Phase 1 A 10-week-old is brought to the emergency department with three days of rhinorrhea, congestion, and cough. He is presenting with mild intercostal retractions, congested cough, HR: 178, RR: 65 breaths/min, his capillary refill is >4 seconds, O2 Sat: 92% on RA, T- 99.2 F, wheezing is heard bilaterally, & mother feels the infant needs help breathing. Unable to stay latched to breast. Restless and has head bobbing. Mother at bedside. Select and highlight the assessment findings that require follow up. Phase 1 A 10-week-old is brought to the emergency department with three days of rhinorrhea, congestion, and cough. He is presenting with mild intercostal retractions, congested cough, HR: 178, RR: 65 breaths/min, his capillary refill is >4 seconds, O2 Sat: 92% on RA, T- 99.2 F, wheezing is heard bilaterally, & mother feels the infant needs help breathing. Unable to stay latched to breast. Restless and has head bobbing. Mother at bedside. Medical History Up to date with vaccine No known allergies Born at 39 weeks

Inability to stay latched to the breast is concerning because it reflects increased work of breathing or fatigue. Infants often show feeding difficulties as an early sign of respiratory compromise, and in this case, poor feeding may also contribute to dehydration and hypoglycemia. Capillary refill greater than 4 seconds suggests delayed peripheral perfusion, which can indicate dehydration or early shock. This is a red flag in infants and requires prompt assessment of circulatory status. Intermittent wheezing in both lungs is an abnormal breath sound typically associated with airway narrowing or obstruction, as seen in bronchiolitis or reactive airway disease. It requires close monitoring for worsening respiratory effort or decreased air exchange. Heart rate of 178 beats per minute is elevated for a 10-week-old infant (normal is generally 100–160 bpm). This tachycardia may be a response to fever, hypoxia, respiratory distress, or dehydration, and should be evaluated in the context of other clinical signs. Oxygen saturation of 92% on room air is below the expected range for a healthy infant (typically ≥95%). This indicates hypoxemia, and supplemental oxygen and further respiratory support may be necessary. Respiratory rate of 65 breaths per minute exceeds the normal range for this age (30–60 breaths/min). Tachypnea can reflect respiratory distress and is especially concerning when paired with other abnormal findings. Mild intercostal retractions are a sign that the infant is using accessory muscles to breathe, which indicates increased work of breathing. Even mild retractions in a young infant warrant close observation. Restlessness and head bobbing are signs of significant respiratory distress. Head bobbing is particularly concerning as it indicates fatigue and the use of neck muscles to assist with breathing, which can precede respiratory failure.