A 68-year-old patient with chronic obstructive pulmonary disease (COPD) is admitted to the medical unit with a…

Question

A 68-year-old patient with chronic obstructive pulmonary disease (COPD) is admitted to the medical unit with acute exacerbation. The patient presents with increased dyspnea, productive cough with purulent sputum, and confusion. Vital signs: BP 140/90 mmHg, HR 110 bpm, RR 28/min, O2 sat 88% on room air, temperature 101.2°F (38.4°C). ABG results show pH 7.32, PaCO2 58 mmHg, PaO2 55 mmHg, HCO3- 28 mEq/L. What is the nurse's priority action?

Accepted Answer

보기 2: Apply supplemental oxygen via nasal cannula at 2-3 L/min

In COPD exacerbation with hypoxemia (O2 sat 88%) and respiratory acidosis, priority is low-flow oxygen (2-3 L/min) to correct hypoxemia while avoiding suppression of hypoxic drive. Other interventions (bronchodilators, sputum culture, family education) are important but secondary to oxygenation.

Answer

보기 1: Administer prescribed bronchodilator nebulizer treatment immediately

Answer

보기 3: Obtain sputum specimen for culture and sensitivity

Answer

보기 4: Explain the patient's condition to the worried family members

Concept	Description	Application in This Case
Hypoxic Drive	A backup stimulus for breathing in some severe COPD patients where chronically high CO2 blunts the central chemoreceptor response. The body relies on low oxygen levels to stimulate breathing.	Requires cautious, low-flow O2 to correct hypoxia without removing this drive, which could cause respiratory arrest.
Respiratory Acidosis (Acute on Chronic)	pH < 7.35, PaCO2 > 45 mmHg. In COPD, chronic elevation is compensated by renal retention of HCO3-. An acute drop in pH indicates exacerbation.	pH 7.32 and PaCO2 58 mmHg confirm an acute worsening of the chronic condition.
Oxygen Therapy in COPD	Goal: Correct hypoxemia (SpO2 88-92%) without causing hypercapnia. Start with low flow (1-2 L/min NC) and titrate up based on ABG/SpO2.	Priority action is to initiate low-flow O2 (2-3 L/min) to raise SpO2 from 88%.
Nursing Priorities (ABCs)	Airway, Breathing, Circulation. Always address threats to oxygenation and ventilation first.	Dyspnea, low SpO2, and confusion indicate impaired oxygenation (Breathing), making it the top priority.

Intervention	Priority in COPD Exacerbation	Rationale
Apply Supplemental O2	Key Point! Highest Priority	Addresses immediate life threat (hypoxemia). Foundation for all other therapies.
Administer Bronchodilator	High Priority (Secondary)	Treats bronchoconstriction to improve airflow, but patient must be oxygenated first for optimal effect and safety.
Obtain Sputum Culture	Important but Not Immediate	Diagnostic step to guide antibiotic therapy. Does not stabilize the patient's acute condition.
Provide Patient/Family Education	Lower Priority (After Stabilization)	Essential for long-term management but deferred until the acute crisis is resolved.

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