Ordered parameters — notify thresholds (self-contained)

A nurse covering this patient acts on the values below without prior knowledge of the patient. Confirm against the current physician orders and plan of care each visit; the figures here are the standing thresholds unless the order states otherwise.

Oxygen saturation: maintain SpO₂ within the ordered range (commonly 88–92% in COPD to avoid carbon-dioxide retention — confirm the individual order). Notify the provider for SpO₂ below the ordered floor, or a sustained drop of ≥4% from the ordered range that does not recover with the ordered oxygen.

Oxygen flow: deliver the ordered flow (state the value, e.g. 2 L/min) and do not titrate above the ordered ceiling. Notify if the patient needs more than the ordered flow to hold the target saturation — a rising oxygen requirement is an exacerbation signal, and over-oxygenation can suppress the respiratory drive.

Three cardinal exacerbation symptoms (Anthonisen): notify for a new increase, over the interval since the last visit, in any of — dyspnea, sputum volume, or sputum purulence. One or more increasing is the definition of a worsening that may need steroids or antibiotics.

Rescue inhaler / nebulizer use: notify if short-acting rescue use exceeds the ordered frequency, or is escalating over the interval — a marker of loss of control.

Emergency signs (activate EMS, then notify): severe dyspnea with accessory-muscle use or inability to speak in full sentences, cyanosis, a silent chest, SpO₂ that will not rise with the ordered oxygen, or new confusion or drowsiness (possible carbon-dioxide narcosis).

Weight / edema (cor pulmonale): notify for a weight gain beyond the ordered threshold (commonly ≥3 lb in a day or ≥5 lb in a week — confirm the order) or new lower-extremity edema, which can signal right-heart strain (cross-reference Cardiovascular).