# A nurse is caring for a patient with chronic obstructive pulmonary disease (COPD) who presents with the following arterial blood gas (ABG) results: pH 7.35, PaCO2 50 mmHg, HCO3- 26 mEq/L, PaO2 70 mmHg. The patient appears drowsy and has shallow respirations at 28 breaths per minute. What is the nurse's priority action? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542692 > language: ko > subject: Fundamentals ## 문제 A nurse is caring for a patient with chronic obstructive pulmonary disease (COPD) who presents with the following arterial blood gas (ABG) results: pH 7.35, PaCO2 50 mmHg, HCO3- 26 mEq/L, PaO2 70 mmHg. The patient appears drowsy and has shallow respirations at 28 breaths per minute. What is the nurse's priority action? ## 보기 1. Administer high-flow oxygen at 15 L/min via non-rebreather mask 2. Encourage deep breathing exercises and use of incentive spirometer 3. Position the patient in Trendelenburg position to improve ventilation 4. Administer low-flow oxygen at 1-2 L/min via nasal cannula **✔ 정답** **정답: 4** ## 해설 Low-flow oxygen is prioritized in COPD to prevent CO2 retention while maintaining oxygenation. High-flow oxygen can suppress hypoxic drive, and other options may worsen ventilation. ## 심화 해설 Understanding the ABG Results The patient's arterial blood gas (ABG) shows a pH of 7.35, which is on the acidic side of normal but not yet fully decompensated. The PaCO2 is elevated at 50 mmHg, and the HCO3- is 26 mEq/L, which is within normal limits. This pattern indicates an uncompensated respiratory acidosis. In a patient with chronic obstructive pulmonary disease (COPD), this is a classic presentation of an acute exacerbation superimposed on chronic CO2 retention. The primary problem is hypoventilation, evidenced by the drowsiness, shallow respirations, and elevated PaCO2. The Danger of High-Flow Oxygen Administering high-flow oxygen to a patient with chronic CO2 retention can be dangerous due to the loss of the hypoxic drive. In healthy individuals, the primary stimulus to breathe is an elevated PaCO2. However, patients with long-standing COPD often have chronically high CO2 levels, and their central chemoreceptors become desensitized to it. Their respiratory drive then shifts to rely on hypoxemia detected by peripheral chemoreceptors. If high-flow oxygen abruptly corrects the hypoxemia, it can remove this critical stimulus, leading to further respiratory depression, worsening hypercapnia, and potential respiratory arrest . The structural and functional changes in respiratory muscles described in chronic lung disease, including fiber-type shifts and reduced oxidative capacity, make these patients particularly vulnerable to the consequences of hypoventilation . Why Low-Flow Oxygen is the Priority The priority action is to correct the patient's hypoxemia (PaO2 70 mmHg) without suppressing their respiratory drive. Administering low-flow oxygen at 1-2 L/min via nasal cannula achieves this balance. This approach provides a controlled, small increase in inspired oxygen concentration, aiming for a target SpO2 of 88-92% in COPD patients at risk of hypercapnic respiratory failure. This is a standard of care that reflects a core competency in oxygen therapy knowledge and practice, which is critical for emergency nurses managing patients with complex respiratory conditions . Why Other Options are Incorrect Encouraging deep breathing exercises and incentive spirometry is inappropriate for a drowsy patient with shallow respirations who is in acute distress; this intervention requires patient alertness and cooperation. Placing the patient in the Trendelenburg position would worsen respiratory status by pushing abdominal contents against the diaphragm, further limiting lung expansion and ventilation. The correct nursing action is to first address the life-threatening hypoxemia in a manner that is safe for a CO2 retainer, which is controlled, low-flow oxygen therapy. ## 임상 시나리오 Clinical Guide: Oxygen Administration in COPD Exacerbation **Priority Action:** Administer low-flow oxygen at 1-2 L/min via nasal cannula. The goal is to maintain SpO2 between 88-92% to correct hypoxemia without suppressing the hypoxic drive. - **Assessment:** Monitor level of consciousness, respiratory rate, and ABGs closely. Watch for signs of CO2 narcosis (drowsiness, confusion). - **Rationale:** Patients with chronic CO2 retention rely on hypoxia to stimulate breathing. High-flow oxygen can lead to respiratory depression and apnea. - **Ventilatory Support:** If the patient's condition deteriorates despite low-flow oxygen, prepare for non-invasive ventilation (BiPAP) to reduce PaCO2. - **Positioning:** Keep the patient in an upright or semi-Fowler's position to maximize diaphragmatic excursion. ## 핵심 개념 - **Hypoxic Drive** — A backup respiratory stimulus in COPD patients where low oxygen levels, rather than high CO2, trigger breathing efforts. - **Uncompensated Respiratory Acidosis** — An ABG pattern showing low pH and high PaCO2 with a normal HCO3-, indicating acute hypoventilation without renal compensation. - **CO2 Narcosis** — A state of drowsiness or coma caused by severely elevated carbon dioxide levels in the blood. ## 같은 주제 문제 - [A nurse is analyzing arterial blood gas (ABG) results for a patient with asthma exacerbati…](https://mymerci.kr/pages/nclex_q.php?qn_id=542686) - [A nurse is caring for a patient with pneumonia who presents with fever, tachypnea, and cra…](https://mymerci.kr/pages/nclex_q.php?qn_id=542687) - [A nurse is analyzing arterial blood gas (ABG) results for a patient admitted with chronic …](https://mymerci.kr/pages/nclex_q.php?qn_id=542688) - [A nurse is caring for a client with asthma exacerbation who has developed respiratory acid…](https://mymerci.kr/pages/nclex_q.php?qn_id=542689) - [A nurse is caring for a patient with chronic obstructive pulmonary disease (COPD) who pres…](https://mymerci.kr/pages/nclex_q.php?qn_id=542690) - [A nurse is caring for a patient with chronic obstructive pulmonary disease (COPD) who pres…](https://mymerci.kr/pages/nclex_q.php?qn_id=542691) - [A nurse is caring for a patient with acute asthma exacerbation who presents with the follo…](https://mymerci.kr/pages/nclex_q.php?qn_id=542693) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._