Medical Surgical COPD #2

Question

A client arrives at the emergency department with an exacerbation of chronic obstructive pulmonary disease (COPD) with SpO2 of 78%, hypercapnia, and a respiratory rate of 32 breaths per minute. Which action by the nurse is considered priority?

Answers

  1. Apply a partial re-breather mask with FIO2 of 60-80% and call for a blood gas sample.
    • Rationale:

      This answer is not correct because partial re-breathers are contraindicated since the one-way valves are removed and will cause rebreathing of carbon dioxide. Additionally, high oxygen delivery will affect the client’s respiratory drive. If the client’s respiratory status deteriorates, a non-rebreather may be indicated.

  2. Apply a Venturi mask at 24% oxygen setting or nasal cannula at 2 L/M pending health provider determination.
    • Rationale:

      This answer is correct because the nurse may initiate a Venturi mask at 24% for hypercapnia in a client with COPD, but will monitor for oxygen delivery settings, oxygen saturations, and a respiratory assessment. The venturi mask will maintain an accurate and specific percentage of oxygen. The client may also receive oxygen per nasal cannula at 1-2 L/min. The health provider and center’s policies may be considered. Low-flow oxygen supplement is preferred with COPD clients in order to avoid affecting the client’s hypoxemic drive to breathe.

  3. Begin an aminophylline drip then prepare a tracheotomy tray and alert the health provider.
    • Rationale:

      This answer is not correct because the most critical intervention is to improve oxygenation while decreasing carbon dioxide as well as the client’s work of breathing. Aminophylline per IV may be ordered to decrease airway obstruction via bronchodilation, however placing a Venturi mask to immediately correct oxygenation is the priority.

  4. Educate on activity tolerance to minimize further episodes.
    • Rationale:

      The answer is not correct because the priority intervention is to intervene to correct the client’s respiratory status. Education can be provided at a later time when respiratory status improves and the client is stable.

Overview

This client is hypoxemic, hypercapneic, and breathing rapidly. The focus of this question is for the nurse to determine the most appropriate oxygen delivery device for a client with COPD experiencing acute respiratory distress.

Explanation

Learning Outcomes

The respiratory drive of a client with healthy lungs is hypercapnia, or build-up of carbon dioxide within the lungs. The respiratory drive of a client with COPD is hypoxemia because COPD clients are chronically hypercapnic. Given that decreased oxygen concentration within the blood is the force behind what causes a COPD client to breathe, a Venturi mask is the perfect choice of an oxygen delivery device as the amount of FIO2 delivered to the client can be precisely regulated.

Test Taking Tip

COPD clients have a different respiratory drive than non-COPD clients. Their respiratory drive is initiated by hypoxemia, so if given too much oxygen, they are at risk for hypoventilation. Placing a COPD client on more than 2 L/M of oxygen is contraindicated.

Video Rationale