A ventilated client with a long-term tracheostomy develops new confusion, accessory-muscle use, and an SpO2 of 89%, down from 96%. Coarse breath sounds and thick secretions are present. The LPN is trained and authorized to provide tracheostomy suctioning under the established protocol; independent changes to prescribed ventilator settings are not authorized. Which action should the LPN take first?
- Increase the prescribed tidal volume beyond the ordered settings to improve oxygenation.
- Complete the electronic change-in-condition report before beginning airway support or calling for help.
- Apply continuous suction for 30 seconds to remove all secretions in one pass.
- Call for immediate RN/respiratory assistance while positioning the client upright and beginning protocol-directed preoxygenation and suctioning.