A nurse is caring for an infant admitted with RSV who exhibits nasal flaring grunting and intercostal retractions. After completing the initial observational respiratory assessment, which action should the nurse take next to best evaluate the infant's respiratory status?

Respiratory syncytial virus (RSV) infection in infants can lead to significant lower respiratory tract involvement, causing airway inflammation, mucus production, and bronchial obstruction. Signs such as nasal flaring, grunting, and intercostal retractions indicate increased work of breathing and possible respiratory distress. After initial observation, the next step in a focused respiratory assessment is auscultation to evaluate airflow and detect abnormal lung sounds. This helps determine severity and guides further interventions. A. Performing deep palpation of the chest is not appropriate in an infant with respiratory distress. Deep palpation can cause discomfort, increase agitation, and worsen oxygen demand. Additionally, it does not provide useful information about airway patency or gas exchange compared to auscultation. Respiratory assessment should prioritize noninvasive and low-stress techniques. B. Measuring orthostatic blood pressure is not relevant in this scenario, especially in an infant. Orthostatic changes are typically assessed in older children and adults to evaluate volume status or autonomic function. It does not contribute to immediate evaluation of respiratory compromise in an infant with RSV. C. Auscultating the lungs bilaterally using the diaphragm of the stethoscope is the correct next step. It allows the nurse to identify abnormal breath sounds such as wheezing, crackles, or diminished airflow, which are common in RSV. This assessment provides critical information about airway obstruction and lung involvement, helping guide oxygen therapy and further management. D. Immediately administering a bronchodilator without completing further assessment is inappropriate. While bronchodilators may sometimes be used, their effectiveness in RSV is variable and should be based on clinical findings. Administering medication without adequate assessment may lead to unnecessary treatment and does not support evidence-based care.