A 64-year-old hospitalized client with chronic obstructive pulmonary disease exacerbation has increased lethargy and confusion. The client's pulse oximetry is 88% on 2 liters of oxygen. Arterial blood gas analysis shows a pH of 7.25, PO₂ of 60 mm Hg (8.0 kPa), and PCO₂ of 80 mm Hg (10.6 kPa). Which of the following should the nurse implement first?

Question

Quizplus · Accepted Answer

An elevated carbon dioxide (CO₂) level (normal: 35-45 mm Hg [4.7-6.0 kPa]) is usually an indicator of hypercapneic respiratory failure. The bilevel positive airway pressure (BIPAP) machine will provide positive pressure oxygen and expel CO₂ from the lungs. This client is already showing signs of lethargy and confusion, which is usually a late indicator of respiratory decline. Therefore, the nurse's priority should be to get the client on the BIPAP machine as soon as possible. (Option A) Nebulizer treatments are commonly part of the treatment plan for a client with chronic obstructive pulmonary disease (COPD). However, these do not take priority when the client has CO₂ retention and is deteriorating. If mental status worsens further (due to continued CO₂ retention), the client will need intubation. Many BIPAP machines are able to deliver nebulizer treatment while providing positive pressurized oxygen. (Option B) Steroid therapy is a common pharmaceutical intervention for COPD exacerbation, but it does not take priority over BIPAP in this deteriorating client. In addition, steroids take hours to days to have an effect. (Option C) In a client with an elevated CO₂ level and a history of COPD, the nurse should not increase the oxygen level as this could cause an increase in CO₂ retention, resulting in further respiratory failure. Educational objective: BIPAP therapy is an effective treatment to decrease CO₂ levels in clients with hypercapnic respiratory failure.

A 64-Year-Old Hospitalized Client with Chronic Obstructive Pulmonary Disease Exacerbation