Medical Surgical ARDS & Acute Respiratory Failure #2

Question

A client with chronic obstructive pulmonary disease (COPD) admitted for suspected acute respiratory failure has just arrived at their room on the med-surg floor. The nurse has a student nurse helping her get the client settled in. Which intervention by the student nurse requires correction?

Answers

  1. Raising the bed for the client to high Fowler's position.
    • Rationale:

      This answer is not correct because raising the bed to high Fowler’s position will enhance the client’s ventilation. This encourages lung expansion and lung excursion.

  2. Assembling the oxygen with 4L bi-nasal cannula onto the client.
    • Rationale:

      This answer is correct because bi-nasal cannula administration is uncontrolled. The client with COPD requires controlled oxygen due to the dependence on their hypoxic drive as a stimulus to breathe. Also, 4 L of binasal cannula will further take away the client’s “hypoxic driveâ€. A venturi mask pulls room air and mixes with oxygen, creating high-flow oxygen of appropriate concentration for the client with COPD.

  3. Making sure intubation supplies are at the bedside.
    • Rationale:

      This answer is not correct because having intubation and mechanical ventilatory support is a great possibility for the client in acute respiratory failure. If the client decompensates, those materials will be readily available at the bedside.

  4. Prepare the client for hemodynamic monitoring.
    • Rationale:

      This answer is not correct because monitoring the client’s hemodynamic status is relevant since the client’s fluid status and arterial blood gases will be assessed regularly. This information will guide the provider as to the need for fluid and electrolyte replacement and the need for other therapies.

Overview

A client with COPD in respiratory failure will require interventions to support ventilation. The COPD client is at risk for respiratory drive suppression with oxygen use, so a Venturi mask is preferred over bi-nasal cannula due to its high flow oxygen delivery system that is unaffected by the client’s respiratory rate.

Explanation

Learning Outcomes

The client with acute respiratory failure will require supported measures for proper ventilation. These include proper positioning, oxygen use, BiPAP, mechanical ventilation, and hemodynamic monitoring. The COPD client can become hypercapnic which leads to what is referred to as “hypoxic drive”. This is a theory that the brain no longer responds to carbon dioxide retention and the client loses the ability to maintain proper oxygen levels. For this reason, a Venturi mask is preferred over a regular oxygen mask or bi-nasal cannula when administering oxygen. The Venturi mask mixes room air with oxygen and creates a high-flow oxygen delivery system. The oxygen is controlled at the appropriate concentration for the client without knocking out the client’s respiratory drive.

Test Taking Tip

Have knowledge of “hypoxic drive” in the client with COPD.

Video Rationale