5. Abnormal findings

Abnormal findings and what they may signal — each warrants Mode B focused documentation and, where parameters are met, intervention and notification:

• Tachypnea or bradypnea; irregular patterns such as Cheyne-Stokes or Kussmaul respirations.
• Increased work of breathing — accessory-muscle use, retractions, nasal flaring, pursed-lip breathing, tripod posture.
• Adventitious sounds — crackles, wheezes, rhonchi, diminished or absent sounds, or a pleural rub.
• SpO2 below the ordered target, or a drop of ≥ 4% from baseline with dyspnea.
• Productive cough with a change in color, amount, or viscosity; hemoptysis.
• Dyspnea at rest or on exertion; orthopnea; PND; fragmented speech.
• Cyanosis; digital clubbing; asymmetric chest expansion.
• Device misuse (poor inhaler or spacer technique, incorrect oxygen flow).
• Medication-related effects — ACE-inhibitor cough, opioid-related hypoventilation, or beta-blocker-associated bronchospasm.