Exacerbation

Increased dyspnea, RR 26, accessory-muscle use, SpO₂ 86% on 2 L (below target), diffuse wheeze, thick green sputum — bronchodilator + O₂ titration (86→90%), SBAR 09:30, neb/steroid/antibiotic/CXR ordered, representative notified 09:45; reassess; supports Section O.

CO₂-retention concern

Rising somnolence/confusion with ‘adequate’ SpO₂ on increased O₂ — oxygen reviewed against the target (avoid over-oxygenation), provider notified, blood gas/evaluation ordered, mental status/respirations monitored; reassess; skilled recognition daily.

Respiratory failure

Severe dyspnea, unable to speak in full sentences, SpO₂ 82% unresponsive to treatment — EMS activated/transfer per policy, treatment and positioning while awaiting transport, provider and representative notified; serial vitals documented.

Base respiratory exam, tracheostomy, and suctioning route to the Respiratory reference; cardiac causes of dyspnea route to the Cardiovascular reference and CHF overlay; pneumonia/aspiration shares the Respiratory reference.