A nurse is completing an assessment following suctioning of a child who has a tracheostomy. Which of the following findings should the nurse identify as an indication that the procedure has been effective?

Choice A rationale An increased respiratory rate following suctioning is typically a sign that the procedure was ineffective or caused respiratory distress. Effective suctioning should clear the airway, leading to a more regular and often decreased respiratory rate, as the child no longer needs to work as hard to breathe. Tachypnea can indicate airway irritation or continued obstruction. Choice B rationale A decrease in oxygen saturation indicates a worsening of the child's respiratory status. Effective suctioning should improve gas exchange by clearing secretions from the airway, leading to an increase in oxygen saturation. A drop in oxygen levels can occur if the suctioning process is too prolonged or if it causes bronchospasms, both of which are adverse outcomes. Choice C rationale Clear breath sounds are a primary indicator that the airway has been effectively cleared of secretions. Suctioning removes mucus and other fluids that can cause adventitious sounds like rhonchi or crackles. The absence of these sounds and the presence of clear, bilateral breath sounds confirm that the procedure has successfully improved air flow and ventilation to the lungs. Choice D rationale An increase in oral secretions after suctioning is not a direct measure of the procedure's effectiveness. While suctioning can sometimes stimulate a cough and increase secretions temporarily, the primary goal is to clear the lower airway. Increased oral secretions might indicate a need for further oral suctioning but do not confirm that the tracheostomy tube and lower airways are clear. Choice E rationale While a cough can be stimulated during suctioning and is a normal protective reflex, an increase in coughing after the procedure is not a direct measure of effectiveness. Persistent coughing may indicate airway irritation or a continued presence of secretions. The most reliable indicator of a clear airway is the change in breath sounds and the child's overall respiratory effort.