Re: slow puncture
how drastically could it alter the station's orbit / attitude / damage structure by pushing or twisting in an unexpected direction?
Assuming the reaction wheels and reaction control system are still working: not much, and not for long.
A sudden venting of station air through an irregular hole would be like an inefficient cold gas thruster* in the vicinity of 50 to 60 seconds specific impulse. The 916 cubic meters of 1-bar air in the ISS amounts to (rounding up) 1200kg. The reaction control system of the station uses hypergolic, storable fuels: UDMH and nitrogen tetroxide, which should give a specific impulse of about 330 seconds.
So, a quick glance at the simplified rocket equation (delta-V = specific impulse * G * natural log [initial mass / final mass]) indicates the station would need to burn about 200kg of fuel to counter the venting of the entire station. The entire 1200kg of air would impart a delta-V of about 1.4m/s, enough to budge the station's altitude by a few kilometers.
*Pardon the redundancy: cold gas thrusters with nitrogen have a peak specific impulse of about 73 seconds, so they're inefficient to begin with.