COPD Exacerbation Management

10:00: Client is a 68-year-old male with a history of COPD and tobacco use (50 pack-years). Presents with increased shortness of breath and productive cough with thick, yellow sputum for three days. Client appears anxious and is sitting in a tripod position. Using accessory muscles for respiration. Breath sounds reveal bilateral expiratory wheezing and diminished bases. Skin is cool and pale; cyanosis noted on nail beds.