The retainer on the edge

68M, severe COPD exacerbation, known CO2 retainer (bed 17), day three, handing over to the night.

Select the 5 lines the night team actually needs, then commit.

• Severe COPD exacerbation, day three; on controlled oxygen with target saturations 88 to 92 percent, written on the chart.
• Afternoon gas on 2 L: pH 7.36, PaCO2 7.1, stable from this morning; repeat gas only if drowsy, saturations off target, or breathing harder.
• If he becomes drowsy or pH falls under 7.35 with a rising CO2: this is the NIV conversation, and the plan agreed with him today is YES to NIV, documented.
• Do not increase oxygen for breathlessness without a gas: comfort is judged against his targets, not against 98 percent.
• Nebulizers are prescribed 4-hourly with PRN in between; steroids and antibiotics day three of five.
• He smoked forty pack-years and quit last spring.
• His inhaler technique was reviewed by pharmacy today.
• Respiratory team will review in the morning regarding home NIV assessment.
• He prefers the fan on and the door open at night.
• Flu swab from admission came back negative.