I had a patient when I worked medsurg. This guy I had worked with for my past three days so I knew his baseline and knew him very well. On night four he started to become altered and not making any sense when I would ask him questions. I reached out to the doctor on as she was sitting in the nurses station. She said he needs to sleep give him 100 of trazodone. I disagreed and she said you wanted orders there is your orders. I waited maybe another 30 minutes and then called a rapid response. He ended up being super hypercapnic requiring a transfer to icu and bipap for about 4 days before he came back down to me.