Respiratory Question #1
A client arrives to the emergency department with exacerbation of chronic obstructive pulmonary disease (COPD) with SpO2 of 78%, hypercapnia, and respiratory rate of 32 per minute. Which action by the nurse is considered priority?
- Apply a partial re-breather mask with Fio2 of 60-80% and call for a blood gas sample.
- Apply Venturi mask at 24% oxygen setting or nasal canula at 2 L/mi pending health provider determination.
- Begin an aminophylline drip then prepare a tracheotomy tray and alert health provider.
- Educate on activity tolerance to minimize further episodes.
The nurse may initiate Venturi mask at 24% for hypercapnia in a client with COPD but will monitor for oxygen delivery settings, oxygen saturations, and respiratory assessment. The venturi mask will maintain the percentage oxygen; however, the caution of affecting the primary drive for breathing must be considered. Or, the client may receive oxygen per nasal canula at 1-2 L/min. The health provider and center’s policies may be considered. Low-flow oxygen supplement is preferred. Partial re-breathers are contraindicated since the one-way valves are removed and will cause rebreathing of carbon dioxide, plus high oxygen delivery (which will affect the respiratory drive). If the condition deteriorates, a non-rebreather may be indicated for deteriorating respiratory status. Aminophylline per IV may be ordered; however, the primary intervention is to assist respiratory burden. Education can be provided at a later time when respiratory status improves.