A nurse is assisting with the care of a 5-month-old infant who was just admitted to the pediatric unit. Exhibits For each potential provider's prescription, click to specify if the potential prescription is anticipated or contraindicated for the infant.

Rationale: Initiate a peripheral IV line: This is essential for fluid resuscitation, medication administration, and potential diuretics. The infant is showing signs of poor perfusion (cap refill >3 sec, cool extremities), which may indicate decreased cardiac output. Offer small, frequent feedings: Infants in respiratory distress often fatigue quickly during feeding. Smaller, more frequent feeds reduce the work of feeding and help prevent aspiration and further decompensation. Monitor intake and output: This is critical in managing fluid status, especially since the infant has only had one wet diaper in the past 24 hours, indicating possible dehydration or reduced renal perfusion. Prepare the infant for a chest x-ray: A chest x-ray helps evaluate pulmonary congestion, pneumonia, or cardiomegaly. This is standard when assessing for worsening respiratory distress or cardiac involvement. Maintain infant in supine position: Supine positioning can worsen respiratory distress. The infant prefers to sit upright, which facilitates lung expansion. Upright or semi-upright positioning is preferred to ease breathing effort. Maintain infant on continuous pulse oximetry: Continuous oxygen saturation monitoring is necessary to detect hypoxemia early and evaluate the need for oxygen adjustments, especially in a previously oxygen-dependent infant.