A 64-year-old female patient having an acute exacerbation of chronic obstructive pulmonary disease (COPD)was admitted to the hospital yesterday.During rounds today the respiratory therapist finds the patient to be difficult to arouse and has the following physical findings: heart rate 102,respiratory rate 23 shallow and slightly labored,breath sounds are bilaterally decreased with rhonchi in both bases.The patient has a frequent,but weak cough.The respiratory therapist draws an arterial blood gas with the following results on a 2 L/min nasal cannula: pH 7.52,partial pressure of carbon dioxide (P_aCO₂)30 mm Hg,partial pressure of oxygen (P_aO₂)45 mm Hg,arterial oxygen saturation (S_aO₂)86%,bicarbonate (HCO₃^-)24 m Eq/L.The most appropriate action is which of the following?

Question

Quizplus · Accepted Answer

It would be inappropriate to intubate or use noninvasive positive pressure ventilation (NPPV)on this patient at this time because the patient is able to move air,as evidence by the partial pressure of carbon dioxide (P_aCO₂)of 30 mm Hg in the arteries.This patient might benefit from lung expansion therapy.However,she would not be able to cooperate to perform the incentive spirometry properly because she is difficult to arouse.The patient would benefit from an increase in oxygen therapy by increasing the nasal cannula flow to 4 L/min since her partial pressure of oxygen in the arteries (P_aO₂)is 45 mm Hg on 2 L/min nasal cannula.When the 2 L/min is estimated to be approximately 28% oxygen the P_aO₂/F_IO₂ is 161.This is a critical value.This patient would also benefit from bronchial hygiene therapy to mobilize the retained secretions.

A 64-Year-Old Female Patient Having an Acute Exacerbation of Chronic