A child with end-stage renal disease is being assessed by the nurse. The nurse notes crackles in the patient's lungs. The nurse should:
1. Documents the lungs sounds.
2. Assess for shortness of breath and the respiratory rate.
3. Obtain a pulse oximetry reading.
4. All of the above should be done.
4
Feedback
1. Documentation is needed for the comparison of the lung sounds at the next assessment.
2. Work of breathing can be an indicator as to how much fluid is building up in the body.
3. A pulse oximetry will notify the staff of the oxygenation status of the child.
4. All of the above steps should be done to ensure quality care for the patient.
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