The nurse is admitting a patient with possible respiratory failure and a high PaCO2. Which assessment information would the nurse immediately report to the health care provider?

Choice A reason: Blood pressure of 164/98 mmHg is elevated but not immediately life-threatening in respiratory failure. It may reflect stress or chronic hypertension, less urgent than neurologic changes signaling CO2 narcosis.

Choice B reason: Oxygen saturation of 90% is low but manageable with oxygen therapy in respiratory failure. It’s concerning, yet less critical than somnolence, which indicates severe CO2 retention requiring urgent intervention.

Choice C reason: Weakness is nonspecific in respiratory failure, possibly from hypoxia or fatigue. It’s not as immediately alarming as somnolence, which directly reflects brain suppression from high PaCO2, needing prompt reporting.

Choice D reason: Somnolence and difficulty arousing signal CO2 narcosis from hypercapnia (high PaCO2), a medical emergency. It indicates respiratory acidosis impairing brain function, requiring immediate provider notification for ventilatory support.

Choice A reason: Tripod position aids breathing in COPD by stabilizing accessory muscles, a common adaptation. It signals distress but isn’t immediately life-threatening compared to respiratory rate, as it reflects chronic compensation rather than acute decompensation requiring urgent intervention.

Choice B reason: O2 saturation of 90% is low but typical in COPD due to ventilation-perfusion mismatch. It warrants monitoring, yet it’s less critical than respiratory rate, as supplemental oxygen can correct it, and it’s not an immediate danger sign.

Choice C reason: Bibasilar crackles suggest fluid or infection, uncommon in pure COPD exacerbations, which show wheezing. This finding needs attention but is less urgent than respiratory rate, as it may indicate pneumonia rather than immediate respiratory failure.

Choice D reason: Respiratory rate of 9 breaths/min is alarmingly low in COPD, where tachypnea (20-30 breaths/min) is expected during exacerbation. Bradypnea indicates potential respiratory depression or fatigue, risking CO2 retention and hypoxia, necessitating immediate reporting for intervention.