A nurse is caring for a 72-year-old patient with acute exacerbation of chronic obstructive pulmonary disease (COPD) who is receiving oxygen therapy at 3 L/min via nasal cannula. The patient's oxygen saturation has dropped from 94% to 89%, respiratory rate has increased from 20 to 30 breaths per minute, and the patient reports increased dyspnea and fatigue. Which nursing intervention should the nurse implement first?
1Increase oxygen flow rate to 4 L/min via nasal cannula
3Position the patient in high Fowler's position and encourage pursed-lip breathing
4Notify the healthcare provider about the patient's deteriorating condition✓ 정답
해설
Assessment (ABG and provider notification) is the priority to determine the cause of respiratory deterioration in a COPD patient before implementing interventions that could worsen CO2 retention. Other options may be helpful but require assessment first.
Clinical Judgment
This question assesses prioritization and management of COPD exacerbation. The key lies in the word "first". The patient exhibits signs of respiratory distress such as SpO2 88%, tachypnea, and anxiety, but this is a common pattern in COPD patients. The priority is to first implement safe and immediate interventions that a nurse can perform independently without a physician's order. High Fowler's position and pursed-lip breathing can immediately improve the breathing pattern by increasing respiratory muscle efficiency, maintaining airway pressure, and reducing the patient's anxiety. This is a fundamental nursing intervention that can be done concurrently while preparing for or performing other interventions.
Memory Tip: For dyspnea in a COPD patient, the priority is Position & Pursed-lip (PP first!). Independent nursing interventions take precedence over interventions requiring an order (medication, oxygen adjustment).
KR vs US: In Korea, immediately reporting to a physician when a patient's condition worsens may be emphasized, but the NGN/US approach first assesses the nurse's independent judgment and intervention skills. Always consider if there is a nursing intervention you can try before reporting.
Clinical Practice Guide
The reason for using low-flow oxygen (1-2 L/min) in COPD patients is to maintain the hypoxic drive. High-flow oxygen can suppress this drive and lead to respiratory failure. Therefore, before increasing the oxygen concentration, other methods to assist breathing (positioning, breathing techniques) should be tried first.
Caution: In SATA (Select All That Apply) questions that ask for the "first action," there is a trap where, even if multiple correct interventions are listed, you must select the most independent, safe, and immediate one. "Notify HCP" is an important intervention, but if there is an opportunity to improve the condition with an independent nursing intervention, that may be a higher priority.
Chronic Obstructive Pulmonary Disease — Chronic obstructive pulmonary disease. A chronic condition where the airways narrow and lung tissue is damaged, causing breathing difficulties. The main cause is smoking, and it includes chronic bronchitis and emphysema.
Hypoxic Drive — Hypoxic respiratory drive. In COPD patients with chronic hypercapnia, the primary respiratory stimulus becomes hypoxemia. If hypoxemia is corrected by administering high-concentration oxygen, the respiratory drive may be suppressed, potentially leading to respiratory failure.
Pursed-lip Breathing — Pursed-lip breathing. A breathing technique where you inhale through the nose and exhale slowly through pursed lips. It maintains positive pressure in the airways to prevent early closure of small airways, improves gas exchange, and relieves dyspnea.
High Fowler's Position — High Fowler's position. The patient sits upright with the head of the bed raised to 60-90 degrees. The diaphragm descends, facilitating lung expansion and reducing breathing effort, which helps patients with dyspnea.
Exacerbation — Exacerbation. A period when symptoms of a chronic disease suddenly or gradually worsen compared to the usual state. COPD exacerbation is characterized by increased shortness of breath, cough, and sputum.