A home health LPN/VN visits a 52-year-old woman with long-standing myasthenia gravis who uses a home mechanical ventilator via tracheostomy at night for chronic respiratory muscle weakness. The client reports feeling more fatigued than usual and says she "barely slept" due to trouble clearing secretions. Vital signs are BP 132/82 mmHg, HR 104 beats/min, RR 26 breaths/min, SpO2 89% on her baseline ventilator settings, and temperature 37.1°C (98.8°F). She is alert but appears anxious and is using accessory muscles to breathe. The LPN/VN notes coarse, wet breath sounds bilaterally with copious secretions in the tracheostomy tube. Which action should the nurse take first?
- Suction the tracheostomy continuously for 30 seconds without preoxygenating first.
- Adjust the ventilator settings independently to increase the delivered oxygen concentration.
- Document the low oxygen saturation and increased secretions, then continue the scheduled visit tasks without intervening or notifying the RN or prescriber.
- Position the client upright, suction the airway, and notify the RN/prescriber of the findings.