A nurse notices intercostal retractions in an infant with irregular breathing. What action should be prioritized?

Intercostal retractions in an infant indicate increased work of breathing, often caused by airway obstruction, respiratory infection, or inadequate lung expansion. Infants are obligate nose breathers with compliant chest walls, making them more vulnerable to respiratory compromise. Irregular breathing patterns combined with retractions suggest increased respiratory effort that requires immediate supportive intervention. Positioning is a first-line, noninvasive action to optimize airway patency and ventilation. A. Administering oxygen therapy may be required if hypoxemia is confirmed, but it is not the first priority without first improving airway mechanics. Oxygen alone does not correct underlying positioning or airway obstruction contributing to retractions. Initial nursing actions should focus on optimizing breathing effort through simple, noninvasive measures such as positioning. B. Repositioning the infant is the priority intervention because it helps improve chest expansion and airway patency. Placing the infant in a position that promotes optimal lung expansion, such as slight elevation of the head, reduces work of breathing and may relieve mild airway obstruction. This immediate intervention supports ventilation and can stabilize respiratory effort before escalation of care. C. Asking the caregiver about recent illness exposure is part of a full assessment but is not the priority in the presence of active respiratory distress signs. Intercostal retractions indicate increased work of breathing that requires immediate supportive action rather than history gathering. Assessment questions can be completed after stabilization. D. Referral for critical congenital heart disease screening is important in newborns but is not an immediate intervention for acute respiratory distress signs in an infant already showing retractions. The priority is stabilizing breathing before pursuing diagnostic evaluations. Screening is part of broader evaluation but does not address the urgent respiratory effort currently observed.