A 9-month-old infant is admitted to the pediatric unit with a diagnosis of RSV bronchiolitis. The infant is experiencing moderate respiratory distress with nasal flaring, subcostal retractions, and oxygen saturation of 85% on room air. Which nursing intervention should be the priority?

For an infant with moderate to severe respiratory distress (SpO2 < 90%), the immediate priority is to support oxygenation. Apply continuous pulse oximetry and administer supplemental oxygen via the least invasive method (e.g., nasal cannula, simple face mask) to maintain SpO2 above 90-92%. Titrate FiO2 based on continuous monitoring and clinical response. Prepare for escalation to high-flow nasal cannula (HFNC) or CPAP if standard oxygen therapy fails to reduce work of breathing or correct hypoxemia.

Position the infant in a semi-upright or head-elevated position (30-45 degrees) to maximize diaphragmatic excursion and lung expansion. Avoid supine positioning, which can compromise the already vulnerable airway and worsen ventilation-perfusion mismatch. Frequent repositioning may help mobilize secretions, but minimize handling to reduce oxygen consumption.

Routine use of bronchodilators is not recommended for first-time RSV bronchiolitis. Focus on supportive measures: ensure adequate hydration via IV or NG route if respiratory rate exceeds 60-70 breaths/min to prevent aspiration, and perform gentle nasal suctioning to clear secretions before feeding and as needed. Continuously monitor respiratory rate, heart rate, SpO2, and signs of fatigue (e.g., decreasing respiratory rate, altered consciousness) to identify impending respiratory failure early.

Withhold oral feedings during periods of significant tachypnea and retractions to reduce the risk of aspiration. Once respiratory status stabilizes and the infant demonstrates a safe swallow with manageable work of breathing, slowly reintroduce small, frequent oral feeds. If oral intake remains inadequate, initiate enteral feeds via nasogastric tube or intravenous fluids to maintain hydration and caloric needs.

Institute strict contact and droplet precautions to prevent nosocomial spread of RSV. Educate caregivers on the natural course of bronchiolitis, signs of deterioration, and the importance of hand hygiene. Provide emotional support and clear updates on the infant's condition and the rationale for all interventions.