A child diagnosed with strep throat 3 days ago enters the clinic crying hysterically. The parent tells the practical nurse (PN) that the child screams in pain even with a light touch. The child is short of breath and anxious. Which manifestations warrant immediate intervention by the PN?

A. Red, hot, and swollen joints: While these signs may indicate inflammation or early rheumatic complications, they are not immediately life-threatening. They require assessment and monitoring, but urgent intervention is not indicated unless systemic symptoms worsen. B. Pulse oximetry of 88% O2 saturation: An oxygen saturation of 88% is critically low and indicates hypoxemia, which can compromise tissue oxygenation and organ function. This finding warrants immediate intervention to stabilize the child’s respiratory status and prevent further deterioration. C. Slightly raised rash with ragged edges: A mild rash may be associated with strep-related skin manifestations or other benign conditions. It requires assessment but does not pose an immediate threat to the child’s health. D. Heart rate 110 beats/minute: A heart rate of 110 in a child can be within the normal range depending on age and anxiety level. While it should be monitored, it does not necessitate immediate intervention compared to significant hypoxemia.