to prevent cold stress, which increases oxygen consumption and worsens respiratory distress. Cooling gases would be harmful.

Daily or alternate-day weight checks help assess fluid balance but do not directly affect respiratory status. It’s a routine monitoring measure, not an intervention for respiratory improvement.

The condition generally stabilizes with positive prognosis: Although some patients recover, ARDS is unpredictable and often fatal. Suggesting stabilization or a positive prognosis gives false reassurance.

The client can be discharged with home oxygen: ARDS is a critical illness requiring ICU management. Recovery, if achieved, is gradual and may include long-term pulmonary rehabilitation, but discharge with home oxygen is not part of the initial plan.

The condition is always fatal: ARDS is not always fatal, and many patients recover with aggressive treatment and ventilatory support. However, it remains life-threatening with a guarded prognosis.

Cough with blood-tinged sputum and respiratory alkalosis: Hemoptysis is not a typical early sign of ARDS. It suggests airway injury or infection. Early ARDS presents with tachypnea and respiratory alkalosis, but this alone is not diagnostic without refractory hypoxemia.

Decrease in both white and red blood cell counts: These changes are not related to ARDS. They may occur in bone marrow suppression or sepsis, but they do not indicate the onset of respiratory distress.

Hypertension and elevated PaO₂: These are opposite of ARDS findings. Clients typically show hypotension due to hypoxia and decreased cardiac output and decreased PaO₂, not elevated values.