A nurse on a pediatric unit has received change-of-shift report for four children. Which of the following children should the nurse assess first?

A. Correct. A 6-month-old infant who has croup and an O2 saturation of 92% on room air is at risk of respiratory distress and hypoxia. Croup causes inflammation and narrowing of the upper airway, which can compromise breathing. An O2 saturation of 92% is below the normal range of 95% to 100% and indicates inadequate oxygenation. This child needs immediate assessment and intervention to prevent further deterioration.

B. Incorrect. A 15-year-old adolescent who is 2 hr postoperative following an open reduction and internal fixation of the left ankle and is requesting pain medication has a priority need for pain management, but not as urgent as a child with respiratory compromise. The nurse should assess the adolescent's pain level, administer the prescribed analgesic, and monitor the effectiveness of the medication.

C. Incorrect. A 3-year-old toddler who has gastroenteritis, moderate dehydration, and had two loose bowel movements over the past 24 hr has a potential risk for fluid and electrolyte imbalance, but not as acute as a child with respiratory compromise. The nurse should monitor the toddler's intake and output, vital signs, weight, and skin turgor, and administer oral or intravenous fluids as prescribed.

D. Incorrect. A 10-year-old child who is awaiting surgery for an appendectomy and experienced sudden relief from pain may have a perforated appendix, which can lead to peritonitis and sepsis. However, this child is not as unstable as a child with respiratory compromise. The nurse should notify the surgeon of the change in pain status, monitor the child's vital signs, abdominal assessment, and laboratory results, and prepare the child for surgery.