Respiratory

4. Abnormal findings — the necessity chain

Finding → severity → comparison → risk → intervention → notification (provider + representative) → orders → response → reassessment.

*Model abnormal 1*
New coarse crackles at the right base with RR 26 and SpO₂ 88% on 2 L, down from a 94% baseline, with a productive change in sputum to thick green — concerning for a new lower-respiratory infection/exacerbation. Applied the PRN bronchodilator and titrated O₂ per order (SpO₂ 88→93%); SBAR to the provider at 09:30, order for a chest film and sputum culture received; responsible party notified 09:45. Aspiration precautions reinforced. Will reassess RR/SpO₂ next shift and evaluate for a Significant Change assessment; supports the Section O respiratory item. Skilled observation and titration required daily at SNF level.

Model abnormal 1

New coarse crackles at the right base with RR 26 and SpO₂ 88% on 2 L, down from a 94% baseline, with a productive change in sputum to thick green — concerning for a new lower-respiratory infection/exacerbation. Applied the PRN bronchodilator and titrated O₂ per order (SpO₂ 88→93%); SBAR to the provider at 09:30, order for a chest film and sputum culture received; responsible party notified 09:45. Aspiration precautions reinforced. Will reassess RR/SpO₂ next shift and evaluate for a Significant Change assessment; supports the Section O respiratory item. Skilled observation and titration required daily at SNF level.

*Model abnormal 2*
Tracheostomy obstruction risk: increasingly thick, tenacious secretions with rising suction frequency, a drop in SpO₂ to 89%, and audible congestion — suctioned per protocol with transient improvement, humidification and saline instillation per order, provider notified, and airway status reassessed. Escalation criteria reviewed with staff; will reassess airway patency each shift. Skilled airway management required to prevent obstruction — a daily SNF-level need.

Model abnormal 2

Tracheostomy obstruction risk: increasingly thick, tenacious secretions with rising suction frequency, a drop in SpO₂ to 89%, and audible congestion — suctioned per protocol with transient improvement, humidification and saline instillation per order, provider notified, and airway status reassessed. Escalation criteria reviewed with staff; will reassess airway patency each shift. Skilled airway management required to prevent obstruction — a daily SNF-level need.

1. Purpose and clinical relevance

4. Abnormal findings — the necessity chain