Chronic obstructive pulmonary disease can progress to respiratory failure. A client with emphysema becomes increasingly drowsy, tachypneic, and tachycardic. The nurse should first:

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Position the client who is conscious to sit up in a supported, forward-leaning position (high-Fowler's, orthopneic) to improve ventilation and oxygenation. A calm and reassuring approach will decrease hyperactivity of the client and oxygen need. Aminophylline is used to combat bronchospasm, but it is not independent nursing action. Low-flow oxygen (2 L) is also administered to the client in respiratory failure; however, nasal cannulas do not provide predictable O₂ concentrations. A Venturi mask would be more appropriate. A higher concentration of O₂ (60%) may lead to respiratory depression unless the client is maintained on controlled mechanical ventilation.

Chronic Obstructive Pulmonary Disease Can Progress to Respiratory Failure