A 28-year-old female patient with a known history of asthma presents to the emergency department (ED) with severe respiratory distress. She reports that her asthma symptoms began worsening three hours ago, and despite using her albuterol inhaler four times today, she is still feeling short of breath.
Upon assessment, the nurse observes the following:
- Respiratory rate: 30 breaths per minute
- Oxygen saturation: 91% on room air
- Diminished breath sounds bilaterally
- Heart rate: 110 beats per minute
- The patient appears anxious and is using accessory muscles to breathe.
- Peak flow meter reading: 50% of her personal best
The healthcare provider orders a nebulized treatment of albuterol and ipratropium, systemic corticosteroids, and continuous oxygen therapy.
Which of the following assessments findings should the nurse identify as the priority concern for this patient?
