A 22-year-old male client on the medical-surgical unit has a tracheostomy placed 3 days ago following a motor vehicle collision with cervical trauma. He is alert and oriented. Vital signs are BP 128/76 mmHg, HR 92 beats/min, RR 26 breaths/min, SpO2 89% on room air, temperature 37.2°C (99°F). The LPN/VN notes coarse, gurgling breath sounds bilaterally and thick, tenacious secretions at the tracheostomy opening. The client appears anxious and is using accessory muscles to breathe. The obturator and a spare tracheostomy tube of the same size are present at the bedside. What should the LPN/VN do first?
- Document the secretion appearance without intervening or reporting the respiratory change until the next observation round.
- Summon urgent help, support oxygenation, and perform indicated sterile open suctioning with each suction event no longer than 15 seconds.
- Apply suction continuously while advancing the catheter and continue for 30 seconds to remove thick secretions.
- Suction using the catheter from the earlier procedure that was left unprotected on the bedside table.