The nurse is admitting a patient with chronic obstructive pulmonary disease (COPD).During the initial head-to-toe assessment the patient's pulse oximetry reading is 89% on room air.What is the nurse's first priority?
A) Administer oxygen immediately @ 4L/NC.
B) Call the primary health care provider for an order for oxygen.
C) Assist the patient into a recumbent position.
D) Determine the patient's normal pulse oximetry reading.

Question

Quizplus · Accepted Answer

The nurse must determine what is normal for this patient.The patient has COPD and the breathing stimulus is low oxygen,not increased carbon dioxide.When caring for patients with COPD and chronically elevated PaCO? levels,remember that inappropriate administration of excessive oxygen will result in hypoventilation.Patients with COPD and hypercapnia (high carbon dioxide levels)have adapted to the higher carbon dioxide level.The carbon dioxide-sensitive chemoreceptors are no longer sensitive to increased carbon dioxide as a stimulus to breathe.Their stimulus to breathe is a decreased PaO?.The most effective position for patients with cardiopulmonary diseases is the 45-degree semi-Fowler's position,using gravity to assist in lung expansion and reduce pressure from the abdomen on the diaphragm.Administering excessive oxygen to patients with COPD satisfies the oxygen requirement of the body and negates the stimulus to breathe.High concentrations of oxygen (e.g.,greater than 24% to 28% [1 to 3 L/min])prevent the PaO? from falling.As a result,this suppresses the stimulus to breathe,resulting in hypoventilation.

The Nurse Is Admitting a Patient with Chronic Obstructive Pulmonary