An elderly client is admitted with chronic obstructive pulmonary disease (COPD) exacerbation. Pulse oximetry is 84% on room air. The client is restless, has expiratory wheezing and a productive cough, and is using his accessory muscles to breathe. Which prescription should the nurse question?

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This client has exacerbation (wheezing) of chronic obstructive pulmonary disease (COPD). Restlessness is an early, subtle sign of hypoxemia. Although morphine can be used to decrease restlessness and slow the respiratory rate to decrease oxygen demand, it can depress respirations. Morphine and other medications (eg, benzodiazepines) that can depress the respiratory center should not be used in clients with COPD exacerbation as they can further worsen CO₂ retention. The oxygen and medications should increase saturation and decrease restlessness, pulse, and respiratory rate. ₂ (Option A) Albuterol is a beta agonist and is appropriate for the immediate relief of bronchoconstriction because of its rapid, short action. (Option B) Methylprednisolone (Solu-Medrol) is a corticosteroid and is appropriate for decreasing inflammation of the lungs during an acute exacerbation of COPD. (Option D) The initiation of low flow, low concentration oxygen at 2 L/min by nasal cannula is appropriate in a client with COPD. It is best to start oxygen at a lower concentration and titrate upward if the saturation does not reach 90% within 20-30 minutes as many clients with COPD rely on their hypoxemic drive to breathe. Educational objective: Morphine and other medications (eg, benzodiazepines) that can depress the respiratory center should not be used in clients with COPD exacerbation as they can further worsen CO₂ retention.

An Elderly Client Is Admitted with Chronic Obstructive Pulmonary Disease